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Incidence of clinically important biphasic reactions in emergency department patients with allergic reactions or anaphylaxis.

Abstract：

STUDY OBJECTIVE:Allergic reactions are common presentations to the emergency department (ED). An unknown proportion of patients will develop biphasic reactions, and patients are often monitored for prolonged periods to manage potential reactions. We seek to determine the incidence of clinically important biphasic reactions. METHODS:Consecutive adult patients presenting to 2 urban EDs with allergic reactions during a 5-year period were identified. Encounters were dichotomized as "anaphylaxis" or "allergic reaction" with an explicit algorithm. A comprehensive chart review was conducted on each index and all subsequent visits to detail patient presentations, comorbidities, ED management, and predefined clinically important biphasic reactions. Regional and provincial databases were linked to identify subsequent ED visits and deaths within a 7-day period. The primary outcome was the proportion of patients with a clinically important biphasic reaction, and the secondary outcome was mortality. RESULTS:Of 428,634 ED visits, 2,819 (0.66%) encounters were reviewed (496 anaphylactic and 2,323 allergic reactions). Overall, 185 patients had at least 1 subsequent visit for allergic symptoms. Five clinically important biphasic reactions were identified (0.18%; 95% confidence interval [CI] 0.07% to 0.44%), with 2 occurring during the ED visit and 3 postdischarge. There were no fatalities (95% CI 0% to 0.17%). In the anaphylaxis and allergic reaction groups, clinically important biphasic reactions occurred in 2 patients (0.40%; 95% CI 0.07% to 1.6%) and 3 patients (0.13%; 95% CI 0.03% to 0.41%), respectively. CONCLUSION:Among ED patients with allergic reactions or anaphylaxis, clinically important biphasic reactions and fatalities are rare. Our data suggest that prolonged routine monitoring of patients whose symptoms have resolved is likely unnecessary for patient safety.

journal_name

Ann Emerg Med

journal_title

Annals of emergency medicine

authors

Grunau BE,Li J,Yi TW,Stenstrom R,Grafstein E,Wiens MO,Schellenberg RR,Scheuermeyer FX

doi

10.1016/j.annemergmed.2013.10.017

subject

Has Abstract

pub_date

2014-06-01 00:00:00

pages

736-44.e2

issue

eissn

0196-0644

issn

1097-6760

pii

S0196-0644(13)01536-9

journal_volume

pub_type

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Incidence of clinically important biphasic reactions in emergency department patients with allergic reactions or anaphylaxis.