Published Online: October 29, 2013
Drug-induced hypersensitivity reactions are a common yet under recognized cause of anaphylaxis in patients presenting to the emergency department (ED). A recent review estimates one case of drug-induced anaphylaxis per 4,000 emergency department (ED) visits. Over the past decade, drug-induced anaphylaxis hospitalizations are reported to have increased by 150%. Unfortunately, there are significant gaps in our knowledge about the characteristics, management, and follow-up of patients with drug-induced anaphylaxis.
In a study recently published in The Journal of Allergy and Clinical Immunology: In Practice, Banerji et al. investigated these issues in a large cohort of patients with ED visit/hospitalization for drug-induced anaphylaxis. Using ICD-9 codes from a large administrative database, Banerji and colleagues identified all patients with an ED visit or hospitalization for drug-induced anaphylaxis between 2002 and 2008. The index date was defined as the initial ED visit or hospitalization. Inclusion required continuous full insurance coverage ≥1 year before and after the index event. The authors examined patient factors during the pre-index period, characteristics of the index event, and outcomes during the post-index period.
This retrospective cohort was compromised of 716 patients with an ED visit/hospitalization for drug-induced anaphylaxis. Most patients (71%) were managed in the ED and only 8% of patients with drug-induced anaphylaxis treated in the ED received epinephrine. Patients with a concomitant allergic condition were more likely to follow-up with an Allergist/Immunologist than those without any concomitant allergic condition, but 82% did not receive any subsequent care with an Allergist/Immunologist in the one year after their ED visit/hospitalization for drug-induced anaphylaxis.
This study by Banerji and colleagues confirmed that drugs are a common cause of anaphylaxis and further revealed that only a small number of patients with drug-induced anaphylaxis received epinephrine in the ED or had subsequent care with an Allergist/Immunologist. These findings identify areas for improvement in the management of individuals with drug-induced anaphylaxis seen in the ED or inpatient setting.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.