Published Online: September 22, 2014
Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. Anaphylaxis guidelines currently recommend that patients with anaphylaxis be referred to an allergist / immunologist for further evaluation after an anaphylactic event. However, the outcomes of patients who follow up with an allergist-immunologist after a visit to the emergency department (ED) for anaphylaxis have not been studied.
In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Campbell et al. systematically evaluated outcomes of follow up among patients evaluated in the ED for anaphylaxis who were referred for consultation with an allergist / immunologist.
The authors studied 573 ED patients who were evaluated for an anaphylactic reaction. Overall, 217 of the patients (38%) followed up with an allergist / immunologist after the ED visit. Following the evaluation, 16 (7%) patients had the diagnosis of anaphylaxis ruled out. Among 74 patients who had an unknown anaphylaxis trigger at the time of the ED evaluation, 24 (32%) had a trigger identified during follow up with the allergist / immunologist. In addition, among 143 patients who had a specific suspected trigger at the time of their ED evaluation, 9 (6%) had a different trigger identified during follow up. Overall, there were a total of 77 (35%) patients who had an alteration in the diagnosis of anaphylaxis or the trigger of the anaphylactic event after allergy / immunology evaluation. Furthermore, four patients (2%) were diagnosed with a mast cell activation disorder (a disorder of the immune cells that are involved in anaphylaxis) and 13 (6%) patients underwent immunotherapy to prevent future episodes of anaphylaxis.
The results of this study underscore the importance of follow up with an allergist/ immunologist after an ED visit for anaphylaxis. Improving follow up rates may improve patient outcomes by increasing the accuracy of trigger identification resulting in decreased risk of re-exposure and unnecessary avoidance.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.