Anaphylaxie et médecine d'urgence : données en région Lorraine et recommandations

Anaphylaxis is an allergic emergency, and its frequency increases in all countries since the 2000s. Epinephrine administration and allergist-emergency room interactions are the key points of its management. The objective of the study was to determine the incidence of anaphylaxis in 2015, to describe its main characteristics and to evaluate practices in Lorraine for this period. Four hospitals in Lorraine were selected. Medical records from each center's adult and pediatric emergency rooms, from 1st January to 31th December 2015, were classified based on their admission cause and diagnosis code. When data were consistent for an anaphylaxis (95 selected ICD-10 codes) record was analyzed by an allergist practitioner and included if confirmed. Epidemiological data, clinical characteristics, management assessment and orientation were provided through a standardized questionnaire. Anaphylaxis is responsible for 0.16% emergency rooms' admissions in the participating centers in 2015; the estimated incidence in Lorraine is 34 per 100,000 person-years. Clinical presentation depends on age, etiologic agent, several cofactors (asthma, cardiovascular comorbidities, treatments) and reaction's gravity. When anaphylaxis was serious (Ring-Messmer's grade ≥ 3), epinephrine use was only 32.4% (48/148) and observation duration was less than 6 hours 4 times on 10. An allergist referral was proposed in 57.9% (187/323) patients. Anaphylaxis is not a rare cause for emergency rooms' admission in Lorraine. Therefore guidelines are insufficiently followed and a better knowledge of the pathology and its management is necessary for emergency healthcare practitioners.