Predictors of Repeat Epinephrine Administration for Emergency Department Patients with Anaphylaxis

Ronna L. Campbell; Curtis J. Bashore; Sangil Lee; Venkatesh R. Bellamkonda; James T.C. Li; John B. Hagan; Christine M. Lohse; M. Fernanda Bellolio

doi:10.1016/j.jaip.2015.04.009

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Predictors of Repeat Epinephrine Administration for Emergency Department Patients with Anaphylaxis

Journal article

Peer reviewed

Predictors of Repeat Epinephrine Administration for Emergency Department Patients with Anaphylaxis

Ronna L. Campbell, Curtis J. Bashore, Sangil Lee, Venkatesh R. Bellamkonda, James T.C. Li, John B. Hagan, Christine M. Lohse and M. Fernanda Bellolio

The journal of allergy and clinical immunology in practice (Cambridge, MA), Vol.3(4), pp.576-584

07/2015

DOI: 10.1016/j.jaip.2015.04.009

PMID: 26032476

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Abstract

Risk factors that predict which patients with anaphylaxis might require repeat doses of epinephrine are poorly understood. The objective of this study was to identify risk factors associated with the need for multiple doses of epinephrine during an anaphylactic reaction. Patients were included if they met diagnostic criteria for anaphylaxis on presentation to the emergency department (ED) at our academic medical center between April 2008 and February 2014. Data were collected on allergic history, presenting signs and symptoms, anaphylaxis management, and disposition. Univariable and multivariable analyses were performed to estimate associations between possible risk factors and the need for multiple doses. Of 582 ED patients with anaphylaxis, 45 (8%) required multiple doses of epinephrine. By multivariable analysis, factors associated with the need for repeat doses were a history of anaphylaxis (odds ratio [OR], 2.5 [95% CI, 1.3-4.7]; P = .005), the presence of flushing or diaphoresis (OR, 2.4 [95% CI, 1.3-4.5]; P = .007), and the presence of dyspnea (OR, 2.2 [95% CI, 1.0-5.0]; P = .046). Patients who received more than 1 dose were more likely to be admitted to the general medical floor (OR, 2.8 [95% CI, 1.1-7.2]; P = .03) or intensive care unit (OR, 7.6 [95% CI, 3.7-15.6]; P < .001). Patients with a history of anaphylaxis, flushing or diaphoresis, or dyspnea may require multiple doses of epinephrine to treat anaphylactic reactions. Patients who require more than 1 dose are more likely to be admitted to the hospital, thus increasing health care resource utilization.

Hypersensitivity

Allergy criteria

Anaphylaxis

Emergency department

Epinephrine

Risk factors

Details

Title: Subtitle: Predictors of Repeat Epinephrine Administration for Emergency Department Patients with Anaphylaxis
Creators: Ronna L. Campbell - Mayo Clinic
Curtis J. Bashore - Mayo Clinic
Sangil Lee - Mayo Clinic Health System
Venkatesh R. Bellamkonda - Mayo Clinic in Florida
James T.C. Li
John B. Hagan - Division of Allergic Diseases, Mayo clinic, Rochester, Minn
Christine M. Lohse - Mayo Clinic in Florida
M. Fernanda Bellolio - Mayo Clinic
Resource Type: Journal article
Publication Details: The journal of allergy and clinical immunology in practice (Cambridge, MA), Vol.3(4), pp.576-584
DOI: 10.1016/j.jaip.2015.04.009
PMID: 26032476
NLM abbreviation: J Allergy Clin Immunol Pract
ISSN: 2213-2198
eISSN: 2213-2201
Publisher: Elsevier Inc
Language: English
Date published: 07/2015
Academic Unit: Emergency Medicine; Injury Prevention Research Center
Record Identifier: 9984296972502771

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