Multicenter study of emergency department visits for food allergies
Multicenter study of emergency department visits for food allergies
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DOI：
10.1016/j.jaci.2003.10.053
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发表时间：
2004-02-01
影响因子：
14.2
通讯作者：
Camargo, CA
中科院分区：
文献类型：
--
作者：
Clark, S;Bock, SA;Camargo, CA
背景：对于因急性过敏反应而到急诊科就诊的患者的特征，我们知之甚少。虽然过敏反应指南建议使用肾上腺素治疗，教授可自行注射的肾上腺素，并推荐过敏专科医生，但目前的ED管理仍然不确定。目的：本研究的目的是描述与食物相关的急性过敏反应的处理。方法：多中心呼吸道研究协作组对21个北美急诊室进行了图表回顾研究。研究人员随机抽样了678例食物过敏患者的病历(国际疾病分类-第九版修订代码693.1、995.0、995.3和995.60-995.69)。结果：患者的平均年龄为29岁；队列中57%是女性，40%是白人。多种食物会引起过敏反应，包括坚果(21%)、甲壳类动物(19%)、水果(12%)和鱼(10%)。虽然接触这些食物可能会危及生命，但只有18%的患者是乘坐救护车来到急诊室的。在ED中，72%的患者接受了抗组胺药物，48%的患者接受了全身皮质类固醇，16%的患者接受了肾上腺素，33%的患者接受了呼吸治疗，如吸入沙丁胺醇。在有严重反应的患者(占总数的55%)中，24%接受了肾上腺素治疗。总体而言，97%的患者已出院回家。在ED出院时，16%的患者服用了可自行注射的肾上腺素，12%的患者被转诊为过敏症患者。结论：尽管指南建议了管理急性过敏反应的具体方法，但ED对食物过敏的符合率似乎很低。这些发现支持过敏和急救医学专业组织之间的新合作，并为ED患者和工作人员开发教育计划和材料。
Background: Relatively little is known about the characteristics of patients who visit the emergency department (ED) for an acute allergic reaction. Although anaphylaxis guidelines suggest treatment with epinephrine, teaching about self-injectable epinephrine, and referral to an allergist, current ED management remains uncertain.Objective: The objective of this study was to describe the management of food-related acute allergic reactions. Methods: The Multicenter Airway Research Collaboration performed a chart review study in 21 North American EDs. Investigators reviewed a random sample of 678 charts of patients who presented with food allergy (International Classification of Diseases-ninth revision codes 693.1, 995.0, 995.3, and 995.60-995.69).Results: Patients had an average age of 29 years; the cohort was 57% female and 40% white. A variety of foods provoked the allergic reaction, including nuts (21%), crustaceans (19%), fruit (12%), and fish (10%). Although exposure to these foods can be life threatening, only 18% of patients came to the ED by ambulance. In the ED, 72% of patients received antihistamines, 48% received systemic corticosteroids, and 16% received epinephrine; 33% received respiratory treatments such as inhaled albuterol. Among patients with severe reactions (55% of total), 24% received epinephrine. Overall, 97% of patients were discharged to home. At ED discharge, 16% of patients were prescribed self-injectable epinephrine, and 12% were referred to an allergist.Conclusions: Although guidelines suggest specific approaches for the management of acute allergic reactions, ED concordance for food allergy appears low. These findings support a new collaboration between professional organizations in allergy and emergency medicine and the development of educational programs and materials for ED patients and staff.