Allergy alerts – The incidence of parentally reported allergies in children presenting for general anesthesia.
This prospective audit documents self-reported allergies in patients presenting for elective surgery at a tertiary paediatric hospital assessing the nature and severity of self-reported reactions. Self-reported reactions were assessed by an immunologist and an anaesthetist. Each was then assessed as ‘likely allergy’, ‘no allergy’, ‘insufficient evidence’, or ‘contact dermatitis’. Drug reactions were classified as either Type A (predictable, dose related, pharmacological actions or drug intolerances) or Type B (unpredictable, dose-independent hypersensitivity reactions). Over a 2-month period, 1361 patients presented for surgery and data was collected for approximately 1000 patients. 15.8 % self-reported an allergy with food, environmental and venom allergies representing about half of these. There were 73 self-reported drug allergies in 55 patients with just over half of these (56.2%) being self-reported allergies to antibiotics. Interestingly only 38.2 % of self-reported allergies had been investigated and food and environmental allergies were most likely to have been investigated. No patient who reported latex allergy had been investigated and less than 5 % of patients with self-reported antibiotic allergy had been assessed following the initial reaction. Only a small percentage (5.5 %)of patients who had self-reported drug allergy could be assigned a likely true drug allergy status with the majority (69.9%) determined to have insufficient supporting evidence for a true drug allergy or no allergy.
Take Home Message
While food allergies are investigated and confirmed by a specialist, reported drug allergies are rarely followed up and confirmed by a specialist. According to the authors, only a minority of parent reported allergies are clinically relevant which means that many children are exposed to modified treatment which may not be warranted. In the case of antibiotic prophylaxis, there is evidence that there may be an increased incidence of surgical site infection when recommended alternate antibiotics are used. This study highlights the growing problem of noise created by unconfirmed self-reported allergy which leads clinicians to make treatment decisions based on inadequate information and potentially modifying care unnecessarily.
Reviewed by: Dr Catherine Olweny