What is the reported hospitalization rate for pediatric anaphylaxis (severe, life-threatening allergic reaction)?

From the Guidelines

Hospitalization rates for children experiencing anaphylaxis should be guided by a standardized approach that prioritizes prompt administration of epinephrine and individualized clinical decision-making based on patient-specific factors, including severity of the reaction, response to initial treatment, and risk of biphasic reactions. The decision to hospitalize a child after an anaphylactic reaction depends on several factors, including the severity of the reaction, the patient's response to initial treatment, risk of biphasic reactions, access to follow-up care, and the family's ability to manage potential recurrences at home 1. Higher hospitalization rates may occur in centers that take a more cautious approach, particularly with younger patients or those with unclear triggers. Lower rates may be seen in institutions with robust outpatient follow-up systems or clear discharge protocols.

Some key points to consider in the management of pediatric anaphylaxis include:

• Prompt intramuscular epinephrine injection in the mid-outer thigh reduces hospitalizations, morbidity, and mortality 1
• Prescribing epinephrine autoinjectors (EAs) facilitates timely epinephrine injection in community settings for patients with a history of anaphylaxis and, if specific circumstances warrant, for some high-risk patients who have not previously experienced anaphylaxis 1
• Patients and caregivers need training in how to recognize anaphylaxis and use an EA, and should be instructed to err on the side of caution and inject epinephrine promptly when symptoms occur after known exposure to a trigger that previously caused a significant reaction 1
• The use of antihistamines is not a substitute for epinephrine, and may place a patient at significantly increased risk for progression toward a life-threatening reaction 1

Overall, the goal of pediatric anaphylaxis management should be to minimize morbidity, mortality, and hospitalization rates while also ensuring that patients and families are empowered to recognize and respond to anaphylactic reactions in a timely and effective manner.

From the Research

Hospitalization Rates for Pediatric Anaphylaxis

• The reported hospitalization rates for pediatric anaphylaxis vary substantially between institutions, with a median rate typically falling between 40% and 50% 2.
• A study published in 2023 found that patients treated with prehospital epinephrine were less likely to be admitted after the reaction (adjusted odds ratio [aOR], 0.964 [95% CI, 0.949-0.980]) 2.
• Another study published in 2017 found that corticosteroids appear to reduce the length of hospital stay, but did not reduce revisits to the emergency department 3.

Treatment of Anaphylaxis

• Epinephrine is the first-line treatment for anaphylaxis and should be administered early 4, 5.
• Antihistamines are often used to treat anaphylaxis, but they do not relieve or prevent all of the pathophysiological symptoms of anaphylaxis, and do not act as rapidly as epinephrine 5.
• Corticosteroids are also frequently used in the treatment of anaphylaxis, but there is no compelling evidence to support or oppose their use in emergency treatment 3.

Factors Associated with Hospital Admission

• Patients treated with prehospital antihistamines were less likely to be admitted after the reaction (aOR, 0.963 [95% CI, 0.949-0.977]) 2.
• Patients who received prehospital corticosteroids were more likely to be admitted (aOR, 1.232 [95% CI, 1.181-1.286]) 2.
• The use of intravenous fluids in the emergency department was also associated with an increased likelihood of hospital admission 2, 6.