Evaluating Practice Patterns of Observation Periods Status Post Epinephrine Administration for Anaphylaxis

Area of Science:

• Emergency Medicine
• Allergy and Immunology
• Clinical Practice Guidelines

Background:

• Anaphylaxis is a critical medical emergency necessitating prompt epinephrine treatment and a subsequent observation period.
• The National Institute of Allergy and Infectious Diseases (NIAID) recommends a minimum observation of 4-6 hours for patients with resolved anaphylaxis to detect biphasic reactions.

Purpose of the Study:

• To evaluate current emergency department (ED) practices regarding observation duration for anaphylaxis patients post-epinephrine administration.
• To analyze adjunct medical management, common allergens, and the incidence of biphasic reactions in anaphylaxis cases.

Main Methods:

• A retrospective chart review was conducted, analyzing data from January 2017 to September 2022.
• Included patients were adults (≥18 years) who received epinephrine for anaphylaxis and had a documented observation period.
• 1751 patients were initially identified, with 488 meeting the inclusion criteria; 1263 were excluded for not receiving epinephrine.

Main Results:

• The median observation time in the ED post-epinephrine was 235 minutes.
• A biphasic reaction occurred in 4.29% of patients (21 individuals).
• Patients with biphasic reactions had a significantly longer median observation time (451.38 minutes) compared to those without (262.13 minutes, p < 0.05).

Conclusions:

• Observed ED observation times post-epinephrine administration were consistent with NIAID guidelines of 4-6 hours.
• Extended observation was associated with patients who experienced biphasic reactions, underscoring its clinical importance.