Adherence to the Australian acute anaphylaxis clinical care standard and outcomes in a regional Queensland specialist outpatient service

Abstract

There is no published information on the recognition and management of anaphylaxis in regional Queensland. The establishment of a clinical immunology and allergy service for the Cairns and Hinterland Hospital and Health Service (CHHHS) has enabled the exploration of patient outcomes. To analyse anaphylaxis presentations, management and outcomes in a regional Queensland cohort compared with the Australian Commission on Safety and Quality in Health Care (ACSQHC) Acute Anaphylaxis Clinical Care Standard. A retrospective cohort study was undertaken with patients identified through clinical immunology and allergy clinic letters. All adults with a clinical immunologist and allergist diagnosis of anaphylaxis were included from service inception (1 March 2016) until 1 January 2024. Clinic letter database searching identified 636 patients with the word anaphylaxis in their problem list. A total of 220 patients (134 females, 61%) with a median age 42 years (IQR: 31-47 years) experienced 303 episodes of anaphylaxis; 350 did not meet inclusion criteria. Anaphylaxis was recognised and adrenaline was administered in 213 episodes (79%). Twenty-two of 46 patients (where site of intramuscular injection was recorded) received an adrenaline injection in the deltoid muscle. The median time to first dose of adrenaline and the duration of monitoring was 8 min and 6 h respectively. The most frequently reported causes for anaphylaxis were drugs/vaccines/contrast media (55 episodes, 18%), food (53 episodes, 17%), idiopathic (46 episodes, 15%) and venom (38 episodes, 13%). The treatment of anaphylaxis generally aligned with the ACSQHC Acute Anaphylaxis Clinical Care Standard; the high proportion of patients excluded demonstrates that more research is needed regarding the diagnostic accuracy in anaphylaxis.