From the Guidelines
Discharge with Oral Corticosteroids
Patients with allergic reactions can be discharged with oral corticosteroids, such as prednisone, to reduce inflammation and prevent symptom recurrence 1.
- The dose and duration of treatment may vary depending on the severity of the reaction and individual patient factors, but a common regimen is prednisone daily for 2-3 days 1.
- First-line treatment for patients at discharge includes an epinephrine auto-injector prescription, education on avoidance of the allergen, and follow-up with a primary care physician 1.
- Adjunctive treatment may include H1 antihistamines, such as diphenhydramine, and H2 antihistamines, such as ranitidine, in addition to corticosteroids 1.
- The decision to discharge a patient with oral corticosteroids should be based on the severity of the reaction and the patient's individual needs, with severe reactions or those requiring multiple doses of epinephrine potentially requiring a longer course of treatment or observation in a clinical setting 1.
From the Research
Discharge with Oral Corticosteroids
- The decision to discharge a patient with an allergic reaction with oral corticosteroids (oral steroids) depends on the severity of the reaction and the patient's overall condition.
- According to a study on the frequency and severity of hypersensitivity reactions in patients after VenaSeal™ cyanoacrylate treatment of superficial venous insufficiency 2, severity was classified as mild if no treatment or over the counter medication was provided, moderate if steroids were required, and severe if the reaction lasted >30 days or required vein excision.
- A study comparing intramuscular triamcinolone and oral prednisone in the outpatient treatment of acute asthma found that a single dose of triamcinolone diacetate, 40 mg intramuscular, produced a relapse rate similar to that of prednisone, 40 mg/day orally for 5 days 3.
- Another study on potential cofactors in accidental food allergic reactions found that cofactors, such as physical exercise and alcohol intake, might be associated with the severity or occurrence of food allergic reactions, but the presence of these factors did not influence the severity of the reactions 4.
- A study on the clinical impact of allergy and pre-medication in CT studies with low-osmolality intravenous iodinated contrast media found that severe allergic reactions to iodinated contrast media are rare and do not appear to be impacted by pre-medication 5.
Severity Grading System
- A severity grading system for acute allergic reactions, including anaphylactic and nonanaphylactic reactions, has been developed to optimize and standardize management practices and advance research 6.
- The system recommends that an optimal grading system encompass the severity of acute allergic reactions on a continuum from mild allergic reactions to anaphylactic shock.
- The severity grading system must be able to discriminate between clinically important differences in reaction severity to be relevant in research while also being intuitive and straightforward to apply in clinical care.
Treatment and Management
- The treatment and management of allergic reactions depend on the severity of the reaction and the patient's overall condition.
- Oral corticosteroids may be prescribed for patients with moderate to severe allergic reactions.
- Patients with a history of allergic reactions should be closely monitored and managed to prevent future reactions.
- Further research is needed to evaluate the effectiveness of pre-medication protocols in preventing allergic reactions 5.