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Acute allergic reactions in the emergency department: characteristics and management practices
Eveline A Hitti1, Fares Zaitoun, Elie Harmouche
1Departments of aEmergency Medicine bPediatrics and Adolescent Medicine, American University of Beirut Medical Center cDepartment of Emergency Medicine, American University of Beirut, Beirut, Lebanon.
Objective:
The objective of this study is to determine the incidence of emergency department (ED) visits for acute allergic reactions, identify the triggers, assess the severity, evaluate the management practices, and examine patient outcomes at a single-center ED in Lebanon.
Patients And Methods:
A retrospective review of all patient charts presenting with a final diagnosis of acute allergic reaction to a single ED within a 6-month period (July-December 2009) was carried out. Age, sex, triggers, management in the ED and at discharge, disposition, and return visit were determined.
Results:
Two hundred and forty-five patients were identified (82.4% mild, 15.1% moderate, and 2.6% severe, respectively). This accounted for 0.96% of all ED visits. Drugs were the most commonly identified trigger (23.7%). In the ED, 72.7% of patients received H1-antihistamines, 51.8% received corticosteroids, 7.3% received H2-antihistamines, and 7.3% received inhaled B2 agonists. Only 15.9% of anaphylaxis cases received epinephrine in the ED. Similarly, the majority of patients were discharged on H1-antihistamines (93.9%), with only 4.5% of patients with anaphylaxis receiving prescriptions for epinephrine injections. All patients except one were discharged home. No fatalities were noted and the return visit rate within 1 week was 9.8%.
Conclusion:
The incidence of ED visits for acute allergic reaction was high compared with other studies, although the majority of cases were mild. Deviations from published guidelines on the treatment of anaphylaxis are common, with rare use of epinephrine and heavy reliance on H1-antihistamines both in the ED and at discharge. This did not seem to result in any measurable impact on mortality.