title: Predictors of hospital admission for food-related allergic reactions that present to the emergency department.
abstract: BACKGROUND
  guidelines do not provide specific hospitalization criteria for patients presenting to the emergency department (ED) with food-related allergic reactions.
  
  
  OBJECTIVE
  to determine predictors of hospital admission for ED patients with food-related allergic reactions.
  
  
  METHODS
  we performed a medical record review at 3 academic centers of patients presenting to the ED for food-related allergic reactions (International Classification of Diseases, Ninth Revision, Clinical Modification codes 693.1, 995.0, 995.1, 995.3, 995.7, 995.60-995.69, 558.3, 692.5, and 708.X) between January 1, 2001, and December 31, 2006. We focused on patient demographics, medical history, food triggers, clinical presentation, pre-ED and ED management with a specific focus on epinephrine treatment, and disposition. Predictors of hospital admission were determined using multivariable logistic regression.
  
  
  RESULTS
  through random sampling and appropriate weighting, the 1,112 cases reviewed represented a study cohort of 2,583 patients. Most patients (80%) were discharged from the ED. The age and sex of patients admitted to the hospital and those discharged were similar. Multivariable analysis identified 3 factors associated with a higher likelihood of hospital admission: meeting the criteria for food-related anaphylaxis (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.23-4.33), pre-ED epinephrine treatment (OR, 6.65; 95% CI, 3.04-14.57), and epinephrine treatment within 1 hour of ED triage (OR, 3.78; 95% CI, 1.68-8.50). Patients with food-related allergic reactions triggered by shellfish were less likely to be admitted to the hospital (OR, 0.23; 95% CI, 0.08-0.68).
  
  
  CONCLUSIONS
  most patients presenting to the ED with food-related allergic reactions are discharged. Several patient factors were independently associated with hospital admission in ED patients with food-related allergic reactions.
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. abanerji@partners.org
authors.forename: Aleena
authors.initials: A
authors.lastname: Banerji
authors.forename: Susan A
authors.initials: SA
authors.lastname: Rudders
authors.forename: Blanka
authors.initials: B
authors.lastname: Corel
authors.forename: Alisha P
authors.initials: AP
authors.lastname: Garth
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005512:Food Hypersensitivity / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055815:Young Adult