Further Evaluation of Factors That May Predict Biphasic Reactions in Emergency Department Anaphylaxis Patients

Sangil Lee, Alexa Peterson, Christine M. Lohse, Erik P. Hess, Ronna L. Campbell

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Anaphylaxis is a systemic allergic reaction that is commonly treated in the emergency department (ED). The risk of a biphasic reaction is the rationale for observation. Objective To derive a prediction rule to stratify ED anaphylaxis patients at risk of a biphasic reaction. Methods We conducted an observational study of a cohort of patients presenting to an academic ED with signs and symptoms of anaphylaxis. We collected clinical data on biphasic reactions meeting National Institutes of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network diagnostic criteria. Logistic regression analyses were conducted to identify predictors of biphasic reactions, and odds ratios (ORs) with 95% CIs are reported. The predictive ability of the model features is summarized using the area under a receiver operating characteristics curve, or AUC. Internally validated AUCs were obtained using bootstrap resampling. Results We identified 872 anaphylaxis-related visits. Thirty-six (4.1%) visits resulted in biphasic reactions. Multivariable analysis showed that prior anaphylaxis (OR, 2.74; 95% CI, 1.33-5.63), unknown inciting trigger (OR, 2.40; 95% CI, 1.14-4.99), and first epinephrine administration more than 60 minutes after symptom onset (OR, 2.29; 95% CI, 1.09-4.79) were statistically significantly associated with biphasic reactions. The AUC of this model was 0.70 (95% CI, 0.61-0.79), with an internally validated AUC of 0.67 (95% CI, 0.59-0.76). The P value from the goodness-of-fit test was.91. Conclusions Our study demonstrated a 4.1% rate of biphasic reactions and found that prior anaphylaxis, unknown inciting trigger, and delayed epinephrine use were risk factors for biphasic reactions.

Original languageEnglish (US)
Pages (from-to)1295-1301
Number of pages7
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume5
Issue number5
DOIs
StatePublished - Sep 1 2017

Fingerprint

Anaphylaxis
Hospital Emergency Service
Area Under Curve
Odds Ratio
Epinephrine
National Institute of Allergy and Infectious Diseases (U.S.)
Food Hypersensitivity
ROC Curve
Signs and Symptoms
Observational Studies
Hypersensitivity
Logistic Models
Regression Analysis
Observation

Keywords

  • Anaphylaxis
  • Biphasic reaction
  • Prediction model

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Further Evaluation of Factors That May Predict Biphasic Reactions in Emergency Department Anaphylaxis Patients. / Lee, Sangil; Peterson, Alexa; Lohse, Christine M.; Hess, Erik P.; Campbell, Ronna L.

In: Journal of Allergy and Clinical Immunology: In Practice, Vol. 5, No. 5, 01.09.2017, p. 1295-1301.

Research output: Contribution to journalArticle

Lee, Sangil ; Peterson, Alexa ; Lohse, Christine M. ; Hess, Erik P. ; Campbell, Ronna L. / Further Evaluation of Factors That May Predict Biphasic Reactions in Emergency Department Anaphylaxis Patients. In: Journal of Allergy and Clinical Immunology: In Practice. 2017 ; Vol. 5, No. 5. pp. 1295-1301.
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abstract = "Background Anaphylaxis is a systemic allergic reaction that is commonly treated in the emergency department (ED). The risk of a biphasic reaction is the rationale for observation. Objective To derive a prediction rule to stratify ED anaphylaxis patients at risk of a biphasic reaction. Methods We conducted an observational study of a cohort of patients presenting to an academic ED with signs and symptoms of anaphylaxis. We collected clinical data on biphasic reactions meeting National Institutes of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network diagnostic criteria. Logistic regression analyses were conducted to identify predictors of biphasic reactions, and odds ratios (ORs) with 95{\%} CIs are reported. The predictive ability of the model features is summarized using the area under a receiver operating characteristics curve, or AUC. Internally validated AUCs were obtained using bootstrap resampling. Results We identified 872 anaphylaxis-related visits. Thirty-six (4.1{\%}) visits resulted in biphasic reactions. Multivariable analysis showed that prior anaphylaxis (OR, 2.74; 95{\%} CI, 1.33-5.63), unknown inciting trigger (OR, 2.40; 95{\%} CI, 1.14-4.99), and first epinephrine administration more than 60 minutes after symptom onset (OR, 2.29; 95{\%} CI, 1.09-4.79) were statistically significantly associated with biphasic reactions. The AUC of this model was 0.70 (95{\%} CI, 0.61-0.79), with an internally validated AUC of 0.67 (95{\%} CI, 0.59-0.76). The P value from the goodness-of-fit test was.91. Conclusions Our study demonstrated a 4.1{\%} rate of biphasic reactions and found that prior anaphylaxis, unknown inciting trigger, and delayed epinephrine use were risk factors for biphasic reactions.",
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AB - Background Anaphylaxis is a systemic allergic reaction that is commonly treated in the emergency department (ED). The risk of a biphasic reaction is the rationale for observation. Objective To derive a prediction rule to stratify ED anaphylaxis patients at risk of a biphasic reaction. Methods We conducted an observational study of a cohort of patients presenting to an academic ED with signs and symptoms of anaphylaxis. We collected clinical data on biphasic reactions meeting National Institutes of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network diagnostic criteria. Logistic regression analyses were conducted to identify predictors of biphasic reactions, and odds ratios (ORs) with 95% CIs are reported. The predictive ability of the model features is summarized using the area under a receiver operating characteristics curve, or AUC. Internally validated AUCs were obtained using bootstrap resampling. Results We identified 872 anaphylaxis-related visits. Thirty-six (4.1%) visits resulted in biphasic reactions. Multivariable analysis showed that prior anaphylaxis (OR, 2.74; 95% CI, 1.33-5.63), unknown inciting trigger (OR, 2.40; 95% CI, 1.14-4.99), and first epinephrine administration more than 60 minutes after symptom onset (OR, 2.29; 95% CI, 1.09-4.79) were statistically significantly associated with biphasic reactions. The AUC of this model was 0.70 (95% CI, 0.61-0.79), with an internally validated AUC of 0.67 (95% CI, 0.59-0.76). The P value from the goodness-of-fit test was.91. Conclusions Our study demonstrated a 4.1% rate of biphasic reactions and found that prior anaphylaxis, unknown inciting trigger, and delayed epinephrine use were risk factors for biphasic reactions.

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