Glucocorticoids and Rates of Biphasic Reactions in Patients with Adrenaline-Treated Anaphylaxis: A Propensity Score Matching Analysis.
Adrenaline
Anaphylaxis
Biphasic reaction
Glucocorticoids
Propensity score
Journal
International archives of allergy and immunology
ISSN: 1423-0097
Titre abrégé: Int Arch Allergy Immunol
Pays: Switzerland
ID NLM: 9211652
Informations de publication
Date de publication:
2022
2022
Historique:
received:
03
10
2021
accepted:
12
04
2022
pubmed:
9
5
2022
medline:
9
9
2022
entrez:
8
5
2022
Statut:
ppublish
Résumé
The effectiveness of glucocorticoids in preventing biphasic reactions in patients with anaphylaxis remains controversial. We evaluated the effects of glucocorticoids on rates of biphasic reactions in hospitalized patients with anaphylaxis treated with adrenaline. In this retrospective observational study using a national inpatient database in Japan, we identified 31,570 hospitalized patients with anaphylaxis treated with adrenaline on the day of admission. We divided them into two groups: those who were treated with adrenaline plus glucocorticoids and those who received adrenaline only on the day of admission. The primary outcome was the occurrence of a biphasic reaction, defined as requiring two or more ampules of adrenaline within 7 days of admission. We performed a one-to-four propensity score matching analysis to compare the outcomes between the two groups. Of the 31,570 eligible patients, 28,145 (89.2%) were treated with glucocorticoids on the day of admission. The overall percentage of biphasic reactions within 7 days of admission was 11.2%. One-to-four propensity score matching created matched cohorts of 3,425 patients in the control group and 13,700 patients in the glucocorticoid group. After propensity score matching, there were no significant differences in rates of biphasic reactions (10.7% in the glucocorticoids group vs. 10.5% in the control group; odds ratio, 1.03; 95% confidence interval, 0.85-1.24; p = 0.77) between patients with anaphylaxis treated with and without glucocorticoids on the day of admission. Our findings do not support the use of glucocorticoids to prevent biphasic reactions in hospitalized patients with severe anaphylaxis requiring adrenaline.
Sections du résumé
BACKGROUND
The effectiveness of glucocorticoids in preventing biphasic reactions in patients with anaphylaxis remains controversial.
OBJECTIVE
We evaluated the effects of glucocorticoids on rates of biphasic reactions in hospitalized patients with anaphylaxis treated with adrenaline.
METHODS
In this retrospective observational study using a national inpatient database in Japan, we identified 31,570 hospitalized patients with anaphylaxis treated with adrenaline on the day of admission. We divided them into two groups: those who were treated with adrenaline plus glucocorticoids and those who received adrenaline only on the day of admission. The primary outcome was the occurrence of a biphasic reaction, defined as requiring two or more ampules of adrenaline within 7 days of admission. We performed a one-to-four propensity score matching analysis to compare the outcomes between the two groups.
RESULTS
Of the 31,570 eligible patients, 28,145 (89.2%) were treated with glucocorticoids on the day of admission. The overall percentage of biphasic reactions within 7 days of admission was 11.2%. One-to-four propensity score matching created matched cohorts of 3,425 patients in the control group and 13,700 patients in the glucocorticoid group. After propensity score matching, there were no significant differences in rates of biphasic reactions (10.7% in the glucocorticoids group vs. 10.5% in the control group; odds ratio, 1.03; 95% confidence interval, 0.85-1.24; p = 0.77) between patients with anaphylaxis treated with and without glucocorticoids on the day of admission.
CONCLUSION
Our findings do not support the use of glucocorticoids to prevent biphasic reactions in hospitalized patients with severe anaphylaxis requiring adrenaline.
Identifiants
pubmed: 35526528
pii: 000524612
doi: 10.1159/000524612
pmc: PMC9533429
doi:
Substances chimiques
Glucocorticoids
0
Epinephrine
YKH834O4BH
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
939-945Informations de copyright
© 2022 The Author(s). Published by S. Karger AG, Basel.
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