306 Utility of Steroid Use in Prevention of Biphasic and Protracted Anaphylaxis

Abstract

To determine the efficacy in the prevention of bipasic and protracted anaphylaxis in pediatric patients in the emergency department (ED) using systematic review and meta-analysis approach. Using a test-treatment threshold model we studied whether administration of steroids in pediatric emergency departments effectively prevented episodes of protracted and biphasic anaphylaxis. We searched PUBMED, EMBASE, SCOPUS, and research meeting abstracts from January 1966 to April 2017 for studies on pediatric patients presenting to the ED with either anaphylaxis or anaphylactoid reactions. We used Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) to evaluate quality of included studies. The operating characteristics of the interventions in prevention of biphasic and protracted anaphylaxis were measured. We included prospective randomized and quasi-randomized controlled trials comparing glucocorticoids with any control (either placebo, adrenaline (epinephrine), an antihistamine, or any combination of these). A total of 204 patients with biphasic anaphylaxis were identified with follow-up. All patients either experienced confirmed biphasic or protracted reactivity. Average time to onset of the second phase was 10.2 hours (CI: 2-38). Time to resolution of initial symptoms was significantly longer for biphasic reactors (112 vs 133 minutes; P = .03). All biphasic and protracted anaphylactoid reactions received corticosteroids. Most importantly, patients who received steroid administration vs those who did not were equally as likely to experience protracted and biphasic reactions (P=.04). Biphasic and protracted anaphlyaxis is a potential outcome for those experiencing anaphylactoid reactions. Prevention of this outcome is primarily unproven and based on observed data; there is no beneficence of steroid administration in the prevention of biphasic/protracted anaphlaxis. This neccessitates the need for further investigation into their efficacy.