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Ann Emerg Med. 2015 Oct;66(4):381-9. doi: 10.1016/j.annemergmed.2015.03.003. Epub 2015 Mar 25.

Emergency Department Corticosteroid Use for Allergy or Anaphylaxis Is Not Associated With Decreased Relapses.

Author information

1
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.
2
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
3
Department of Emergency Medicine and the School of Public Health, University of Alberta, Edmonton, AB, Canada.
4
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.
5
Division of General Surgery, University of British Columbia, Vancouver, BC, Canada.
6
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
7
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.
8
St. Paul's Hospital, Vancouver, BC, Canada; Division of Allergy and Clinical Immunology, University of British Columbia, Vancouver, BC, Canada.
9
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.
10
St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.

Abstract

STUDY 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.

CONCLUSION:

Among ED patients with allergic reactions or anaphylaxis, corticosteroid use was not associated with decreased relapses to additional care within 7 days.

[Indexed for MEDLINE]

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