Methods: Referrals to the Tan Tock Seng Hospital Clinical Immunology/Allergy Clinic from 1 Jan 1998 to 15 May 2015 were retrospectively reviewed. The demographic profile of servicemen, types of allergic/immunologic diseases and definitive therapies prescribed were studied.
Results: There were 247 referrals comprising 90.7% males, predominantly active full-time national servicemen (NSF) and regulars. The mean age at diagnosis was 24±6 years. They comprised 88.3% Chinese, 5.3% Malays and 3.3% Indians. The most common referring diagnoses were for insect venom allergy (37.5%), urticarial/angioedema (18.3%), anaphylaxis (17.8%); drug allergy (15.4%), food allergy (9.1%), nonsteroidal anti-inflammatory drug [NSAID] hypersensitivity (6.3%) and allergic rhinitis (5.8%). Following evaluation by the allergist, insect venom allergy (36.5%), anaphylaxis (24.0%), allergic rhinitis (23.8%) and NSAID hypersensitivity (20.7%) were the most common conditions. Of the 32 servicemen diagnosed with insect venom anaphylaxis, 9 (28.1%) underwent allergen immunotherapy (AIT), of whom 6 were regulars and 3 NSF. All received yellow jacket and paper wasp venom AIT, and 1 in addition received honey bee venom AIT. No serviceman developed systemic reactions during AIT. Only 1 serviceman has completed 5 years of AIT, the mean duration of all servicemen on AIT to date being 2.2±1.3 years.
Conclusions: Insect venom allergy, anaphylaxis, allergic rhinitis and NSAID hypersensitivity were the most common referrals from the SAF. Medical officers in the military should be trained and equipped to manage military servicemen with these conditions at primary care level: in particular knowledge of the anaphylaxis action plan, and when and how to use epinephrine autoinjectors. Knowledge of NSAID hypersensitivity reactions is also important especially since non-selective NSAIDs are commonly used in the treatment of musculoskeletal injuries during training.