Ag. Stewart et Pw. Ewan, THE INCIDENCE, ETIOLOGY AND MANAGEMENT OF ANAPHYLAXIS PRESENTING TO AN ACCIDENT AND EMERGENCY DEPARTMENT, Quarterly Journal of Medicine, 89(11), 1996, pp. 859-864
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.