Multiphasic anaphylaxis: an uncommon event in the emergency department

Area of Science:

• Emergency Medicine
• Allergy and Immunology

Background:

• Anaphylaxis is a severe allergic reaction requiring prompt emergency department (ED) evaluation and management.
• Understanding the rate of symptom recurrence is crucial for determining appropriate post-ED care strategies.

Purpose of the Study:

• To determine the incidence of clinically significant symptom recurrence in patients treated for anaphylaxis in the ED.
• To evaluate the safety and feasibility of outpatient management for select anaphylaxis patients.

Main Methods:

• A retrospective chart review was conducted on 67 patients diagnosed with anaphylaxis in an ED over a 4.5-year period.
• Patients met criteria for anaphylaxis involving at least two organ systems (cutaneous, respiratory, cardiovascular).
• Symptom recurrence was tracked for 7 days post-ED discharge, including hospital records and death registries.

Main Results:

• Of 67 anaphylaxis cases, 93% had immediate symptom resolution in the ED.
• Only 2 cases (3%) experienced symptom recurrence, both presenting solely as urticaria.
• No life-threatening recurrences or out-of-hospital deaths were identified in the study cohort.

Conclusions:

• Clinically significant anaphylaxis recurrence is uncommon (3%) and generally not life-threatening.
• Selective outpatient management may be a reasonable option for severe anaphylaxis cases with rapid and complete symptom resolution.
• Further research is needed to establish clear criteria for guiding outpatient disposition decisions in anaphylaxis management.