G62(P) Recognition of paediatric anaphylaxis – an audit of allergy admissions to our emergency department

Abstract

Background Anaphylaxis is uncommon but very serious. The recognition of anaphylaxis can vary with experience. Although the guidelines from the Resuscitation Council provide a useful framework for diagnosis, the criteria they give are very much open to interpretation. Therefore, there is a wide heterogeneity in recognition and management of anaphylaxis. Aims and objectives We aimed to audit whether anaphylaxis in children is being correctly identified and managed, as well as the epidemiology of allergy and anaphylaxis, in children presenting to our emergency department (ED). Methods Retrospective case notes audit of all paediatric attendances to our ED between the 1 st of April 2015 and the 31 st August 2016. The notes were screened and a total of 279 children were identified as having IgE mediated reactions. Audit standards were based on NICE (Quality standards 118) and Resuscitation council recommendations. Results 7.12% (20/279 patients) had documented signs of anaphylaxis. Only 11 of these patients were diagnosed and treated as anaphylaxis in ED. Of the 9 unrecognised and untreated patients 4 had documented wheeze and 5 had documented airway swelling. In addition, 2.5% (n=7) children who had no objective symptoms of anaphylaxis were treated with adrenaline (1 self-administered, 2 paramedics, 4 in ED). Only 11/20 patients with anaphylaxis were referred to paediatrics for observation and allergy assessment. In 70% cases of anaphylaxis (n=14), the trigger was food. In 30% (n=6) no trigger was identified. Tree nuts (42%, 6 cases) was the most common food trigger for anaphylaxis. While allergic reactions are more common in younger children (228 under 10 years vs 51 cases 11–16 years.), the proportion presenting in anaphylaxis is much higher in adolescents with 22% (11/51) presenting in anaphylaxis vs 4% (9/219) in 0–10 year olds. Conclusion Our audit has given insight in to the age, sex, triggers and symptoms of children presenting in anaphylaxis and identifies disparity in the recognition and management of anaphylaxis in the ED. To standardise and improve care, it was recommended that a paediatric anaphylaxis care pathway should be implemented in line with the current guidance.