Concordance With Recommended Postdischarge Care Guidelines Among Children With Food-Induced Anaphylaxis

Abstract

To describe patient characteristics, compliance with postdischarge care, and risk of repeat events for children discharged from the emergency department (ED) or hospital for food-induced anaphylaxis within the United States.Children under 18 years of age with an ED visit or hospitalization for food-induced anaphylaxis were identified from 2002 to 2008 through databases using International Classification of Diseases, Ninth Revision, codes.The initial ED encounter was the index event. Rates at 1 year postdischarge of epinephrine autoinjector (EAI) prescription fills, allergist visits, and repeat events were analyzed for patients with continuous medical and prescription coverage for >1 year.There were 1009 patients in the study cohort. The average age was 7 years, 58% were male, 27% had a history of asthma, and 90% were discharged from the ED. Within 1 year from discharge, 83% had filled their prescription for an EAI, 43% had visited an allergist, and 6.4% had a repeat event of an anaphylaxis-related ED visit or hospitalization within 1 year of the index event.Within 1 year of discharge from the ED or hospital among patients with food-induced anaphylaxis, prescription of EAI was much higher than follow-up with an allergist. Repeat events were low. More studies were recommended to further delineate reasons and barriers with regard to follow-up with an allergist.There are specific US guidelines with recommendations for physicians regarding patient instructions after an ED visit or hospitalization for anaphylaxis. Previous studies have focused on physicians’ compliance with discharge recommendations for patients seen for food-induced anaphylaxis. This study measures patient compliance with these instructions. Although 83% of patients filled their prescription for an EAI, a percentage closer to 100% would be more ideal given the higher rates for recurrence in food-induced anaphylaxis. With only 43% of patients following up with an allergist after such an event, future studies focusing on the barriers that keep these numbers from being higher would be beneficial in preventing future recurrences.