Paediatric allergic reactions in the emergency department: a review

Background: Allergic diseases are increasing in incidence worldwide and large numbers of children are now affected by allergy. Few studies have examined allergic reactions in children, particularly in the emergency department (ED) setting. Outcome Measures: Primary-to describe the epidemiology of acute paediatric allergic reactions. Secondary-to describe the treatment and outcome of allergic reactions presenting to a paediatric ED. Setting: The ED of a paediatric tertiary referral hospital with approximately 29 000 ED attendances annually. Methods: A retrospective review of allergic reactions presenting to a paediatric ED over a 2-year period. Main Results: 237 patients (61% male, median age 46 months) had reactions. 137/ 100 000 children attend the ED annually. The main identified causative agents were nuts (23%), dairy products (16.5%) and medication (10%). Oral contact was associated with 58.6% of reactions and dermatological symptoms were the most frequent presentation. Only 11(5%) received adrenaline (epinephrine). 46 (19%) were admitted. 55% of all patients received no formal follow-up. Conclusions: Acute allergic reactions affect boys more than girls and frequently occur at a young age. Food allergies, in particular to nuts, are a major cause of reactions. Allergy represents a frequent presentation to the paediatric ED. There remains a concern about the adequacy of follow-up.