Outcomes of allergy/immunology follow-up after an emergency department evaluation for anaphylaxis

J Allergy Clin Immunol Pract. Jan-Feb 2015;3(1):88-93. doi: 10.1016/j.jaip.2014.07.011. Epub 2014 Sep 22.

Abstract

Background: Anaphylaxis guidelines currently recommend referring patients with anaphylaxis seen in the emergency department (ED) to an allergist for follow up.

Objective: The objective of our study was to evaluate outcomes of allergy/immunology follow-up after an ED visit for anaphylaxis.

Methods: A retrospective health records review was conducted from April 2008 to August 2012. Charts were reviewed independently by 2 allergists to determine outcomes. Descriptive statistics with corresponding 95% CIs were calculated.

Results: Among 573 patients seen in the ED who met anaphylaxis diagnostic criteria, 217 (38%) had a documented allergy/immunology follow-up. After allergy/immunology evaluation, 16 patients (7% [95% CI, 5%-12%]) had anaphylaxis ruled out. Among those with an unknown ED trigger (n = 74), 24 (32% [95% CI, 23%-44%]) had a trigger identified; and, among those who had a specific suspected ED trigger (n = 143), 9 (6% [95% CI, 3%-12%]) had a trigger identified in a category other than the one suspected in the ED, and 28 (20% [95% CI, 14%-27%]) had an unknown trigger. Thus, there were a total of 77 patients (35% [95% CI, 29%-42%]) who had an alteration in the diagnosis of anaphylaxis or trigger after allergy/immunology evaluation. Four patients (2% [95% CI, 0.7%-4.6%]) were diagnosed with a mast cell activation disorder, and 13 patients (6% [95% CI, 4%-10%]) underwent immunotherapy or desensitization.

Conclusion: Overall, 35% of the patients with suspected anaphylaxis in the ED had an alteration in the diagnosis or suspected trigger after allergy/immunology evaluation. These results underscore the importance of allergy/immunology follow-up after an ED visit for anaphylaxis.

Keywords: Anaphylaxis; Emergency medicine; Follow-up studies; Immunologic desensitization; Mast cell disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Allergy and Immunology / statistics & numerical data*
  • Anaphylaxis / complications
  • Anaphylaxis / drug therapy
  • Anaphylaxis / immunology*
  • Emergency Service, Hospital*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypersensitivity / complications
  • Hypersensitivity / diagnosis*
  • Hypersensitivity / immunology*
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data
  • Referral and Consultation / statistics & numerical data*
  • Retrospective Studies
  • Young Adult