Identifying the Service Gaps in the Management of Severe Systemic Allergic Reaction/Anaphylaxis by Paediatrics Departments of the the Hospital Authority

Abstract

Background: Anaphylaxis and severe systemic allergic reaction are potentially life-threatening conditions. There is a paucity of data on the management of such condition amongst Hong Kong children. Objective: This review was designed to assist health professionals to evaluate the current process of care for children admitted with anaphylaxis or severe systemic allergic reaction, to identify service gaps so that patients are appropriately investigated, treated and taught how to recognise and manage severe allergic reactions. Methods: The anaphylaxis and severe allergic reaction/angioedema for children under age of 18 were identified using ICD-9 codes 995.0, 995.1, 995.6. We performed a retrospective chart review of one hundred children. We assessed the clinical practice among all Paediatric Departments within the Hospital Authority (HA) from January 2006 to December 2007. Results: The standardised admission rates of anaphylaxis aged below 18 years was 0.5 /100,000 (CI 0.6-0.7), which was probably 5-7 fold less compared with Western countries. This territory wide survey confirmed that food allergy was the leading cause in systemic allergic reactions amongst children admitted to HA service. Drug was the second commonest cause, accounting for 24% of the cases. The causes could not be determined in one out of six cases (17%). The attempt to identify the exact aetiologies was hampered by the lack of allergy assessment in most of the units. Adrenaline auto-injector was infrequently prescribed and used in our practice. Conclusion: This study provided background information for possible implementation of improvement measures that might be needed in the management of this possible life-threatening reaction. 背景：過敏反應和嚴重全身過敏性反應有可能危及生命。關於香港兒童此方面的資料很少。目的：本綜述旨在幫助醫護人員評估目前對確診過敏反應或嚴重過敏性反應兒童的診治過程，發現服務的不足之處以正確調查、治療和教導患者怎樣識別和處理嚴重過敏性反應。方法：使用ICD-9代碼 995.0, 995.1, 995.6標記18歲以下兒童過敏反應和嚴重全身過敏性反應/血管性水腫。我們對100例兒童做了回顧性綜述。並評估了從2006年1 月至2007年12月醫院管理局（HA）所有兒科的臨床實用性。結果：符合標準的18歲以下過敏反應發生率為 0.5 /100,000 （CI 0.6-0.7），與西方國家相比少5-7倍。此次區域內調查證實食物過敏是導致醫管局服務範圍內兒童全身過敏性反應的首要致病因素。藥物是第二大致敏原因，佔24%。六分之一（17%）不能確定原因。大多數單位沒有過敏性反應評估，限制了病原的準確識別。我們很少處方腎上腺素自動注射器。結論：處理此可致命的疾病可能需要改進方法，本研究為此提供參考。