Content area
Full text
ABSTRACT
AIM: Emergency department (ED) visits for food-related acute allergic reactions enable estimation of temporal trends in food allergy prevalence. To use this approach in New Zealand requires an understanding of the proportion of ED visits coded as 'anaphylaxis, unspecified' or 'allergy, unspecified' that are food-related allergic reactions.
METHOD: We reviewed all ED presentations of children, coded as 'anaphylaxis, unspecified' or 'allergy, unspecified', from 1988-2011 to the Auckland City Hospital ED. Charts were reviewed independently by two investigators to determine agreement on categorisation of presentations as being food-related acute allergic reactions. We compared ED presentation rates in different time intervals using rate ratios (RR) and 95% confidence intervals (CI).
RESULTS: Sixty-five (29%) of the 221 ED presentations given a discharge code of 'anaphylaxis, unspecified' or 'allergy, unspecified', were a food-related allergic reaction. Inter-observer agreement was very good (kappa >0.80). The ED presentation rate with food-related allergic reactions in 2004-2011 was 98% higher than in 1988-1995 (RR=1.98, 95%CI 1.10-3.72). By contrast, ED presentation rates for non-food-related allergic reactions did not change over these years.
CONCLUSION: ED presentations for food-related allergic reactions are identifiable from within ED presentations coded as 'anaphylaxis, unspecified' or 'allergy, unspecified'. ED presentations for food-related allergic reactions have increased over time in Auckland.
Worldwide, food allergies have been the subject of much debate in recent decades due to what many observe as a dramatic increase in childhood food allergy prevalence, incidence, and severity.1-5 Despite New Zealand having one of the highest prevalences of asthma worldwide, the epidemiology of other atopic diseases, including food allergy, has been poorly characterised.6-8
Due to difficulties inherent with the establishment of stable and repeatable measures of food allergy prevalence in the community or in primary care settings, hospital emergency department (ED) presentations for food-related acute allergic reactions have been used in other countries to estimate temporal trends.9-12 Such an approach would seem particularly appropriate in New Zealand given that acute hospital-based secondary care services are free, the hospital presentation data is stored and accessible at both a national and regional level, and each person having contact with health services in New Zealand is assigned a unique identifier: the national health index (NHI) number.
While hospital event data only describes food-related allergic reactions at the severe end of...