title: Emergency Department Corticosteroid Use for Allergy or Anaphylaxis Is Not Associated With Decreased Relapses.
abstract: OBJECTIVE
  Corticosteroids (steroids) are often used to mitigate symptoms and prevent subsequent reactions in emergency department (ED) patients with allergic reactions, despite a lack of evidence to support their use. We sought to determine the association of steroid administration with improved clinical outcomes.
  
  
  METHODS
  Adult allergy-related encounters to 2 urban EDs during a 5-year period were identified and classified as "anaphylaxis" or "allergic reaction." Regional and provincial databases identified subsequent ED visits or deaths within a 7-day period. The primary outcome was allergy-related ED revisits in the steroid- and nonsteroid-exposed groups, adjusting for potential confounders with a propensity score analysis; secondary outcomes included the number of clinically important biphasic reactions and deaths.
  
  
  RESULTS
  Two thousand seven hundred one encounters (473 anaphylactic) were included; 48% were treated with steroids. Allergy-related ED revisits occurred in 5.8% and 6.7% of patients treated with and without steroids, respectively (adjusted odds ratio [OR] 0.91; 95% confidence interval [CI] 0.64 to 1.28), with a number needed to treat (NNT) to benefit of 176 (95% CI NNT to benefit 39 to ∞ to NNT to harm 65). The adjusted OR in the anaphylaxis subgroup was 1.12 (95% CI 0.41 to 3.27). In the allergic reaction group, the adjusted OR was 0.91 (95% CI 0.63 to 1.31), with an NNT to benefit of 173 (95% CI NNT to benefit 38 to ∞ to NNT to harm 58). In the steroid and nonsteroid groups, there were 4 and 1 clinically important biphasic reactions, respectively. There were no deaths.
  
  
  CONCLUSIONS
  Among ED patients with allergic reactions or anaphylaxis, corticosteroid use was not associated with decreased relapses to additional care within 7 days.
authors.affiliation: St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, University of Alberta, Edmonton, AB, Canada. Electronic address: brian.grunau2@vch.ca.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Grunau
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Wiens
authors.affiliation: Department of Emergency Medicine and the School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, University of Alberta, Edmonton, AB, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: McKay
authors.affiliation: Division of General Surgery, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Tae Won
authors.initials: TW
authors.lastname: Yi
authors.affiliation: Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, University of Alberta, Edmonton, AB, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Stenstrom
authors.affiliation: St. Paul's Hospital, Vancouver, BC, Canada; Division of Allergy and Clinical Immunology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: R Robert
authors.initials: RR
authors.lastname: Schellenberg
authors.affiliation: St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, University of Alberta, Edmonton, AB, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Grafstein
authors.affiliation: St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Frank X
authors.initials: FX
authors.lastname: Scheuermeyer
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy*; D001955:British Columbia; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones