Objectives & Background There is limited epidemiological data for allergy Emergency Department (ED) presentations. Following recent launch of NICE guidelines and World Allergy Organisation (WAO) severity descriptions we investigated the epidemiology, management and outcomes of allergy patients presenting to a single ED.

Methods A retrospective review of consecutive presentations to a single tertiary ED (assessing 112,000 adults annually) between 28/02/2011 and 29/02/2012 was conducted. Key-word search of ED PAS records identified a suitable cohort. WAO criteria were used to define severity of allergic presentation.

Results 405 patients were identified (268 acute allergy patients, 137 anaphylaxis). Median age 33 (range 13 to 92) years. Male to female ratio was 0.6:1. 28 patients met criteria for life-threatening reactions. 259 (64%) patients self-presented and 141 (34.8%) presented via ambulance. 6 (21.4%) patients with life-threatening anaphylaxis self-presented. Precipitants were identified in 235 (58%) patients. 89 (21.9%) patients had a known allergy to the precipitating agent, including 38 (27.7%) anaphylaxis patients. 33 (12.8%) acute allergy and 65 (47.4%) anaphylaxis patients received pre-hospital adrenaline (48 from ambulance service, 49 self-administered). In the ED, 103 (75.2%) anaphylaxis patients received H1 antagonists, 86 (62.8%) received oral or IV steroids, 24 (17.5%) received IM adrenaline and 23 (16.8%) received salbutamol. Only 63 (15.5%; n=405) were admitted to hospital including 3 anaphylaxis patients to critical care. Of those admitted; 57 (90.5%) received adrenaline pre-hospital or in the ED. Overall 21 (5%) patients re-presented within 72 hours of discharge; 3 of these patients had been admitted. An epipen was prescribed on discharge to 82 (20.2%) patients overall and 44 (10.9%) were referred to allergy services. 34 (54%) admitted patients were not referred to specialists and 36 (57.1%) did not receive an epipen.

Conclusion NICE guidelines were not consistently followed but this did not seem to result in measurable short terms complications. A significant number of patients had a known precipitant.