Allergic emergencies in the prehospital setting: a 5 year retrospective study

João Paulo Cardoso Lopes joaolopes1493@gmail.com¹, 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 Costa^1,3
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2^nd Prize Winner for Best Oral Communication at the 43^ª National Congress of the Portuguese Society of Allergology and Clinical Immunology (SPAIC) 2022. 

Doi
10.23822/EurAnnACI.1764-1489.297

Summary
Background. 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. 

Key words
Emergency; prehospital care; anaphylaxis; epinephrine; allergy.
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