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Evaluating Practice Patterns of Observation Periods Following Epinephrine Administration for Anaphylaxis Among
Hannah B Short1, Benjamin Walters1, Maria Fabi1
1Department of Emergency Medicine, Penn State College of Medicine, Hershey, USA.
Cureus
|October 15, 2024
Summary
Current guidelines recommend 4-6 hour observation for anaphylaxis patients. This study found biphasic reactions occurred both within and well after this period, suggesting individualized observation for pediatric anaphylaxis management.
Area of Science:
- Pediatric Emergency Medicine
- Allergy and Immunology
- Clinical Research
Background:
- Current anaphylaxis guidelines recommend 4-6 hours of observation post-epinephrine to monitor for biphasic reactions.
- Conflicting data exists on the efficacy of these guidelines, particularly in the pediatric population.
- Biphasic reactions are a recurrence of anaphylactic symptoms without re-exposure to the trigger.
Purpose of the Study:
- To evaluate the appropriateness of current anaphylaxis observation guidelines in pediatric patients.
- To analyze the timing and patterns of biphasic reaction development after epinephrine administration.
- To identify potential risk factors for biphasic reactions in children.
Main Methods:
- Retrospective study of 292 pediatric patients (under 18) treated with epinephrine for anaphylaxis at a tertiary academic medical center ED (2017-2022).
- Analysis of observation duration, time to epinephrine, symptom characteristics, allergen type, and biphasic reaction occurrence.
- Comparison of variables between patients who did and did not experience biphasic reactions using contingency tables and t-tests.
Main Results:
- 3.4% (10/292) of pediatric patients developed biphasic reactions.
- Reactions occurred both within 150 minutes of symptom resolution and >10 hours post-resolution (after discharge).
- No significant difference in ED observation time or time to first epinephrine dose was found between groups. Respiratory symptoms were linked to persistent symptoms post-epinephrine.
Conclusions:
- Biphasic reactions in pediatric anaphylaxis can occur outside the standard 4-6 hour observation window.
- Extending observation periods may not prevent all post-discharge biphasic reactions.
- An individualized approach to anaphylaxis observation, considering factors like respiratory involvement, may be more appropriate, potentially reducing ED burden for low-risk patients.
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