Predictors of hospital admission for food-related allergic reactions that present to the emergency department

Background Guidelines do not provide specific hospitalization criteria for patients presenting to the emergency department (ED) with food-related allergic reactions. Objective To determine predictors of hospital admission for ED patients with food-related allergic reactions. Methods We performed a medical record review at 3 academic centers of patients presenting to the ED for food-related allergic reactions ( International Classification of Diseases, Ninth Revision, Clinical Modification codes 693.1, 995.0, 995.1, 995.3, 995.7, 995.60–995.69, 558.3, 692.5, and 708.X) between January 1, 2001, and December 31, 2006. We focused on patient demographics, medical history, food triggers, clinical presentation, pre-ED and ED management with a specific focus on epinephrine treatment, and disposition. Predictors of hospital admission were determined using multivariable logistic regression. Results Through random sampling and appropriate weighting, the 1,112 cases reviewed represented a study cohort of 2,583 patients. Most patients (80%) were discharged from the ED. The age and sex of patients admitted to the hospital and those discharged were similar. Multivariable analysis identified 3 factors associated with a higher likelihood of hospital admission: meeting the criteria for food-related anaphylaxis (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.23–4.33), pre-ED epinephrine treatment (OR, 6.65; 95% CI, 3.04–14.57), and epinephrine treatment within 1 hour of ED triage (OR, 3.78; 95% CI, 1.68–8.50). Patients with food-related allergic reactions triggered by shellfish were less likely to be admitted to the hospital (OR, 0.23; 95% CI, 0.08–0.68). Conclusions Most patients presenting to the ED with food-related allergic reactions are discharged. Several patient factors were independently associated with hospital admission in ED patients with food-related allergic reactions.