Sommerfield David L, Sommerfield Aine, Schilling Alina, Slevin Lliana, Lucas Michaela, von Ungern-Sternberg Britta S
Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.
School of Medicine, The University of Western Australia, Perth, Australia.
Paediatr Anaesth. 2019 Feb;29(2):153-160. doi: 10.1111/pan.13541. Epub 2018 Dec 19.
Pediatric patients increasingly report allergies, including allergies to food and medications. We sought to determine the incidence and, nature of parent-reported allergies in children presenting for surgery and its significance for anesthetists.
We prospectively collected data on admissions through our surgical admission unit over a 2-month period at a pediatric tertiary care teaching hospital. Data collected included patient demographics, history of atopy, with more comprehensive information collected if an allergy was reported. A clinical immunologist and an anesthetist reviewed the documentation of all patients reporting an allergy.
We reviewed 1001 pediatric patients, 158 (15.8%) patients with parent-reported allergies; to medications/drugs (n = 73), food (n = 66), environmental allergens (dust/grasses, n = 35), tapes/dressings (n = 27), latex (n = 4), and venom (eg, bee, wasp, n = 9). Forty-one patients reported antibiotic allergies, with Beta-lactam antibiotics being the most common, with the majority presenting with rash alone (57%). Ten patients reported allergies to nonsteroidal anti-inflammatory drugs and eight to opioids. Twenty-four patients reported egg and/or peanut allergy. Only 3/1001 (0.3%) patients were deemed to have evidence of likely IgE-mediated drug allergy. Of the reported allergies, only 60 (38.2%) had been investigated prior, most likely to be followed up were food (53%) and environmental allergies (44.4%). Only 4/73 (5.5%) reported medication allergies had further follow-up. Just four patients (0.4% of the entire cohort) had drug sensitivities/allergies that were likely to majorly alter anesthesia practice.
Only the minority of parent-reported allergies in pediatric surgical patients were specialist confirmed and likely to be clinically relevant. Self-reported food allergy is commonly specialist verified whereas reactions to medications were generally not. Over-reporting of allergies is increasingly common and limits clinician choice of medications. Better education of patients and their families and more timely verification or dismissal of parent-reported reactions is urgently needed.
儿科患者报告过敏的情况越来越多，包括对食物和药物的过敏。我们试图确定手术患儿中家长报告的过敏发生率、性质及其对麻醉医生的意义。
我们在一家儿科三级护理教学医院的外科住院部，前瞻性地收集了为期2个月的住院患者数据。收集的数据包括患者人口统计学信息、特应性病史，如果报告有过敏，则收集更全面的信息。一名临床免疫学家和一名麻醉医生对所有报告过敏的患者的病历进行了审查。
我们审查了1001名儿科患者，158名（15.8%）有家长报告的过敏；对药物（n = 73）、食物（n = 66）、环境过敏原（灰尘/草，n = 35）、胶带/敷料（n = 27）、乳胶（n = 4）和毒液（如蜜蜂、黄蜂，n = 9）过敏。41名患者报告有抗生素过敏，其中β-内酰胺类抗生素最常见，大多数仅表现为皮疹（57%）。10名患者报告对非甾体抗炎药过敏，8名对阿片类药物过敏。24名患者报告有鸡蛋和/或花生过敏。仅3/1001（0.3%）患者被认为有可能由IgE介导的药物过敏证据。在报告的过敏中，只有60例（38.2%）之前接受过调查，最有可能接受随访的是食物过敏（53%）和环境过敏（44.4%）。仅4/73（5.5%）报告的药物过敏患者有进一步随访。只有4名患者（占整个队列的0.4%）的药物敏感性/过敏可能会极大地改变麻醉方案。
儿科手术患者中家长报告的过敏只有少数得到专科医生确认且可能具有临床相关性。自我报告的食物过敏通常会得到专科医生的核实，而对药物的反应通常不会。过敏报告过度的情况越来越普遍，限制了临床医生的用药选择。迫切需要对患者及其家属进行更好的教育，并更及时地核实或排除家长报告的反应。
