Type of publication:
Conference abstract
Author(s):
*Elshahawy M.; *Kadambi M.; *Inani M.; Hughes D.; Clarke D.; Cooper A.; Goddard S.; Diwakar L.
Citation:
Allergy: European Journal of Allergy and Clinical Immunology. Conference: European Academy of Allergy and Clinical Immunology Hybrid Congress. Virtual. 79(Supplement 113) (pp 328-329), 2024. Date of Publication: 01 Oct 2024.
Abstract:
Background: In 2021, the UK Resuscitation Council made changes to the guidance on the management of acute anaphylaxis. The most significant of these included a) removal of antihistamine (chlorpheniramine) and steroid (hydrocortisone) from the algorithm b) Advise to administer repeated doses of IM adrenaline every 5 minutes until there has been an improvement in breathing and circulation. We carried out an audit to understand how the change in guideline has impacted patient care. Other aspects audited include measurement of serum tryptase and referral to specialist clinic. Method(s): This was a retrospective study using Ambulance Service and hospital notes to assess management of all patients presenting to the accident and emergency department at the university hospital of North Midlands (UHNM) and Shrewsbury and Telford hospitals (SaTH) with anaphylaxis in the years 2018 and 2022. ICD 10 codes were used to identify patients. Result(s): A total of 103 and 109 patients presented in 2018 and 2022 respectively with anaphylaxis. A&E and ambulance notes were available for 100 patients in 2018 (97%) and 103 (95%) patients in 2022. There were no deaths. Patient groups similar in age (range: 1-90 yrs) and gender (60% female) for both years across both sites. Less than half had tryptase measured. A significant number of patients with only skin symptoms were classified as having anaphylaxis. There was a significant reduction in the use of steroids and antihistamines between 2018 and 2022. Use of adrenaline was lower in 2022. Very few patients were referred to specialist clinics in both years, particularly from SaTH hospital. Conclusion(s): Anaphylaxis maybe over diagnosed in the emergency department. There has been some adherence to the new UK guideline for anaphylaxis management. Most patients still do not have serum tryptase checked. Referral rates are low.
DOI: 10.1111/all.16299
