THE INCIDENCE, ETIOLOGY AND MANAGEMENT OF ANAPHYLAXIS PRESENTING TO AN ACCIDENT AND EMERGENCY DEPARTMENT

We retrospectively studied anaphylaxis in an A&E department from compu terized records. In 1993 (Study A), of 55 000 patients seen in casualt y, nine had severe anaphylaxis (ANA) with loss of consciousness (LOG) or fainting (about 1:6000). Fifteen had generalized allergic reactions (CR) without LOC or fainting, but including dyspnoea due to laryngeal oedema or asthma, angioedema and/or urticaria. Thus there were 24 (ab out 1:2300) generalized reactions involving hypotension and/or respira tory difficulty. A further case diagnosed as hyperventilation syndrome was probably a wasp sting GR. Six cases of urticaria and/or angioedem a were also identified. Of the nine with ANA, a possible cause was ide ntified in eight (3 stings; 2 drugs; 3 foods). There was delay in arri val in A&E: hypotension was noted in three and had resolved spontaneou sly in six. Only 3/9 were treated with adrenaline: i.v. hydrocortisone and chlorpheniramine was the mainstay of treatment. No investigation was recommended nor advice given on future management. Four patients w ere later referred to our allergy clinic by their GPs. In study B (Aug -Oct 1994), nine cases of ANA were identified (1:1500), eight due to b ee or wasp stings. The increased incidence was probably related to mor e detailed history-taking. Only three were treated with adrenaline. Th e use of adrenaline for future anaphylaxis was discussed with six pati ents, and five were referred to our allergy clinic. A reaction to the same allergen had occurred previously in 24%. Improved awareness of an aphylaxis and its management is necessary.