title: Prescriptions for self-injectable epinephrine and follow-up referral in emergency department patients presenting with anaphylaxis.
abstract: BACKGROUND
  Anaphylaxis guidelines recommend that patients with a history of anaphylactic reaction should carry self-injectable epinephrine and should be referred to an allergist.
  
  
  OBJECTIVE
  To evaluate how frequently patients dismissed from the emergency department after treatment for anaphylaxis received a prescription for self-injectable epinephrine or allergist referral.
  
  
  METHODS
  A retrospective medical record review identified patients with anaphylaxis in a community-based study from 1990 through 2000. Records of patients with Hospital Adaptation of the International Classification of Diseases, Second Edition or International Classification of Diseases, Ninth Revision codes representing anaphylaxis were reviewed, and a random sample of patients with associated diagnoses was also reviewed. Patients who met the criteria for diagnosis of anaphylaxis were included in the study.
  
  
  RESULTS
  Among 208 patients identified with anaphylaxis, 134 (64.4%) were seen in the emergency department and discharged home. On dismissal, 49 patients (36.6%; 95% confidence interval [CI], 28.4%-44.7%) were prescribed self-injectable epinephrine, and 42 patients (31.3%; 95% CI, 23.5%-39.2%) were referred to an allergist. Treatment with epinephrine in the emergency department (odds ratio, 3.6; 95% CI, 1.6-7.9; P = .001) and insect sting as the inciting allergen (odds ratio, 4.0; 95% CI, 1.6-10.5; P = .004) were significantly associated with receiving a prescription for self-injectable epinephrine. Patient age younger than 18 years was the only factor associated with referral to an allergist (P = .007).
  
  
  CONCLUSIONS
  Most patients dismissed after treatment for anaphylaxis did not receive a self-injectable epinephrine prescription or allergist referral. Emergency physicians may be missing an important opportunity to ensure prompt treatment of future anaphylactic reactions and specialized follow-up care.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. campbell.ronna@mayo.edu
authors.forename: Ronna L
authors.initials: RL
authors.lastname: Campbell
authors.forename: Anuradha
authors.initials: A
authors.lastname: Luke
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: St Sauver
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Bergstralh
authors.forename: James T
authors.initials: JT
authors.lastname: Li
authors.forename: Veena
authors.initials: V
authors.lastname: Manivannan
authors.forename: Wyatt W
authors.initials: WW
authors.lastname: Decker
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy* / Q000453:epidemiology*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data*; D008910:Minnesota / Q000453:epidemiology; D010351:Patient Discharge; D012017:Referral and Consultation; D012189:Retrospective Studies; D012646:Self Administration
chemical_list: D001993:Bronchodilator Agents; D004837:Epinephrine