Paediatric anaphylaxis in South Africa

INTRODUCTION: Anaphylaxis is a severe, life-threatening generalized hypersensitivity reaction. While guidelines to reduce the morbidity, risk, and mortality of anaphylaxis are widely available, adherence to these is often suboptimal. We aimed to audit paediatric anaphylaxis at a South African tertiary allergy referral centre, comparing our data to those of the large Network of Severe Allergic Reactions (NORA) registry. METHODS: Children treated for severe allergic reactions between January 2014 and August 2016 were identified for screening using ICD-10 coding of all admissions and discharges, pharmacy records of adrenaline autoinjector dispensing, and additional referrals from the allergy department to the study. Screened participants not meeting the inclusion criteria after preliminary questioning and/or folder review were excluded. Data were collected via a standardized questionnaire using direct interviews, and captured on a local web-based registry. RESULTS: Of the 156 episodes analysed, >40% were graded as severe and nearly two-thirds of patients were seen for a recurrent episode. Males, younger children, and individuals of mixed-race ethnicity were more frequently affected. Skin and mucosa were most commonly involved, followed by respiratory and gastrointestinal involvement; cardiovascular and other systemic involvement occurred infrequently. Specific IgE assay was the most frequently requested test. Food-related triggers (peanut, hen's egg, fish, cashew nuts and cows' milk) predominated and decreased with age. Anaphylaxis was strongly correlated with atopic conditions. While prophylactic measures were almost universally instituted, adrenaline was rarely used, by both lay persons and healthcare professionals. Hospital admissions were infrequent, and no deaths were recorded. CONCLUSION: Management of anaphylaxis can be improved. Specifically, the use of adrenaline prior to hospital arrival remains suboptimal. Ongoing education and training of patients, parents, teachers, and healthcare workers is identified as an area requiring intensification.