Kawano Takahisa, Scheuermeyer Frank X, Gibo Koichiro, Stenstrom Robert, Rowe Brian, Grafstein Eric, Grunau Brian
Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Department of Emergency Medicine, University of Fukui Hospital, Fukui Prefecture, Japan.
Acad Emerg Med. 2017 Jun;24(6):733-741. doi: 10.1111/acem.13147.
H1-antihistamines (H1a) can be used to treat emergency department (ED) patients with allergic reactions; however, this is inconsistently done, likely because there is no evidence that this therapy has an impact on serious outcomes. Among ED patients initially presenting with allergic reactions, we investigated whether H1a were associated with lower rates of progression to anaphylaxis.
This was a retrospective cohort study conducted at two urban Canadian EDs from April 1, 2007, to March 31, 2012. We included consecutive adult patients with allergic reactions while excluding those presenting with anaphylaxis, according to prespecified criteria. The primary outcome was the proportion of patients who subsequently developed anaphylaxis during medical care, either by emergency medical services (EMS) or in the ED. A prespecified subgroup analysis excluded patients who received H1a prior to EMS or ED contact. We compared those who received H1a and those who did not and used multivariable regression and propensity score adjustment techniques to compare outcomes.
Of 2,376 overall patients included, 1,880 (79.1%) were managed with H1a. Of the latter group, 36 of 1,880 (1.9%) developed anaphylaxis, compared to 17 of 496 (3.4%) in the non-H1a-treated group (adjusted odds ratio [AOR] = 0.34, 95% confidence interval [CI] = 0.17-0.70; number needed to treat [NNT] to benefit = 44.74, 95% CI = 35.36-99.67). In the subgroup analysis of 1,717 patients who did not receive H1a prior to EMS or ED contact, a similar association was observed (AOR = 0.26, 95% CI = 0.10-0.50; NNT to benefit 38.20, 95% CI = 32.58-55.24).
Among ED patient with allergic reactions, H1a administration was associated with a lower likelihood of progression to anaphylaxis. These data indicate that early H1a treatment in the ED or prehospital setting may decrease progression to anaphylaxis.
H1 抗组胺药（H1a）可用于治疗急诊科（ED）有过敏反应的患者；然而，这种做法并不一致，可能是因为没有证据表明这种治疗对严重后果有影响。在最初表现为过敏反应的急诊科患者中，我们调查了 H1a 是否与进展为过敏反应的较低发生率相关。
这是一项回顾性队列研究，于 2007 年 4 月 1 日至 2012 年 3 月 31 日在加拿大两个城市的急诊科进行。我们纳入了连续的有过敏反应的成年患者，同时根据预先设定的标准排除那些表现为过敏反应的患者。主要结局是在医疗护理期间，无论是通过紧急医疗服务（EMS）还是在急诊科，随后发生过敏反应的患者比例。一项预先设定的亚组分析排除了在与 EMS 或急诊科接触之前接受 H1a 的患者。我们比较了接受 H1a 和未接受 H1a 的患者，并使用多变量回归和倾向评分调整技术来比较结局。
在纳入的 2376 名总体患者中，1880 名（79.1%）接受了 H1a 治疗。在后者组中，1880 名中有 36 名（1.9%）发生了过敏反应，相比之下，未接受 H1a 治疗组的 496 名中有 17 名（3.4%）（调整后的优势比[AOR]=0.34，95%置信区间[CI]=0.17 - 0.70；受益所需治疗人数[NNT]=44.74，95%CI=35.36 - 99.67）。在对 1717 名在与 EMS 或急诊科接触之前未接受 H1a 的患者进行的亚组分析中，观察到了类似的关联（AOR=0.26，95%CI=0.10 - 0.50；受益所需治疗人数 38.20，95%CI=32.58 - 55.24）。
在有过敏反应的急诊科患者中，给予 H1a 与进展为过敏反应的可能性较低相关。这些数据表明，在急诊科或院前环境中早期给予 H1a 治疗可能会降低进展为过敏反应的发生率。
