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Accurate of the diagnosis of allergy reactions at the Emergency Department

Lacombe-Barrios J1*, Gómez F1*, Perez N1, Barrionuevo E1, Doña I1, Fernández Tahia D2, Mayorga C2-3, Torres MJ1-2, Moreno E4, Gador B1, Salas M1*.

1Allergy Unit, IBIMA-Regional University Hospital of Malaga UMA, Malaga, Spain.
2 Research Laboratory, IBIMA-Regional University Hospital of Malaga UMA, Málaga, Spain.
3BIONAND—Andalusian Centre for Nanomedicine and Biotechnology
4Allergy Unit, University Hospital of Salamanca, Spain
*Contributed equally to this work.4. Allergy Unit, University Hospital of Salamanca, Spain. 

J Investig Allergol Clin Immunol 2019; Vol. 29(3)
doi: 10.18176/jiaci.0313

Background: Suspicion of an acute allergic reaction is a common reason for attending Emergency Departments (ED). However, little work has been performed comparing the initial diagnosis made in the ED of patients with suspected allergic reaction, with the definitive diagnosis made subsequently in the allergy department (AD).
Objective: Compare details of the initial diagnoses given in the ED relating to allergy with the final diagnoses performed in the AD.
Methods: Patients attending the ED of two hospitals with suspected allergic reactions were prospectively enrolled based on keywords. A certified allergy specialist revised the ED records of these patients and, if suggestive of an allergic reaction, the patients were scheduled for further evaluation at the allergy clinic.
Results: In total, 2000 patients were enrolled between April 2013-October 2015, of which 1333 passed the initial revision and underwent further evaluation. Of these, 528 underwent allergological study and 206 were confirmed as allergic. Regarding drug allergy, non-steroidal anti-inflammatory drugs were the most common triggers, followed by β-Lactams; in food allergy, plant-based foods were the most common. Only 16.4% of patients confirmed as having anaphylaxis in the AD were initially diagnosed as such in the ED.
Conclusion: Of the 528 patients that finally underwent full allergological study, less than half could be confirmed as allergic. Moreover, there appears to be an underdiagnosis of anaphylaxis in ED. Better communication between ED and AD is necessary to improve this situation and improve the diagnosis and management of these patients.

Key words: Anaphylaxis, Hypersensitivity drug reactions, Emergency medicine, Food allergy, Follow-up studies

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