Background: Anaphylaxis is a life threatening systemic hypersensitivity reaction, with increasing prevalence worldwide. The diagnosis of anaphylaxis is not easy to make in the PED setting. Therefore, children are often underdiagnosed and undertreated. In a previous study, we characterized diagnostic and treatment practices for anaphylaxis and found that most cases (66%) of anaphylaxis were underdiagnosed and eventually discharged without a prescription for AEI.
Objectives: In this follow-up study, we examined the management of anaphylaxis in PED visits. We hypothesized that after a guided intervention program, the rates of cases diagnosed and treated correctly will be higher.
Methods: A retrospective review of all patients presenting to the PED of the TLVMC within a 2-year period (2015-2016), with a final diagnosis of anaphylaxis or allergic reaction. The clinical features, causative agents, treatment and recommendations were recorded.
Results: A total of 428 patients were diagnosed with an allergic or anaphylactic reaction. Of these, 134 (31.3%) met the criteria for anaphylaxis, accounting for 0.24% of all PED visits. Fifty-four patients (40%) were appropriately diagnosed with anaphylaxis. Food was the most common causative agent (91%), Specifically, exposure to nuts and milk. Seventy-two patients (53%) were treated with IM adrenaline. A prescription for AEI was given to 74% of patients, compared to 60% in our previous study.
Conclusion: The rate of PED visits due to anaphylaxis among children in our institution doubled during the study period. This is consistent with reports of increasing incidence of anaphylaxis and food allergy worldwide. Most cases of anaphylaxis were underdiagnosed.
