PDF(Pubmed)
Abstract：
Objectives Anaphylaxis is an acute, life-threatening immediate allergic reaction caused by the sudden systemic release of mediators from mast cells. This study aims to assess the current practice of emergency management of children and adults diagnosed with anaphylaxis at the Royal Hospital, Muscat, Oman, in line with the National Institute for Health and Clinical Excellence (NICE) guidelines. Methods This is an observational retrospective study of all anaphylaxis cases seen at the emergency department (ED) from January 2013 to January 2018 and compared with the management of anaphylaxis in the ED as per the NICE guidelines. Inclusion criteria were all patients, children (age 16 and below), and adults diagnosed with anaphylaxis based on the World Allergy Organization (WAO) criteria. Exclusion criteria are all cases labeled as anaphylaxis that did not match the WAO criteria for anaphylaxis. Results Of 100 patients with a preliminary diagnosis of anaphylaxis, 49 patients (49%) were true-anaphylaxis cases based on the WAO definition 16 were children (age 16 years and below), and 33 were adults ( age 16 years and above). The other 51 patients (51%) with misdiagnosed anaphylaxis were later diagnosed with spontaneous urticaria, septic shock, vocal cord dysfunction, severe asthma, and anxiety attack. All 49 patients with true-anaphylaxis appropriately received adrenaline intramuscularly at the ED. All 16 children were admitted, seen by an allergist, and received an adrenaline auto-injector when indicated. Only 5 of the 33 adults were admitted and seen by an allergist, and 4 of those required an adrenaline auto-injector upon discharge. The remaining 28 adults were discharged from the ED, and only 3 of these were referred to the allergist. None received an adrenaline auto-injector upon discharge from the ED, and no mention in the ED notes on patient education regarding allergen avoidance. Conclusion Third of the patients who presented to ED were children (<16 years), and two third were adults. Insect venom was the main reason for anaphylaxis in both age groups. There was an underutilization of adrenaline auto-injector prescriptions for adult patients. This could be very well improved by disseminating policies and guidelines to adult physicians.
摘要：
目的过敏反应是一种急性,由肥大细胞突然全身释放介质引起的危及生命的立即过敏反应。这项研究旨在评估皇家医院诊断为过敏反应的儿童和成人的紧急管理的当前做法，马斯喀特,阿曼,符合美国国家健康与临床卓越研究所(NICE)的指导方针。方法这是一项观察性回顾性研究，对2013年1月至2018年1月在急诊科（ED）看到的所有过敏反应病例进行观察性研究，并根据NICE指南与ED的过敏反应管理进行比较。纳入标准为所有患者，儿童（16岁及以下），和根据世界过敏组织（WAO）标准诊断为过敏反应的成年人。排除标准是标记为过敏反应的所有病例，其与过敏反应的WAO标准不匹配。结果在100例初步诊断为过敏反应的患者中,根据WAO定义，49例患者（49％）为真正的过敏反应病例，16为儿童（16岁及以下），33人为成年人(16岁及以上)。另外51例(51%)误诊为过敏反应的患者后来被诊断为自发性荨麻疹,感染性休克,声带功能障碍,严重哮喘,和焦虑攻击。所有49例真正的过敏反应患者均在ED接受了肌内肾上腺素治疗。所有16名儿童都被录取了，被一个过敏症专科医生看到了,并在指示时接受了肾上腺素自动注射器。33名成年人中只有5名被过敏症患者收治并看过，其中4人在出院时需要肾上腺素自动注射器。其余28名成年人已从急诊室出院,其中只有3人被转介给过敏症专科医生。没有人在从急诊室排出时接受了肾上腺素自动注射器，ED注释中没有提及有关避免过敏原的患者教育。结论ED患者中有三分之一是儿童（<16岁），三分之二是成年人。昆虫毒液是两个年龄组过敏反应的主要原因。成人患者的肾上腺素自动注射器处方利用率不足。通过向成年医生传播政策和准则，可以很好地改善这种情况。
