Allergic emergencies in the prehospital setting: a 5 year retrospective study
João Paulo Cardoso Lopes firstname.lastname@example.org
, Jóni Seabra da Costa Carvalho1
, Helena Pires Pereira1
, Inês Filipa da Costa Farinha1
, Pedro Botelho Alves1
, Fabiana da Costa Pimentel2
, Carmelita Ribeiro1
, Ana Maria Pego Todo-Bom Ferreira da Costa1,3Show more: Authors information and Publication history
Department of Allergy and Clinical Immunology, Coimbra Hospital and University Center, Coimbra, Portugal2
National Institute of Medical Emergency, Central Base HUC, Coimbra Hospital and University Center, Coimbra, Portugal3
Coimbra Clinical Academic Center, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Published: 18 May 2023
Accepted: 12 May 2023
Received: 08 March 2023
Prize Winner for Best Oral Communication at the 43ª
National Congress of the Portuguese Society of Allergology and Clinical Immunology (SPAIC) 2022.
Patients with severe allergic conditions often request support from the prehospital emergency services given the rapid, unexpected and potentially life-threatening nature of the reactions, such as anaphylaxis. Studies regarding prehospital incidents for allergic conditions are scarce. This study aimed to characterize prehospitalar medical requesting assistance due to suspected hypersensitivity reactions (HSR). Methods.
Retrospective study of allergic-related requesting assistances between 2017-2022 of a Portuguese emergency dispatch centre - Emergency and Resuscitation Medical Vehicle (VMER), in Coimbra University Hospital. Demographic and clinical variables were analysed, including clinical manifestations, anaphylaxis severity grading, therapeutic interventions, and post-incident allergic work-up. Regarding anaphylactic events, three diagnosis timings were compared: on-site, hospital emergency department and Investigator-diagnosis based on data reviewed. Results.
Out of 12689 VMER requesting assistances, 210 (1.7%) were classified as suspected HSR reactions. After on-site medical evaluation, 127 (60.5%) cases maintained the HSR classification (median age 53 years; 56% males) and the main diagnoses included HSR to Hymenoptera venom (29.9%), food allergy (29.1%), and pharmaceutical drugs (25.5%). Anaphylaxis was assumed on-site in 44 (34.7%) cases, in the hospital emergency department in 53 cases (41.7%) and by investigators in 76 (59.8%) cases. Regarding management, epinephrine was administered on-site in 50 cases (39.4%). Conclusions.
The main reason for prehospital requesting assistance was HSR to Hymenoptera venom. A high proportion of incidents met the criteria for anaphylaxis and despite the inherent difficulties of the prehospital setting, many of the on-site diagnoses agreed with the criteria. Regarding management, epinephrine was underused in this setting. Referral to specialized consultation is crucial for the management of prehospital incidents.
Emergency; prehospital care; anaphylaxis; epinephrine; allergy. FULL TEXT