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Presentations to emergency departments by children and young people with food allergy are increasing

Rachel O'Loughlin and Harriet Hiscock
Med J Aust || doi: 10.5694/mja2.50604
Published online: 25 May 2020

The prevalence of food allergy among Victorian children is rising.1 In Victoria, children with suspected food allergies can be on hospital outpatient clinic waiting lists for months before being assessed.2 This may lead families to consider alternative avenues, which can lead to poor allergy management and the need for emergency care. Increasing numbers of Victorian children are presenting to emergency departments,3 but we do not know whether the number visiting with food allergy is also rising.

We analysed Victorian Emergency Minimum Dataset (VEMD) data for the period 2005–06 to 2014–15. The VEMD is a statewide administrative dataset that includes non‐identifiable patient‐level data for all Victorian public emergency department encounters. We included all food allergy‐related presentations by children and young people aged 0–19 years, selected according to International Classification of Diseases, tenth revision, Australian modification (ICD‐10‐AM) codes: T78.0 (anaphylactic shock due to a food reaction), T78.1 (other adverse food reactions, not elsewhere classified), T78.4 (allergy, unspecified: includes non‐food‐related allergies), and L27.2 (dermatitis due to ingested food). Presentation rates by age group were calculated using Australian Bureau of Statistics (ABS) age‐stratified population data for Victorians aged 0–19 years;4 rates for regions were calculated using ABS population data for Statistical Areas 2 (SA2).5

The study was deemed exempt from the need for formal ethics approval by the Royal Children's Hospital Human Research Ethics Committee.

The number of children presenting to emergency departments with food allergy‐related problems increased from 2368 in 2005–06 to 4263 in 2014–15; the presentation rate increased from 18 to 29 per 10 000 population (Box 1). About half the children who presented with food allergy‐related problems were aged 0–4 years, the rate for this age group increasing from 38 to 55 per 10 000 population (Box 2). The proportion of presentations triaged as being more urgent (triage categories 1–3) also increased, from 51% to 63% (Box 1).

The rate of presentations to metropolitan hospitals increased more (from 18 per 10 000 in 2005–06 to 32 per 10 000 in 2014–15; 78% increase) than did the rate for rural hospitals (26 per 10 000 in 2005–06 to 36 per 10 000 in 2014–15; 38% increase) (Box 1). Hospitals in the North‐West Melbourne region received about one‐third of all allergy‐related emergency department visits, and the number in this region doubled over the study period (706 in 2005–06; 1536 in 2014–15) (Box 3).

These data indicate that the demand for emergency services associated with food allergy‐related problems in children increased during 2005–15. The increase was particularly marked for children aged 0–4 years and for children and young people in the North‐West Melbourne and Southern Melbourne regions. While the reason for the increased burden is not clear — that is, whether the prevalence of allergy had increased (including because of a change in population composition), management plans had changed, or access to community services was reduced — the consequence is greater demand on emergency services across Melbourne.

Box 1 – Presentations to Victorian public emergency departments by childen and young people (0–19 years) with food allergy‐related problems

 

2005–06

2006–07

2007–08

2008–09

2009–10

2010–11

2011–12

2012–13

2013–14

2014–15


All food allergy presentations

Number

2368

2680

2754

2991

3082

3159

3185

3422

3881

4263

Rate (per 10 000 population)*

18

20

21

22

23

23

23

24

27

29

ICD‐10‐AM diagnostic codes

 T78.0

141 (6.0%)

152 (5.7%)

154 (5.6%)

168 (5.6%)

233 (7.6%)

283 (9.0%)

289 (9.1%)

339 (9.9%)

437 (11.3%)

501 (11.8%)

 T78.1

800 (33.8%)

948 (35.4%)

962 (34.9%)

1127 (37.7%)

1167 (37.9%)

1152 (36.5%)

1117 (35.1%)

1288 (37.6%)

1464 (37.7%)

1624 (38.1%)

 T78.4

1234 (52.1%)

1351 (50.4%)

1441 (52.3%)

1488 (49.8%)

1552 (50.4%)

1597 (50.6%)

1633 (51.3%)

1702 (49.7%)

1881 (48.5%)

2031 (47.6%)

 L27.2

193 (8.2%)

229 (8.5%)

197 (7.2%)

208 (7.0%)

130 (4.2%)

127 (4.0%)

146 (4.6%)

93 (2.7%)

99 (2.6%)

107 (2.5%)

Age

 

 

 

 

 

 

 

 

 

 

Number

 

 

 

 

 

 

 

 

 

 

 0–4 years

1202 (50.8%)

1364 (50.9%)

1424 (51.7%)

1537 (51.4%)

1520 (49.3%)

1595 (50.5%)

1593 (50.0%)

1759 (51.4%)

2015 (51.9%)

2152 (50.5%)

 5–9 years

466 (19.7%)

515 (19.2%)

521 (18.9%)

573 (19.2%)

673 (21.8%)

608 (19.3%)

660 (20.7%)

702 (20.5%)

813 (21.0%)

967 (22.7%)

 10–14 years

305 (12.9%)

335 (12.5%)

355 (12.9%)

405 (13.5%)

403 (13.1%)

426 (13.5%)

383 (12.0%)

433 (12.7%)

515 (13.3%)

561 (13.2%)

 15–19 years

395 (16.7%)

466 (17.4%)

454 (16.5%)

476 (15.9%)

486 (15.8%)

530 (16.8%)

549 (17.3%)

528 (15.4%)

538 (13.8%)

583 (13.7%)

Rate (per 10 000 population)*

 0–4 years

38

42

43

45

43

45

44

47

53

55

 5–9 years

15

16

16

18

21

18

19

20

22

26

 10–14 years

9

10

11

12

12

13

12

13

15

16

 15–19 years

12

13

13

13

14

15

15

15

15

16

Sex

 

 

 

 

 

 

 

 

 

 

Number

 

 

 

 

 

 

 

 

 

 

 Boys

1284 (54.2%)

1435 (53.5%)

1476 (53.6%)

1625 (54.3%)

1663 (54.0%)

1723 (54.5%)

1779 (55.9%)

1867 (54.6%)

2158 (55.6%)

2388 (56.0%)

 Girls

1084 (45.8%)

1245 (46.5%)

1278 (46.4%)

1366 (45.7%)

1419 (46.0%)

1436 (45.5%)

1406 (44.1%)

1555 (45.4%)

1723 (44.4%)

1875 (44.0%)

Rate (per 10 000 population)*

 Boys

19

21

21

23

24

25

25

26

29

32

 Girls

17

19

20

21

21

22

21

22

24

26

Hospital region

 

 

 

 

 

 

 

 

 

 

Number

 

 

 

 

 

 

 

 

 

 

 Metropolitan

1560 (65.9%)

1860 (69.4%)

1907 (69.2%)

2008 (67.1%)

2071 (67.2%)

2194 (69.5%)

2186 (68.6%)

2345 (68.5%)

2781 (71.7%)

3149 (73.9%)

 Rural

808 (34.1%)

820 (30.6%)

847 (30.8%)

983 (32.9%)

1011 (32.8%)

965 (30.5%)

999 (31.4%)

1077 (31.5%)

1100 (28.3%)

1114 (26.1%)

Rate (per 10 000 population)*

 Metropolitan

18

22

22

23

23

25

24

25

29

32

 Rural

26

27

27

32

33

31

32

35

35

36

Triage category

 Categories 1–3

1198 (50.6%)

1429 (53.3%)

1568 (57.0%)

1707 (57.0%)

1830 (59.3%)

1861 (59.0%)

1807 (56.8%)

2047 (59.8%)

2365 (61.0%)

2694 (63.2%)

 Categories 4, 5

1170 (49.4%)

1251 (46.7%)

1186 (43.0%)

1284 (43.0%)

1252 (40.7%)

1298 (41.0%)

1378 (43.2%)

1375 (40.2%)

1516 (39.0%)

1569 (36.8%)


ICD‐10‐AM = International Classification of Diseases, tenth revision, Australian modification.  * All presentation rates are per 10 000 children in Victoria aged 0–19 years in the corresponding category.  † Victorian Emergency Minimum Dataset (VEMD) regions: North‐West, Southern, and Eastern Melbourne.  ‡ VEMD regions: Loddon Mallee, Gippsland, Barwon South West, Hume, Grampians.

Box 2 – Presentations to Victorian public emergency departments by people aged 0–19 years with food allergy‐related problems: rates per 10 000 population, by age group


 

Box 3 – Presentations to Victorian public emergency departments by people aged 0–19 years with food allergy‐related problems, by hospital campus region


 

Received 19 July 2019, accepted 6 February 2020

  • Rachel O'Loughlin1,2
  • Harriet Hiscock1,2

  • 1 Royal Children's Hospital Melbourne, Melbourne, VIC
  • 2 Murdoch Children's Research Institute, Melbourne, VIC

Correspondence: harriet.hiscock@rch.org.au

Acknowledgements: 

Harriet Hiscock is supported by a National Health and Medical Research Council Practitioner Fellowship (1136222). The Health Services Research Unit is funded by the Royal Children's Hospital Foundation. The Murdoch Children's Research Institute is supported by the Victorian Government Operational Infrastructure Support Program.

Competing interests:

No relevant disclosures.

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