Does Anaphylaxis Treatment Require Inpatient Intervention?

Test tube with blood sample for food intolerance test

A study that was published as part of the AAAAI Annual Meeting assessed the necessary level of inpatient intervention for those admitted for anaphylaxis treatment and found that prolonged observation and significant inpatient intervention are not usually necessary in pediatric patients.

Medical records for patients admitted to the emergency department (ED) between January 2016 and December 2017 with an anaphylaxis diagnosis were examined. Of 70 documented admissions, 45 (64.3%) reacted to known or later confirmed allergens, 88.9% of which were related to food. The vast majority of admissions (95.7%) were given epinephrine for the initial reaction. About one-quarter of admissions (n=18; 25.7%) presented to the ED extended care unit, 65.7% (n=46) to the wards, and 8.6% (n=6) to the intensive care unit.

Significant symptoms recurred during admission in one patient who received further intramuscular epinephrine; the cause was believed to be a pumpkin cupcake. Five cases required continued epinephrine infusions that started in the ED as a result of refractory anaphylaxis: One case was triggered by a macadamia nut, and the remaining four by wheat. Patients who received epinephrine infusions were significantly more likely to have a history of asthma (80% vs. 40%; P<0.0001), have hypotension upon presentation (40% vs. 4.6%; P<0.0001), need more epinephrine doses for the initial reaction (2.4 vs. 1.5; P=0.0321), and need more intravenous fluid (100% vs. 35.4%; P<0.0001). None of the other admissions necessitated further epinephrine, and no deaths were reported.

The study authors concluded, “During admission for anaphylaxis, recurrence of significant symptoms requiring epinephrine is rare. Further research is required to help ascertain which patients presenting with anaphylaxis truly require admission.”

https://www.jacionline.org/article/S0091-6749(19)32560-6/fulltext