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

Grunau, Brian; Wiens, Matthew O.; Rowe, Brian H.; McKay, Rachel; Li, Jennifer; Yi, Tae Won; Stenstrom, Robert; Schellenberg, R. Robert; Grafstein, Eric; Scheuermeyer, Frank

doi:10.1016/j.annemergmed.2015.03.003

Cited by 41 publications

(38 citation statements)

References 20 publications

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“…These rates were lower than reported in an Italian retrospective observational study (93%) of 459 patients with acute urticaria prompting emergency department admission . There is no evident explanation for this discrepancy with the Italian study, especially as our study had a larger proportion of angioedema (79% vs 30%) and the US study had a larger proportion of anaphylaxis (18% vs 6%) . In univariate analysis of our study, presence of angioedema, especially that of the larynx, was associated with corticosteroid administration while the efficacy of steroids has not been established in studies with a high level of evidence .…”

Section: Discussioncontrasting

confidence: 92%

“…In our study, the overall prevalence of corticosteroid administration for treatment of acute urticaria was high and was similar to a US retrospective observational study (55% vs 48%) . These rates were lower than reported in an Italian retrospective observational study (93%) of 459 patients with acute urticaria prompting emergency department admission .…”

Section: Discussionsupporting

confidence: 83%

“…On the other side, in a recent double‐blind randomized controlled trial, the addition of prednisone to levocetirizine did not improve the symptomatic and clinical response of acute urticaria . Moreover, only the last trial investigated short‐term relapses, without a significantly different rate between the two groups, while corticosteroid treatment was not associated with a decreased relapse rate on additional care within 7 days in a recent retrospective study with allergic reactions . No long‐term follow up was investigated in the three studies, while oral steroids might have confered resistance to antihistamine in chronic urticaria in a prospective study in 17 patients…”

Section: Introductionmentioning

confidence: 97%

“…4 Moreover, only the last trial investigated short-term relapses, without a significantly different rate between the two groups, while corticosteroid treatment was not associated with a decreased relapse rate on additional care within 7 days in a recent retrospective study with allergic reactions. 5 No longterm follow up was investigated in the three studies, 2-4 while oral steroids might have confered resistance to antihistamine in chronic urticaria in a prospective study in 17 patients. 6 The aim of the present study was to determine the factors associated with relapses in patients presenting with acute urticaria.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with relapses among patients treated for acute urticaria

Maillet

Soria

Adnet

et al. 2019

The Journal of Dermatology

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The benefit of corticosteroids in acute urticaria is controversial. Our objective was to determine the factors associated with relapses in patients presenting with acute urticaria. A retrospective observational study, including all patients with acute urticaria who visited the angioedema reference center of Academic Public Hospitals – Saint‐Antoine in Paris between January 2015 and June 2017, was conducted. The study inclusion criterion was a diagnosis of acute urticaria in an adult patient. The urticaria was spontaneous or inducible urticaria. The primary outcome was relapse at day 7 and the secondary outcome was relapse at week 6. A total of 184 patients with a first episode of acute urticaria were included. Most of the patients were female (66%) with a mean age of 42 ± 16 years. Corticosteroid administration for treatment of acute urticaria was used in 102 (55%) patients. Overall, 85 (46%) patients had relapses after less than 7 days whereas 168 (91%) patients had relapses after more than 6 weeks. In univariate analysis, the rate of corticosteroid administration was significantly higher in cases of relapse after less than 7 days. No difference in relapse rates after more than 6 weeks appeared. In the multivariate analysis, the independent factor associated with relapses after less than 7 days was the administration of corticosteroids as treatment of acute urticaria (odds ratio, 1.93; 95% confidence interval, 1.06–3.57; P = 0.03). The prevalence of corticosteroid administration for patients with acute urticaria was high. Corticosteroid administration was an independent risk factor associated with relapses after less than 7 days.

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Section: Discussioncontrasting

confidence: 92%

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Factors associated with relapses among patients treated for acute urticaria

Maillet

Soria

Adnet

et al. 2019

The Journal of Dermatology

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“…[18] However, glucocorticoids did not significantly reduce the risk of relapse in adults with anaphylaxis. [19] In the absence of a clinical trial to guide decision-making, we believe steroids should be given in the ED as adjuvant treatment, especially to patients with asthma or airway edema. Evidence to guide outpatient use of glucocorticoids is sparse, but 48-72 hours of continuing treatment based on the time window of biphasic reactions is typical.…”

Section: Adjuvant Medicationsmentioning

confidence: 99%

Anaphylaxis in children

Farbman

Michelson²

2016

Current Opinion in Pediatrics

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Incorporation of a theme‐based research model into a pharmacy department research program

Welch

Johns

Nicholls

et al. 2019

Pharmacy Practice and Res

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In Australian hospital pharmacy departments, research programs are growing. Research is encouraged to be part of standard practice by many Society of Hospital Pharmacists of Australia (SHPA) Standards of Practice documents and, in 2017, the SHPA National Translational Research Collaborative was implemented. Traditionally, the postgraduate research degree format is one of a themebased research model. Theme-based research has been implemented in the Pharmacy Department of St Vincent's Hospital (Sydney) and a body of work has been produced. To illustrate this process, our work in the area of anaphylaxis and allergy in the emergency department over 10 years is described. This model has also been implemented for other target areas with success. It is a model that could be implemented at other sites to promote a collaborative research culture in a pharmacy department and build a body of work in a targeted area.Theme-based pharmacy research model a Two to an allergy clinic, two via a general practitioner.

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

Cited by 41 publications

References 20 publications

Factors associated with relapses among patients treated for acute urticaria

Factors associated with relapses among patients treated for acute urticaria

Anaphylaxis in children

Incorporation of a theme‐based research model into a pharmacy department research program

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