We read the recent paper by Holgate and Lack1 with much interest. The use of appropriate allergy testing with the aim of accurate diagnosis is of particular importance in the setting of increasing incidence of allergic disease.2,3
We recently audited the impact of atopy on the workload within our paediatric A&E department; 14 369 episodes from a one year period were analysed. Presentations assigned a diagnosis of asthma, eczema, urticaria, angioedema, anaphylaxis, food allergy, drug allergy, or hay fever were felt to be related to atopy. Children under the age of 4 who presented with wheeze associated with a concurrent respiratory tract infection were assigned a diagnosis of viral induced wheeze and not included within the atopy grouping. Of these presentations, 811 (5.6%) were assessed as relating to atopy (fig 1).
Figure 1 Percentage of allergic presentations with respect to total episodes.
We also compared the percentage of admissions and medical follow up between allergic presentations to A&E and non‐allergic presentations. Not only did allergic conditions form a significant proportion of the department's workload, but a statistically significant higher proportion of these patients required admission (p < 0.001), outpatient follow up (p < 0.01), and general practitioner follow up (p < 0.001) when compared with the non‐allergic population (fig 2).
Figure 2 Comparison of National Health Service utilisation for follow up.
The change in the pattern of allergic presentations (the atopic march) across the paediatric age range was evident, with eczema and food allergies being more prevalent in infants and young children and asthma becoming more prevalent in older children. There is evidence that early diagnosis and treatment of atopic disease prevents progression of the allergic march.4,5,6
With the above in mind, the recommendations from Holgate and Lack to utilise specific allergy testing may be useful as a follow up in children presenting to A&E with disease thought to be secondary to atopy. The A&E setting could facilitate early allergic diagnosis, increase parental awareness, and potentially improve patient management.
Footnotes
Competing interests: none
References
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