Emergency department anaphylaxis: A review of 142 patients in a single year

Brown, Anthony F. T., McKinnon, David and Chu, Kevin (2001) Emergency department anaphylaxis: A review of 142 patients in a single year. Journal of Allergy And Clinical Immunology, 108 5: 861-866. doi:10.1067/mai.2001.119028

Author Brown, Anthony F. T.
McKinnon, David
Chu, Kevin
Title Emergency department anaphylaxis: A review of 142 patients in a single year
Journal name Journal of Allergy And Clinical Immunology   Check publisher's open access policy
ISSN 0091-6749
Publication date 2001-01-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1067/mai.2001.119028
Open Access Status
Volume 108
Issue 5
Start page 861
End page 866
Total pages 6
Editor Donald Y. M. Leung
Place of publication USA
Publisher Mosby
Language eng
Subject C1
320201 Allergy
730102 Immune system and allergy
1107 Immunology
Formatted abstract
Background: There are few data on the incidence, clinical features, and management of patients with acute anaphylaxis presenting to the emergency department. We investigated all presentations to one department during the course of a year to improve current awareness of this medical emergency.
Objective: The purpose of the study was to describe the clinical features, management, and outcome of anaphylaxis presentations to a single Australian adult emergency department in a single year, 1998-1999.
Methods: This was a retrospective, case-based study of adult patients (greater than or equal to 13 years of age) attending a single emergency department in Brisbane, Australia, during the year 1998-1999. The medical records of 304 patients satisfying the relevant discharge diagnostic codes were studied. We determined incidence, sex ratio, age, clinical features, management, disposal, asthma prevalence, and causes in patients presenting with acute allergic reactions and anaphylaxis.
Results: In all, 162 emergency department patients with acute allergic reactions and 142 emergency department patients with anaphylaxis, including 60 whose anaphylaxis was severe, were seen during the year, for an anaphylaxis presentation incidence of 1 in 439. One patient died; this gave a case fatality rate of 0.70%. Cutaneous features were present in 94% of the patients with anaphylaxis. Of those with severe anaphylaxis, 35% had dizziness syncope before hospital presentation, 25% laryngeal edema, and 21.7% systolic hypotension on hospital presentation. A cause was recognized in 73% of the anaphylaxis cases; most commonly, the causative agent was a drug, insect venom, or food. Adrenaline was used in 57% of the severe cases before hospital presentation or in the hospital. The emergency department alone definitively cared for 94% of all patients, though only 43% severe anaphylaxis cases were referred for follow-up.
Conclusion: The emergency department anaphylaxis presentation incidence of I in 439 cases is greater than previously recognized, though death remains rare. In three fourths of cases, a precipitant was identified, a fact that emphasizes the need for a detailed initial history. Definitive management in the emergency department alone is possible in most cases, provided that the appropriate use of adrenaline and the need for allergy clinic follow-up are appreciated.
Keyword Allergy
Epinephrine (adrenaline)
Histamine H-1 Antagonists (antihistamines)
Histamine H(2) Antagonists
Immediate Hypersensitivity
Managing Acute Anaphylaxis
Intravenous Adrenaline
Idiopathic Anaphylaxis
Q-Index Code C1

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
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Created: Wed, 15 Aug 2007, 02:30:42 EST