A new study published in JACI: In Practice finds that patients who visit an allergist/immunologist after being treated for anaphylaxis in the emergency department (ED) receive a more accurate diagnosis, which can lead to more effective management of their allergy. This is the first study to examine how a follow-up visit affects outcomes in patients who receive emergency treatment for potentially life-threatening reactions.
Ronna L. Campbell, M.D., Ph.D., and colleagues at the Mayo Clinic (Rochester, Minn.) analyzed the records of 573 patients who were evaluated in an ED for an anaphylactic reaction. After their ED visit, 217 patients followed up with an allergist/immunologist. Most of these patients (67 percent) underwent some type of testing. Anaphylaxis was ruled out in 16 patients. The allergist/immunologist was able to identify the trigger of the reaction in 74 patients whose trigger was unknown after evaluation in the ED. Of the 143 patients who had a suspected trigger during their ED evaluation, nine had a different trigger identified during the follow-up visit. The most common trigger identified by the allergist/immunologist was food, followed by medication.
Overall, after evaluation by an allergist/immunologist, either the diagnosis of anaphylaxis or the identification of the trigger of the reaction was changed in 77 patients. In addition, four patients were diagnosed with a mast cell activation disorder. “These results underscore the importance of allergy/immunology follow-up after an ED visit for anaphylaxis,” the authors conclude. Improving follow-up rates, they add, would help ensure that anaphylaxis triggers are identified accurately. Helping patients understand exactly which triggers to avoid decreases the risk of re-exposure to allergens and prevents unnecessary avoidance. In addition, patients can benefit from additional education and advice, including assistance in developing an anaphylaxis action plan and completing documentation for school, work or travel.