Should I stay or should I go?

Abstract

When a child presents to the emergency department (ED) with anaphylaxis the first priority is immediate stabilization. Shortly thereafter, though, the clinician must decide whether a prolonged period of monitoring, including hospitalization, is warranted. And although concomitant asthma is a recognized risk factor for severe anaphylaxis (Allergy 2014;69:1026-45), it may not be a strong predictor (Allergy 2016;71:1241-55) and little is certain as to whether a co-existing diagnosis of asthma should, in and of itself, enter into that decision to admit. Dribin et al in this volume of The Journal report the results of their study which sought to determine if a history of asthma is associated with severity of anaphylaxis in a population of children hospitalized for anaphylaxis. This was a pre-planned secondary analysis of children admitted from the ED for anaphylaxis (PLoS ONE 2019;14:e0211949). Thus, the decision had already been made to admit. If anything, this would enrich the population with children for whom there was enhanced concern on the part of the care team for biphasic anaphylaxis or another complication. Of 603 children, 231 had asthma, and, after adjusting for patient age, allergen, and history of atopic dermatitis or anaphylaxis history, there was no association between asthma history and severe anaphylaxis reactions. Although these data are not robust enough to independently change existing guidelines, they do underscore the need to identify reliable predictors of severe reactions. A history of asthma, without any current symptoms, may not portend an increased risk of severe anaphylaxis, or, if risk is higher, that risk may not extend into the period of hospitalization. This work highlights the need to refine our ability to predict the severity of anaphylaxis, including risk factors and time frame, to better inform the next generation of guidelines. Article page 159▸ Are Children with a History of Asthma More Likely to Have Severe Anaphylactic Reactions? A Retrospective Cohort StudyThe Journal of PediatricsVol. 220PreviewTo assess whether a history of asthma was associated with anaphylaxis severity in children hospitalized for anaphylaxis. Full-Text PDF