Emergency anaphylaxis observation times can be cut for children

Most children seen in the emergency department for anaphylaxis can be discharged after two hours or less, according to a study presented at the annual meeting of the Pediatric Academic Societies, held from April 27 to May 1 in Washington, D.C.

Tim Dribin, M.D., from Cincinnati Children's Hospital, and colleagues sought to understand optimal anaphylaxis observation periods based on reaction severity. The analysis included 4,735 patients (6 months to <18 years) who had anaphylaxis, received epinephrine in the pre-emergency department or emergency department setting, and presented for care between October 2015 and December 2019.

The researchers found that the median patient age was 7.6 years, and the most common reaction trigger was food (71.7 percent), although etiology was unknown in 18.6 percent of cases. Among these patients, 92.5 percent were treated with one dose of epinephrine, 6.2 percent with two doses, and 1.3 percent with three or more doses. Optimal lengths of observation included 65 minutes for all patients, five minutes for patients without respiratory or cardiovascular involvement, 65 minutes for children with respiratory but no cardiovascular involvement, and 120 minutes for patients with cardiovascular involvement.

"Our findings suggest that for patients without cardiovascular involvement, anaphylaxis observation periods of two hours or potentially less are safe," the authors write. "Prospective validation of these findings is needed before they can be applied in clinical practice."