1 - Serviço de Imunoalergologia, Hospital Central do Funchal - Dr. Nélio Mendonça, SESARAM, Funchal, Portugal
2 - Serviço de Imunoalergologia, Hospital de Dona Estefânia, Unidade Local de Saúde de São José, Lisboa, Portugal.
3 - Centro Clínico Académico de Lisboa, Lisboa, Portugal
4 - Comprehensive Health Research Center (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Póster em reunião internacional – EAACI Hybrid Congress, Valência, Espanha, 31 de maio a 3 de junho, 2024
Resumo:
Background: Anaphylaxis is a potentially life-threatening allergic reaction, with many diagnostic challenges. There is no consensus for a universal definition, and a broad range of differential diagnoses can contribute to a demanding approach in the emergency room. We intended to evaluate the challenges in the management of anaphylaxis in a paediatric population.
Method: Retrospective analysis of medical records of paediatric patients discharged from the emergency room (2018–2023) coded with the diagnosis of anaphylaxis (A) or who received intramuscular adrenaline (B) but did not meet anaphylaxis criteria (WAO Anaphylaxis Guidance 2020). We included 88 from a total of 125 patients.
Results: We analysed 88 patients, 67% male, mean age was 9+5.6 years [min 5 months; max 17 years]. All patients were admitted from the community, 11 of which assessed in pre-hospital care. Median onset of symptoms was 60 minutes [8.8–180]. In subgroup A, 20 of 49 patients received intramuscular adrenaline, 9 before hospital admission, 5 of which in self-administration. Twelve out of 20 had self-reported allergy and received adrenaline mostly due to mucocutaneous complaints. Four patients had infectious symptoms. In subgroup B, all patients received intramuscular adrenaline in a hospital setting. Sixteen patients had infectious symptoms, with signs that can mimic allergic reactions. None of these patients self-reported allergy. The remaining 23 had no infectious symptoms and 12 of them self-reported allergy Adrenaline was mainly used when the suspected allergen was previously identified in a non-anaphylactic reaction or identified by the patient, or when mucocutaneous symptoms were combined with infectious or reported, but not verifiable, symptoms. Upon discharge patients in subgroups A and B, received an adrenaline autoinjector in 30.6% and 35.9%, and were referred to the allergy department in 59.2% and 82.1%, respectively. Full description in Table 1. Conclusion: Identifying an episode of anaphylaxis in the emergency room can be challenging. There are several confounding factors like infections that can act as a cofactor of the allergic reaction or simulate its symptoms, as observed in the results. Self-reported allergy is very common and can cause bias in the way symptoms are interpreted, with an obvious impact in the approach. A continuous collaboration and partnership between the allergist and the emergency physician can be of added value to improve management and anaphylaxis education.
Palavras Chave: anafilaxia, imunoalergologia pediátrica, alergia alimentar