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Allergic reactions in the emergency department
  1. J Fleming1,
  2. J Hughes2,
  3. M Smith1
  1. 1Paediatrics, Craigavon Hospital, Craigavon, UK
  2. 2Paediatrics, Antrim Hospital, Antrim, Northern Ireland

Abstract

Introduction “No child shall experience a 2nd unmanaged anaphylactic reaction” is the standard set within the Service Framework for Respiratory Health and Wellbeing, published by the Department of Health, Social Services and Public Safety in Northern Ireland (2009). Children with acute allergic reactions frequently present to the emergency department; acute management of these children has been previously reported as good however follow-up arrangements were unknown.

Aims The authors wanted to review notes of all children attending the emergency department in a district general hospital following a generalised allergic reaction (GAR) or anaphylaxis. The authors particularly wanted to assess follow-up arrangements.

Methods A retrospective case note review of all children <14 years of age attending the emergency department during 2008. The computer-based record system within the department was searched using the keywords anaphylaxis, allergic urticaria, allergic reaction, acute conjunctivitis, drug hypersensitivity and insect bite. The charts were subsequently reviewed to assess whether each cases fulfilled the criteria for a GAR1 or anaphylaxis.2

Results 104 case notes were pulled; 33 were subsequently analysed as they fulfilled the criteria for a GAR (32) or anaphylaxis (1). Twenty-four (73%) male, median age 5.1 years. The main causative agents were nuts (24%), milk (12%), drug (9%) and egg (9%). In 5 (15%) cases the cause was not identified. One child received intramuscular epinephrine prior to attendance at the emergency department. The commonest treatment used in the emergency department was oral antihistamine (25 cases, 76%). The majority of children (85%) were discharged home; 5 (15%) were further assessed on the paediatric ward. Only 2 (6%) were referred from the emergency department for further out-patient assessment; 12 (36%) were asked to attend their general practitioner for assessment regarding review, 14 (42%) had no review arrangements made.

Conclusion All children were safely managed with regards their acute reaction; however, follow-up arrangements were infrequently made. There is a continuing need for education of staff within the emergency department to ensure children presenting following a GAR or anaphylaxis are comprehensively assessed at an appropriate out-patient clinic with regards their future risk of an anaphylactic reaction.

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