Randomized blinded pilot trial of corticosteroid after mild-moderate anaphylaxis to prevent recurrence

Area of Science:

• Pediatric Emergency Medicine
• Allergy and Immunology
• Clinical Pharmacology

Background:

• Corticosteroids may shorten hospital stays for anaphylaxis but their benefit for Emergency Department (ED)-discharged children is unclear.
• Routine corticosteroid use carries potential adverse effects.

Purpose of the Study:

• To determine if predischarge oral dexamethasone reduces anaphylaxis recurrence in children treated in the ED.
• To evaluate the efficacy of dexamethasone versus placebo in preventing anaphylaxis recurrence within 7 days.

Main Methods:

• A pilot, blinded, randomized trial involving children aged 3 months to 14 years presenting with anaphylaxis.
• Participants received either oral dexamethasone (0.3 mg/kg, max 10 mg) or an identical placebo before ED discharge.

Main Results:

• Recruitment was suspended early due to COVID-19; 152 patients were randomized (68 dexamethasone, 75 placebo).
• Recurrence rates were low: 4.4% in the dexamethasone group versus 6.7% in the placebo group.
• The absolute risk reduction was 2.3%, with a number needed to treat of 44, and P-value of .7.

Conclusions:

• The uncommon rate of recurrence and high number needed to treat suggest routine predischarge corticosteroids are not beneficial for ED-treated anaphylaxis.
• Corticosteroid use should be reserved for cases with a clear clinical rationale.