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Researchers identify predictors of delayed allergic reactions in children

The severity of biphasic reactions in children with anaphylaxis appears associated with the severity of the initial reaction, according to study results.

Researchers have identified five predictors that may be used to identify patients who would benefit from prolonged emergency department monitoring and to enable better utilization of emergency department visits.

Waleed Alqurashi

“The key message here for patients, parents, caregivers, teachers and first-responder health professionals is to prevent an anaphylactic reaction from worsening, administer epinephrine immediately after the onset of the early symptoms of an allergic reaction,” Waleed Alqurashi, MD, MSc, an emergency medicine physician at the Children’s Hospital of Eastern Ontario, said in a press release. “Our team has created an evidence-based prognostic tool so that physicians can monitor the more serious cases appropriately.”

Alqurashi and colleagues conducted a health record review of patients who attended the ED at two pediatric hospitals in Ontario with anaphylaxis in 2010.

The researchers reviewed 1,749 ED records and included 484 visits in the study.

The researchers identified 14.7% of anaphylactic reactions as being biphasic, also known as delayed.

Patients who developed delayed reactions after ED discharge did not have a high likelihood of being treated with epinephrine for their initial reaction compared with those who developed delayed reactions before discharge (55.6% vs. 84.9%, P = .02).

The researchers identified five independent predictors of delayed reactions in children:

• A 90 minute or more delay in arriving to an ED after initial allergic reaction;
• wide pulse pressure at triage;
• using more than one dose of epinephrine to treat initial reaction;
• a reaction requiring the administration of inhaled salbutamol, and
• children aged 6 to 9 years.

Alqurashi, in the release, said children should be monitored for a longer period after initial reaction and the length should be individualized.

“It’s clear that children with severe initial reactions would benefit from a prolonged period of observation in the emergency department,” he said in the release. “On the flip side, knowing what to look for helps to better utilize resources so that children with mild allergic reactions, who do not match any of the identified predictors, can go home sooner.” – by Ryan McDonald

Disclosure: The researchers report no relevant financial disclosures.