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Obs after anaphylaxis

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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

How long do you observe in ED after epi tx for mild anaphylaxis?

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pemsou5_wp • May 24, 2019

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  1. Kelly August 5, 2019 - 12:54 am Reply

    Patient with ongoing symptoms of anaphylaxis or severe symptoms (e.g. angioedema, respiratory distress) concerning for airway compromise, should be admitted for a period of observation, even if they are stabilized in the ED. However, those with more mild symptoms that responded well to initial epinephrine can be discharged with allergist follow-up. There are no clear guidelines as to the duration of this ED observation period, although an anaphylaxis practice parameter recommends observation for at least 4 to 8 hours. The period of observation is meant to identify any biphasic reaction. Biphasic reactions are rare (4%) though. Some risk factors for biphasic reaction are: history of prior anaphylaxis, unknown precipitating trigger, first epinephrine dose > 60 minutes after symptoms started, and possibly symptoms of diarrhea or wheezing.
    Campbell RL et al. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol 2014;113:599-608
    Lee S et al. Predictors of biphasic reactions in the ED for patients with anaphylaxis. J Allergy Clin Immunol Pract 2014;2:281-7
    Lee S et al. Further evaluation of factors that may predict biphasic reactions in anaphylaxis patients. J Allergy Clin Immunol Pract 2017;5:1295-1301

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