A Model for Consolidating High-Risk Allergy Procedures in Clinic

Area of Science:

• Allergy and Immunology
• Clinical Procedures
• Anaphylaxis Management

Background:

• Allergists perform procedures with potential risks, including anaphylaxis.
• Risk assessment is crucial for patient safety during allergy-related procedures.
• Epinephrine use frequency can indicate procedural risk levels.

Purpose of the Study:

• To develop risk assessments for allergy procedures based on epinephrine use.
• To evaluate the safety and outcomes of various procedures in a specialized clinic.
• To assess the effectiveness of a high-risk procedure clinic model.

Main Methods:

• Retrospective review of medical records from a 5.5-year period (2016-2021).
• Analysis of 596 procedures performed in a monthly high-risk procedure clinic.
• Data collected included procedure type, termination instances, and epinephrine administration.

Main Results:

• 8.6% of procedures (51/596) required epinephrine, with highest rates in drug desensitizations (25%) and food challenges (10.5%).
• Most procedures (92.4%) were completed; 7.6% were aborted for various reasons.
• Two patients needed emergency department transfer; no hospitalizations or deaths occurred.

Conclusions:

• Diverse allergy procedures carry manageable anaphylaxis risks, with most reactions handled in-clinic.
• Allergists play a key role in managing potential anaphylaxis during procedures.
• The procedure clinic model effectively trains fellows in anaphylaxis identification and management.