Characteristics of Auckland City hospital immunology day ward use

Abstract

Introduction: The adult immunology service at Auckland City Hospital serves a population of over 1.4 million and has a dedicated Immunology DayWard, staffed by 2 specialist nurses. Methods: Attendances at the DayWard were categorised according to the number of individual patients and visit type. Procedures included drug challenge and desensitisation, food challenge, venom and aeroallergen immunotherapy (IT), immunoglobulin (Ig) replacement (intravenous and subcutaneous). Challenge outcomes were recorded as positive, negative or indeterminate. The numbers of individual patients in these categories has been extracted from the booking diary for the 5 year period from 1/1/09 to 31/12/13. Individual attendances have been analysed by the hospital electronic booking system, according to procedure type and length of stay, for the 4 year period 1/07/2010 to 30/06/2014. Results: Mean annual attendances included venom and inhalant IT (n = 912), Ig replacement (n = 695), challenge procedures of >3 hours (n = 184), desensitisation of >3 hours (n = 124), with 289 attendances for other procedures e.g. vaccination, education. Antibiotics (most frequently amoxycillin/clavaulanic acid) were the most common challenges. (Table presented) Individual venoms: 116 over 5 years (53% honey bee, 31%Vespula, 16% Polistes) with both cluster (44%) and conventional regimes used. Aeroallergen IT was administered to 127 patients, predominantly D pteronyssinus, grass and plantain pollens, cat. Only patients with risk factors e.g. asthma are treated in the hospital clinic. Conclusion: Drug challenges (predominantly antibiotic, aspirin and NSAIDs) are the most numerous patient group; 85-90% of patients receiving antibiotic challenge were found to tolerate the challenge drug. Venom and aeroallergen IT and Ig replacement therapy are the largest groups of individual attendances.