Campbell Ronna L, Park Miguel A, Kueber Michael A, Lee Sangil, Hagan John B
Department of Emergency Medicine, Mayo Clinic, Rochester, Minn.
Division of Allergic Diseases, Mayo Clinic, Rochester, Minn.
J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):88-93. doi: 10.1016/j.jaip.2014.07.011. Epub 2014 Sep 22.
Anaphylaxis guidelines currently recommend referring patients with anaphylaxis seen in the emergency department (ED) to an allergist for follow up.
The objective of our study was to evaluate outcomes of allergy/immunology follow-up after an ED visit for anaphylaxis.
A retrospective health records review was conducted from April 2008 to August 2012. Charts were reviewed independently by 2 allergists to determine outcomes. Descriptive statistics with corresponding 95% CIs were calculated.
Among 573 patients seen in the ED who met anaphylaxis diagnostic criteria, 217 (38%) had a documented allergy/immunology follow-up. After allergy/immunology evaluation, 16 patients (7% [95% CI, 5%-12%]) had anaphylaxis ruled out. Among those with an unknown ED trigger (n = 74), 24 (32% [95% CI, 23%-44%]) had a trigger identified; and, among those who had a specific suspected ED trigger (n = 143), 9 (6% [95% CI, 3%-12%]) had a trigger identified in a category other than the one suspected in the ED, and 28 (20% [95% CI, 14%-27%]) had an unknown trigger. Thus, there were a total of 77 patients (35% [95% CI, 29%-42%]) who had an alteration in the diagnosis of anaphylaxis or trigger after allergy/immunology evaluation. Four patients (2% [95% CI, 0.7%-4.6%]) were diagnosed with a mast cell activation disorder, and 13 patients (6% [95% CI, 4%-10%]) underwent immunotherapy or desensitization.
Overall, 35% of the patients with suspected anaphylaxis in the ED had an alteration in the diagnosis or suspected trigger after allergy/immunology evaluation. These results underscore the importance of allergy/immunology follow-up after an ED visit for anaphylaxis.
过敏反应指南目前建议，将在急诊科（ED）就诊的过敏反应患者转诊给过敏症专科医生进行后续治疗。
我们研究的目的是评估因过敏反应在急诊科就诊后，过敏/免疫科后续治疗的结果。
对2008年4月至2012年8月期间的健康记录进行回顾性研究。由2名过敏症专科医生独立查阅病历以确定结果。计算描述性统计数据及相应的95%置信区间。
在急诊科就诊且符合过敏反应诊断标准的573例患者中，有217例（38%）有过敏/免疫科后续治疗的记录。经过过敏/免疫科评估后，16例患者（7% [95%置信区间，5%-12%]）的过敏反应被排除。在急诊科触发因素不明的患者中（n = 74），24例（32% [95%置信区间，23%-44%]）确定了触发因素；在怀疑有特定急诊科触发因素的患者中（n = 143），9例（6% [95%置信区间，3%-12%]）确定的触发因素与急诊科怀疑的类别不同，28例（20% [95%置信区间，14%-27%]）触发因素不明。因此，共有77例患者（35% [95%置信区间，29%-42%]）在经过过敏/免疫科评估后，过敏反应的诊断或触发因素发生了改变。4例患者（2% [95%置信区间，0.7%-4.6%]）被诊断为肥大细胞活化障碍，13例患者（6% [95%置信区间，4%-10%]）接受了免疫治疗或脱敏治疗。
总体而言，急诊科疑似过敏反应的患者中，35%在经过过敏/免疫科评估后，诊断或疑似触发因素发生了改变。这些结果强调了因过敏反应在急诊科就诊后进行过敏/免疫科后续治疗的重要性。
