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An audit of acute paediatric allergy presenting to a large city teaching hospital
  1. R Tall
  1. Department of Paediatrics, Royal Victoria Infirmary, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK

Abstract

Aims To characterise the presentation, management and care of paediatric patients presenting with acute allergy to a city hospital.

Methods A prospective data collection was undertaken in Newcastle RVI accident and emergency of all patients suspected of having an acute allergic reaction. Over nine months, 62 patients were recruited, of whom seven were excluded with idiopathic urticaria. Full notes were available for 43 of the remaining 55 patients.

Results Patients varied from five months to sixteen years. Of the 43 patients, the majority (37) had experienced minor reactions (grade 1-2 severity, Sampson 2003). Seven had grade four reactions, but none had hypotension, or required fluids or steroids. Three were administered adrenaline; two of the others were given bronchodilators. Thirty-nine patients were discharged directly; and only one was admitted overnight.

All patients were given antihistamines; medical staff prescribed either chlorphenamine (21) or cetirizine (9); with no other antihistamines used. Two patients were given oral steroids in A&E - both given prednisolone for severe urticarial symptoms.

By far the most common suspected triggers were egg (9) and tree nut (6). Peanut was only suspected in one case; possibly reflecting low peanut consumption in children.

Twelve patients were referred to the allergy clinic, of whom eight have attended. All had at least one acute allergy confirmed on testing, and two had unsuspected triggers confirmed.

Conclusion The data collected gives a picture of the causes and management of acute allergy presenting to a typical UK city hospital; and followed up in a dedicated allergy clinic. The majority of acute paediatric allergy is mild, but 16% of attendances are for systemic episodes. Despite firm guidelines regarding the use of adrenaline, less than half of patients eligible received it; but despite this only one patient required admission. This audit will continue to recruit patients for a full year. Full data will be available for presentation at the RCPCH conference in 2012.

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