Anaphylaxis in an Emergency Department: a Retrospective 10-year Study in a Tertiary Hospital

Background. Anaphylaxis is a potentiallyfatal medical emergency. Thefrequency ofhospital admissionsfor anaphylaxis seems to be increasing in the recent decades. Objective. Characterize thepatients admittedfor anaphylaxis to the adult emergency department (ED) ofa tertiary care hospital over a 10-year period discriminating aetiologies, clinicalfeatures and therapy administered. Methods. Retrospective, descriptive and inferential study evaluating age, sex, Manchester triage system, suspected allergen, site ofallergen exposure, comorbidities, cofactors, clinicalfindings and symptoms, treatment and management. Patients admitted between January 2007 and December 2016 were included Results. Forty-three patients were enrolled: 23 males, mean age 54.3 162 years, n = 22 had history ofallergic disease. Two patients were triaged as non-urgent. The mostfrequently suspected causes ofanaphylaxis were: drugs (33%, n = 14), Hymenoptera venoms (23%, n = 10), foods (21%, n = 9) and iodinated contrastproducts (12%, n = 5). Adrenaline was used in 88% ofthe episodes (n = 38), 55% ofwhich (n = 21) intramuscularly. Mortality was registered in one case. At discharge, adrenaline auto-injector was prescribed in 7% (n = 3) of the patients, and Allergy and Clinical Immunology consultation (ACIC) was requested in 65% ofthe episodes (n = 28). Statistically significant associations (p < 0.05) were established: a, anaphylaxis to drugs associated with a low intramuscular adrenaline use and with frequent oxygen therapy; b, anaphylaxis to food associated with intramuscular adrenaline administration; c, anaphylaxis to Hymenoptera venom associated with male sex; and d anaphylaxis to iodinated contrasts associated with referral to ACIC and with shock. All obesepatients developed shock. Conclusions. Anaphylaxis is a life-threatening condition that requires early recognition. Although mostpatients received adrenaline, administration was not always performed by the recommended route and only a few patients were prescribed adrenaline auto-injector.