From the Guidelines
A patient with an allergic reaction should be admitted to the hospital when they show signs of severe or potentially life-threatening symptoms, particularly anaphylaxis, as outlined in the 2020 practice parameter update 1. These signs include sudden respiratory symptoms and signs, such as shortness of breath, wheeze, cough, stridor, or hypoxemia, or sudden reduced blood pressure or symptoms of end-organ dysfunction, such as hypotonia or incontinence.
- Key indicators for hospital admission also include:
- Two or more of the following that occur suddenly after exposure to a likely allergen: skin or mucosal symptoms, respiratory symptoms, reduced blood pressure, or gastrointestinal symptoms
- Reduced blood pressure after exposure to a known allergen, with specific criteria for infants, children, and adults
- The decision to admit is guided by the severity of the reaction, the patient's response to initial treatment, and their individual risk factors for adverse outcomes, including the need for multiple doses of epinephrine or a history of biphasic reactions 1.
- Hospital admission allows for continuous monitoring of vital signs, potential administration of additional epinephrine if needed, and management of airway complications that might develop, with treatments including IV fluids, antihistamines, H2 blockers, and corticosteroids.
- The duration of admission is typically 24 hours but may be extended based on clinical response, with the goal of preventing biphasic anaphylaxis and ensuring patient safety 1.
From the Research
Admission Criteria for Allergic Reactions
When deciding whether to admit a patient with an allergic reaction to the hospital, several factors should be considered:
- Severity of the reaction: Patients with severe anaphylaxis, especially those with coexisting asthma, mast cell disorders, older age, underlying cardiovascular disease, peanut and tree nut allergy, and drug-induced reactions, may require hospital admission 2.
- Presence of biphasic reactions: Although mandatory observation periods are not necessary, patients at risk for biphasic reactions may need to be monitored for a longer period 3, 4.
- Response to treatment: Patients who do not respond to initial treatment with epinephrine and adjunct medications may require further management in a hospital setting 5, 6.
- Presence of airway, breathing, or circulatory compromise: Patients with these symptoms may require urgent airway monitoring and support, and hospital admission may be necessary 3, 6.
Patient Factors to Consider
The following patient factors may influence the decision to admit a patient with an allergic reaction:
- Underlying medical conditions: Patients with underlying medical conditions, such as cardiovascular disease or asthma, may be at higher risk for severe allergic reactions and may require hospital admission 2.
- Age: Older patients may be at higher risk for severe allergic reactions and may require hospital admission 2.
- History of previous allergic reactions: Patients with a history of previous severe allergic reactions may be at higher risk for future reactions and may require hospital admission 2.