Changing pattern of pediatric anaphylaxis in Hong Kong, 2010-2019.

BACKGROUND: Anaphylaxis is a significant health burden in most Western countries, but there are little published data on the incidence and pattern of anaphylaxis in Asia. We aim to determine the incidence rate and pattern of anaphylaxis over the past decade among the pediatric population in Hong Kong. METHODS: Medical records of patients presenting with allergy-related symptoms during the period 2010 to 2019 were examined. Pediatric patients aged below 18 years who fulfilled the diagnostic criteria for anaphylaxis laid out by the NIAID/FAAN were analyzed. Incidence rates were calculated using population statistics as the denominator. All information pertaining to the anaphylaxis events and patients' characteristics was retrieved using standardized data collection forms. RESULTS: The overall 10-year estimated incidence of anaphylaxis was 9.76 per 100,000 person-years, with a rising trend of anaphylaxis incidence across time. Food-induced anaphylaxis accounted for the majority of hospital presentations, of which peanut and shellfish were the top food triggers in our population. Majority of anaphylaxis episodes were of Grade 4 severity, and young age was a significant predictor of severe allergic reactions. Half of the anaphylaxis episodes were misdiagnosed and adrenaline was only utilized in 42.2% of cases, of which 9.4% were administered adrenaline prior to hospital arrival. CONCLUSIONS: An increasing trend of anaphylaxis incidence over the past decade is evident in Hong Kong children, with a discrepantly low accuracy in diagnosis and suboptimal management of anaphylaxis. There is a pressing need to heighten public and physicians' awareness of the distinctive features of anaphylaxis in the pediatric age-group.

Increasing incidence of anaphylaxis in Hong Kong from 2009 to 2019-discrepancies of anaphylaxis care between adult and paediatric patients.

BACKGROUND: Anaphylaxis has been increasing in developed countries but there is very little published data on the burden of anaphylaxis and the pattern of adrenaline autoinjector (AAI) prescription from Asia. We aim to determine the incidence rates of anaphylaxis and prescription rates of AAI over the past decade in Hong Kong. METHODS: Using a centralized electronic database of Hong Kong's sole public-funded healthcare provider, we obtained and analysed all patients between 2009 and 2019 with physician-reported diagnosis of anaphylaxis. Incidence rates were calculated using population statistics as the denominator. Patients' prescriptions on discharge were collected to determine the AAI prescription rates. RESULTS: The overall 10-year estimated incidence rate of anaphylaxis was 3.57 per 100,000 person-years. An increasing trend over time across both paediatric and adult populations from 2009 to 2014 was found, which remained stable until 2019. This was more marked among the paediatric population (paediatric vs adult incidence rate ratio in 2019: 3.51 [95% CI 1.12-2.66] vs 1.82 [95% CI 1.05-1.60]). There was an overall increasing rate of AAI prescription for patients admitted for anaphylaxis, but the overall AAI prescription rate was less than 15% and was significantly less likely to be prescribed for the adult compared to paediatric patients (36.5% vs. 89.4%, p < 0.001). CONCLUSIONS: An increasing trend of anaphylaxis incidence rates over the past decade is evident in Asian populations, with a discrepantly low rate of AAI prescription, particularly in the adult patients.