Anaphylaxis is widely accepted to be an increasing problem worldwide. This inquiry into pre-hospital incidence and patient demographics is useful to determine status of anaphylaxis in Tasmania. Our main goal was to determine the incidence of pre-hospital anaphylaxis in Tasmania and identify trends in characteristics of affected patients.
Raw data was searched and extracted from Ambulance Tasmania electronic recording system and case records for the period 1st January 2007 to 31st December 2011. This involved data mining 279,482 cases with the search parameters of anaphylaxis and allergy/ allergic reaction.
There were 1,570 patients were classified as having allergic reaction (including the most severe form of anaphylaxis). 379 (24.1%) of the atopic group were given a final primary diagnosis of anaphylaxis. The adult cases distribution was female at 219 (57.8%) versus males at 160 cases (42.2%). Interestingly 21.1% of the total anaphylaxis cases were paediatric (n=80) with a greater percentage of male (n=46) to female (n=34) paediatric patients. Aetiology was identified in 85.5% of the cases accordingly: envenomation (insects) 141 (37.2%), food 118 (31.1%), medication 58 (15.3%), known other 4 (1.1%), exercise 3 (
ConclusionThese findings suggest that almost a quarter of all calls for allergy or allergic reaction are of a severe potentially life-threatening nature, with the most common aetiology envenomation from insects (jack jumper bites).
ASCIA. Health professional information paper (HPIP). Anaphylaxis, September 2013. Available at: www.allergy.org.au/health-professionals/hp-information/asthma-and-allergy/anaphylaxis
Boros CA, Kay D, Gold MS. Parent reported allergy and anaphylaxis in 4173 South Australian children. J Paediatr Child Health 2000;36(1):3640.
Decker WW, Campbell RL, Manivannan V, et al. The etiology and incidence of anaphylaxis in Rochester, Minnesota: A report from the Rochester Epidemiology Project. J Allergy Clin Immunol 2008;122(6):1161–5.
Liu AH, Jaramillo R, Sicherer SH, et al. National prevalence and risk factors for food allergy and relationship to asthma: results from the national health and nutrition examination survey 2005-2006. ibid. 2010;126(4):798–806.
Sheikh A, Hippisley-Cox J, Newton J, Fenty, J. Trends in national incidence, lifetime prevalence and adrenaline prescribing for anaphylaxis in England. J Royal Soc Med 2008;101(3):139–143.
Mullins RJ, Cook M, Doublass J, Mallon D, Smith J, Wong M. The economic impact of allergic disease in Australia: not to be sneezed at. ASCIA/Access Economics Report, November 2007. Available at: www.allergy.org.au/images/stories/pospapers/2007_economic_impact_allergies_report_13nov.pdf
Dinakar C. Anaphylaxis in children: current understanding and key issues in diagnosis and treatment. Curr Allergy Asthma Rep 2012;12(6):641–9.
Yocum MW, Butterfield JH, Klein JS, et al. Epidemiology of anaphylaxis in Olmsted County: a population-based study. J Allergy Clin Immunol 1999;104:452–6.
ASCIA. Allergy and immune diseases in Australia (AIDA) report, July 2013. Available at: www.allergy.org.au/images/stories/reports/ASCIA_AIDA_Report_2013.pdf
Rappo TB, Cottee AM, Ratchford A, Burns BJ. Tick bite anaphylaxis: incidence and management in an Australian emergency department. Emerg Med Australas 2013;25(4):297–301.
Gibbs NM, Sadleir PH, Clarke RC, Platt PR. Survival from perioperative anaphylaxis in Western Australia 2000-2009. Br J Anaesth 2013;111(4):589–93.
Liew WK, Williamson E, Tang MLK. Anaphylaxis fatalities and admissions in Australia. J Clin Immunol Allergy 2009;123(2):434–42.
Sadleir PH, Clarke RC, Bunning DL, Platt PR. Anaphylaxis to neuromuscular blocking drugs: incidence and cross-reactivity in Western Australia from 2002 to 2011. Br J Anaesth 2013;110(6):981–7.
Churchman A1, O'Leary MA, Buckley NA, et al. Clinical effects of red-bellied black snake (Pseudechis porphyriacus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11). Med J Aust 2010;193(11–12):696–700.
Mullins RJ, Dear KBG, Tang MLK. Characteristics of childhood peanut allergy in the Australian Capital Territory, 1995 to 2007. J Allergy Clin Immunol 2009;123(3):689–693.
Brown SGA, Franks RW, Baldo BA, Heddle RJ. Prevalence, severity, and natural history of jack jumper ant venom allergy in Tasmania. ibid. 2003;111:187–92.
Brown SGA, Mullins RJ, Gold MS. Anaphylaxis: diagnosis and management. Med J Aust 2006;185(5):283–89.
Mullins RJ, Clark S, Camargo CA Jr. Socio-economic status, geographic remoteness and childhood food allergy and anaphylaxis in Australia. Clin Exp Allergy 2010;40(10):1523–32.
Australian Institute of Health and Welfare. Allergic rhinitis (‘hay fever’) in Australia. Cat. no. ACM 23. Canberra: AIHW, 2011.
Chung T, et al. Pre-hospital management of anaphylaxis in one Canadian Urban Centre. Resuscitation 2014; In press.
Capps JA, Sharma V, Arkwright PD. Prevalence, outcome and pre-hospital management of anaphylaxis by first aiders and paramedical ambulance staff in Manchester, UK. Resuscitation 2010;81(6):653–7.
Rea TD, Edwards C, Murray JA, Cloyd DJ, Eisenberg MS. Epinephrine use by emergency medical technicians for presumed anaphylaxis. Prehosp Emerg Care 2004;8(4):405–10.
Safdar B, Cone DC, Pham KT. Subcutaneous epeinphrine in the prehospital setting. ibid. 2001;5(2):200–7.
Lammers R, Willoughby-Byrwa M, Fales W. Medication errors in prehospital management of simulated pediatric anaphylaxis. ibid. 2014;18(2):295–304.
Tiyyagura GK, Arnold L, Cone DC, Langhan M. Pediatric anaphylaxis management in the prehospital setting. ibid. 2014;18(1):46–51.
Pumphrey RS. Lessons from management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 2000;30(8):1144–50.
Department of Health and Human Services. Service files - Ambulance Tasmania, 2014. Available at: www.dhhs.tas.gov.au/service_information/services_files/tasmanian_ambulance_service [Accessed 28 May 2014].
National Health and Medical Research Council 2013. National Statement on Ethical Conduct in Human Research. Commonwealth of Australia. Available at: www.nhmrc.gov.au/_files_nhmrc/publications/attachments/e72_national_statement_140130.pdf
de Silva IL, Mehr SS, Tey D, Tang MLK. Paediatric anaphylaxis: a 5 year retrospective review. Allergy 2008;63(8):1071–6.