Clark Sunday, Bock S Allan, Gaeta Theodore J, Brenner Barry E, Cydulka Rita K, Camargo Carlos A
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass, USA.
J Allergy Clin Immunol. 2004 Feb;113(2):347-52. doi: 10.1016/j.jaci.2003.10.053.
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.
The objective of this study was to describe the management of food-related acute allergic reactions.
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).
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.
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.
对于因急性过敏反应前往急诊科（ED）就诊的患者特征，人们了解相对较少。尽管过敏反应指南建议使用肾上腺素治疗、教授自我注射肾上腺素以及转诊至过敏症专科医生，但目前急诊科的管理仍不明确。
本研究的目的是描述与食物相关的急性过敏反应的管理情况。
多中心气道研究协作组在北美21家急诊科进行了一项病历回顾研究。研究人员随机抽取了678例患有食物过敏（国际疾病分类第九版编码693.1、995.0、995.3以及995.60 - 995.69）患者的病历进行回顾。
患者的平均年龄为29岁；该队列中女性占57%，白人占40%。多种食物引发了过敏反应，包括坚果（21%）、甲壳类动物（19%）、水果（12%）和鱼类（10%）。尽管接触这些食物可能危及生命，但只有18%的患者通过救护车前往急诊科。在急诊科，72%的患者接受了抗组胺药治疗，48%接受了全身性皮质类固醇治疗，16%接受了肾上腺素治疗；33%接受了诸如吸入沙丁胺醇等呼吸治疗。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%的患者出院回家。在急诊科出院时，16%的患者被开了自我注射肾上腺素的处方，12%被转诊至过敏症专科医生。
尽管指南提出了急性过敏反应管理的具体方法，但急诊科对食物过敏的依从性似乎较低。这些发现支持过敏和急诊医学专业组织之间开展新的合作，并为急诊科患者和工作人员开发教育项目及材料。
