title: The diagnosis and management of children presenting with anaphylaxis to a metropolitan emergency department: A 2-year retrospective case series.
abstract: OBJECTIVE
  To investigate the diagnosis and management of children with anaphylaxis presenting to an Emergency Department (ED). We compared the management with the Australasian Society of Clinical Immunology and Allergy (ASCIA) guidelines to gauge compliance.
  
  
  METHODS
  A retrospective case series was developed from children aged from birth to 16 years presenting to the ED at Sunshine Hospital (SH) in Melbourne, Australia over a 2-year period from 1 January 2012 to 31 December 2013. The demographic characteristics, causative agents, clinical features, treatment administered and discharge destination were recorded.
  
  
  RESULTS
  Fifty-five children diagnosed with anaphylaxis during the 2-year period were identified. Fifty-two children (95%) met the ASCIA diagnostic criteria, 49 (94%) children received adrenaline. The median age of presentation was five years, with males predominating (32 (62%)). The most common setting was home (35 (67%)), and food (39 (75%)) was the most common causative agent. Cutaneous symptoms (50 (96%)) were the most prevalent. Twenty-eight (54%) children received adrenaline prior to arrival in ED, whilst 22 (42%) received adrenaline in the ED. Thirty-three (63%) children were discharged home.
  
  
  CONCLUSIONS
  Childhood anaphylaxis commonly presents to the ED. More than half of children presenting with anaphylaxis were treated prior to attending the ED. The findings demonstrate that anaphylaxis diagnosis and management guidelines are being adhered to in the majority of cases. There were no adverse outcomes recorded.
authors.affiliation: School of Medicine, The University of Notre Dame Australia, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Nogic
authors.affiliation: Emergency Department, Sunshine Hospital, Victoria, Australia.|Department of Allergy and Immunology, Royal Children's Hospital, Victoria, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Belousoff
authors.affiliation: Emergency Department, Sunshine Hospital, Victoria, Australia.|Department of Paediatrics, Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: David
authors.identifier: http://orcid.org/0000-0002-7173-6993
authors.initials: D
authors.lastname: Krieser
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D012189:Retrospective Studies
keywords: allergy; anaphylaxis; children; emergency department