Anaphylactic Reactions in the Emergency Department of a Portuguese Tertiary Hospital: Clinical Characterization and Disease Notification.

INTRODUCTION: Anaphylaxis is significantly underdiagnosed, and the medical community's knowledge about it is precarious. The aim of this study is to characterize the patient population and the Emergency Department approach of anaphylaxis. MATERIAL AND METHODS: Retrospective study of adult patients attending the Emergency Department of a tertiary care Portuguese hospital, over a year, with anaphylaxis. Data were obtained from each patient's clinical records and anonymized. A questionnaire evaluating knowledge about the notification of anaphylaxis was applied to Emergency Department physicians. RESULTS: The study included 69 patients. Cutaneous (97%) and respiratory features (80%) were most prevalent; 22% of patients presented with shock or related symptoms. There were no reported biphasic reactions or deaths. The likely allergen was identified in 73%, most commonly food; 12% of reactions were related to a previously known allergen. Epinephrine was administered to 15%. Referral to an Immunoallergologist was done in 36% of patients, and 10% received or already possessed an epinephrine autoinjector. Among six parameters recommended for auditing clinical practice, 70% of cases fulfilled less than half. Only 13% of physicians knew it was mandatory to register all cases in the Portuguese Catalogue of Allergies and Other Adverse Reactions, and only 4% knew how to do it; regarding notification to the National Authority of Medicines and Health Products results were slightly better. DISCUSSION: Many patients with anaphylaxis present to the Emergency Department every year, and their clinical approach is not in agreement with national guidelines. CONCLUSION: An educational program to increase medical awareness of the national guidelines and mandatory notification of all anaphylactic reactions should be implemented.

Introdução: A anafilaxia é significativamente subdiagnosticada e o conhecimento médico acerca da mesma é precário. Pretende-se caracterizar a população de doentes e a abordagem clínica da anafilaxia no Serviço de Urgência. Material e Métodos: Estudo retrospetivo da população adulta que recorreu ao Serviço de Urgência de um hospital terciário português durante um ano, com anafilaxia. Os dados foram obtidos dos registos clínicos de cada paciente e anonimizados. Um questionário para avaliar conhecimentos sobre notificação de reações anafiláticas foi aplicado aos médicos do Serviço de Urgência. Resultados: O estudo incluiu 69 doentes. Os sintomas cutâneos (97%) e respiratórios (80%) foram os mais prevalentes; 22% apresentaram-se com choque ou sintomas associados. Não se registaram reações bifásicas ou óbitos. O alergénio provável foi identificado em 73%; maioritariamente foram alimentos; 12% das reações foram com um alergénio previamente conhecido. Adrenalina foi administrada em 15%; 36% foram encaminhados para Imunoalergologia; 10% receberam ou já possuíam adrenalina autoinjetável. Em 70% dos casos, menos de metade dos seis parâmetros das Normas de Orientação Clínica foram cumpridos. Apenas 13% dos médicos sabia que era obrigatório registar todos os casos no Catálogo Português de Alergias e Outras Reações Adversas e apenas 4% sabiam como fazê-lo; relativamente à notificação das reações a fármacos à Autoridade Nacional do Medicamento e Produtos de Saúde, I.P., obtiveram-se resultados ligeiramente melhores. Discussão: Muitos doentes recorrem ao Serviço de Urgência com reações anafiláticas e a sua abordagem não está em concordância com as normas de orientação clínica nacionais. Conclusão: É necessário implementar ações de formação relativamente à abordagem clínica e notificação da anafilaxia.

Characteristics, Etiology and Treatment of Pediatric and Adult Anaphylaxis in Iran.

Despite the increasing prevalence of anaphylaxis, there is little information about the characteristics and practice of healthcare providers in treating anaphylaxis, so this study was conducted to record the characteristics and therapeutic approaches of anaphylaxis from May 2012 until April 2015, the data of all patients diagnosed with anaphylaxis in the Allergy department of three referral university hospitals in Tehran, Iran were recorded. Thereafter, the demographics, clinical features, triggers and therapeutic approach were evaluated. This study investigated 136 individuals, 64 males (47%) between 6 months and 68 years old, as well as 72 others (52.94%) under 18 years of age (pediatric). The following were the most common organs involved: Skin 86.02% (pediatric 91.66% vs adult 79.68%), respiratory tract 51.47% (pediatric 43.05% vs adult 60.93%), cardiovascular 50.73% (pediatric 54.16% vs adult 46.87%), gastrointestinal 20.58% (pediatric 27.7% vs adult 12.5% ) and neurologic system 5.88% (only in adults). The following were the most identified causing foods 69 (50.37%)[42 pediatric (children) and 27 adults], drugs 34( 25%)[14 pediatric and 20 adults], idiopathic 16( 11.77%)[3 pediatric and 13 adults], insect sting 7( 5.15%)[3 pediatric and 4 adults] , exercise 6( 4.42%) [1 pediatric and 5 adults]. Milk, egg and wheat were the most common causative foods in pediatric cases but sesame, as well as egg and milk were the most common causes in adults. Epinephrine injection, auto injector epinephrine prescription as a discharging plan and referral to an allergist were: 10.78, 1.96 and 7.8 %, respectively. In this case series we found that, cutaneous, respiratory, cardiovascular and gastrointestinal complains were the most common manifestations and food, drug and idiopathic were the most common causes.In this study, the diagnosis of anaphylaxis, epinephrine subscription and referral to an allergist were significantly lower in comparison to other studies.