Two-Hour Observation Probably Safe for Most Children With Anaphylaxis
THURSDAY, June 26, 2025 -- For most children who present to an emergency department with an acute allergic reaction requiring epinephrine, a two-hour observation period is probably safe, according to a study published online June 10 in The Lancet Child & Adolescent Health.
Timothy E. Dribin, M.D., from Cincinnati Children's Hospital Medical Center, and colleagues conducted a multicenter, retrospective cohort study across 30 emergency departments involving children presenting to the emergency department with anaphylaxis to calculate the incidence rate and timing of repeat epinephrine dosing. A total of 5,641 patients with anaphylaxis were eligible for inclusion (median age, 7.9 years).
The researchers found that 4.7 percent of patients received a repeat epinephrine after two hours of the first dose, while 1.9, 1.1, and 0.8 percent received repeat epinephrine after four, six, and eight hours, respectively. The observation period at which the increase in cumulative incidence of repeat epinephrine was less than 2 percent was 115, 105, 109, and 161 minutes for all patients, patients without respiratory or cardiovascular involvement, for patients with respiratory but no cardiovascular involvement, and for patients with cardiovascular involvement, respectively. Based on these findings, 95.3 and 98.1 percent of patients in the cohort would have been safely discharged two and four hours after the first epinephrine dose, respectively.
"This data allows clinicians to make decisions about observation based on their risk tolerance and that of the patient and the family," Dribin said in a statement.
One author disclosed ties to the biopharmaceutical industry.
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Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.
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