title: Outcomes of allergy/immunology follow-up after an emergency department evaluation for anaphylaxis.
abstract: BACKGROUND
  Anaphylaxis guidelines currently recommend referring patients with anaphylaxis seen in the emergency department (ED) to an allergist for follow up.
  
  
  OBJECTIVE
  The objective of our study was to evaluate outcomes of allergy/immunology follow-up after an ED visit for anaphylaxis.
  
  
  METHODS
  A retrospective health records review was conducted from April 2008 to August 2012. Charts were reviewed independently by 2 allergists to determine outcomes. Descriptive statistics with corresponding 95% CIs were calculated.
  
  
  RESULTS
  Among 573 patients seen in the ED who met anaphylaxis diagnostic criteria, 217 (38%) had a documented allergy/immunology follow-up. After allergy/immunology evaluation, 16 patients (7% [95% CI, 5%-12%]) had anaphylaxis ruled out. Among those with an unknown ED trigger (n = 74), 24 (32% [95% CI, 23%-44%]) had a trigger identified; and, among those who had a specific suspected ED trigger (n = 143), 9 (6% [95% CI, 3%-12%]) had a trigger identified in a category other than the one suspected in the ED, and 28 (20% [95% CI, 14%-27%]) had an unknown trigger. Thus, there were a total of 77 patients (35% [95% CI, 29%-42%]) who had an alteration in the diagnosis of anaphylaxis or trigger after allergy/immunology evaluation. Four patients (2% [95% CI, 0.7%-4.6%]) were diagnosed with a mast cell activation disorder, and 13 patients (6% [95% CI, 4%-10%]) underwent immunotherapy or desensitization.
  
  
  CONCLUSIONS
  Overall, 35% of the patients with suspected anaphylaxis in the ED had an alteration in the diagnosis or suspected trigger after allergy/immunology evaluation. These results underscore the importance of allergy/immunology follow-up after an ED visit for anaphylaxis.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Rochester, Minn. Electronic address: campbell.ronna@mayo.edu.
authors.forename: Ronna L
authors.initials: RL
authors.lastname: Campbell
authors.affiliation: Division of Allergic Diseases, Mayo Clinic, Rochester, Minn.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kueber
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Sangil
authors.initials: S
authors.lastname: Lee
authors.affiliation: Division of Allergic Diseases, Mayo Clinic, Rochester, Minn.
authors.forename: John B
authors.initials: JB
authors.lastname: Hagan
mesh_terms: D000293:Adolescent; D000328:Adult; D000486:Allergy and Immunology / Q000706:statistics & numerical data*; D000707:Anaphylaxis / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006967:Hypersensitivity / Q000150:complications / Q000175:diagnosis* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Anaphylaxis; Emergency medicine; Follow-up studies; Immunologic desensitization; Mast cell disease