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

Ronna L. Campbell, Miguel Park, Michael A. Kueber, Sangil Lee, John B. Hagan

Research output: Contribution to journalArticle

26 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)88-93
Number of pages6
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2015

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Anaphylaxis
Allergy and Immunology
Hospital Emergency Service
Mast Cells
Immunotherapy
Guidelines
Health

Keywords

  • Anaphylaxis
  • Emergency medicine
  • Follow-up studies
  • Immunologic desensitization
  • Mast cell disease

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Outcomes of allergy/immunology follow-up after an emergency department evaluation for anaphylaxis. / Campbell, Ronna L.; Park, Miguel; Kueber, Michael A.; Lee, Sangil; Hagan, John B.

In: Journal of Allergy and Clinical Immunology: In Practice, Vol. 3, No. 1, 01.01.2015, p. 88-93.

Research output: Contribution to journalArticle

Campbell, Ronna L. ; Park, Miguel ; Kueber, Michael A. ; Lee, Sangil ; Hagan, John B. / Outcomes of allergy/immunology follow-up after an emergency department evaluation for anaphylaxis. In: Journal of Allergy and Clinical Immunology: In Practice. 2015 ; Vol. 3, No. 1. pp. 88-93.
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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.",
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