Most kids don't need overnight care after allergic reactions
Researchers said most children with allergic reactions can be safely treated with an epinephrine injection and discharged. Photo by Adobe Stock/HealthDay News
Many kids are spending a lot of unnecessary time under observation in a hospital following a sudden allergic emergency, a new study concludes.
About 17% of kids are admitted for overnight observation following a scary allergic reaction to food, medicine or insect bites, researchers reported.
But 95% of children treated for allergic reactions can be safely discharged within two hours after receiving a dose of epinephrine, according to results published in The Lancet: Child and Adolescent Health.
That number rises to 98% if doctors err on the side of caution and keep kids under observation for four hours, researchers found.
"For most patients, we are probably observing them too long," said researcher Dr. Kenneth Michelson, a pediatric emergency specialist at Ann & Robert H. Lurie Children's Hospital of Chicago.
"This might sound minor, but if you brought your toddler in for a scary allergic reaction, it's the difference between going home at 11 p.m. versus going home at 1 a.m. or 3 a.m.," he said in a news release. "Our finding gives us more confidence that after a couple of hours, if symptoms are improving in specific ways, we can probably send the child home."
Most kids who'd had an allergic reaction can be routinely treated with an epinephrine jab and sent home, researchers said in background notes.
However, about 5% experience a "biphasic reaction," meaning their symptoms can return despite that first dose of epinephrine, researchers said.
For this study, researchers gathered data from more than 5,600 ER visits at 31 hospitals in the U.S. and Canada where allergic reactions were treated with an epinephrine injection.
About 90% of the kids had experienced an allergic reaction to foods like peanuts, eggs, milk, shellfish, sesame, gluten or soy, researchers said. Another 6% reacted to medication and 3% to insect stings.
Only about 5% of the kids needed a second dose of epinephrine within two hours of their initial injection, researchers found. Likewise, only 2% needed the second jab after four hours.
Most kids admitted to hospital beds never needed a second epinephrine shot or intensive care, the study concluded.
This means these kids and their parents are undergoing additional hassle for no real benefit, researchers said.
"We have seen patients and their families avoid or delay going to the emergency department because they didn't want to sit there for hours of observation," researcher Dr. Hugh Sampson, an allergist at Icahn School of Medicine at Mount Sinai in New York City, said in a news release. "Such delays can prove dangerous. This study's findings support discharging patients more expeditiously, which will likely reduce patient reluctance to seek necessary help."
Holding kids needlessly also ties up crucial hospital resources, the team added.
"Pediatric emergency departments can get crowded quite quickly, especially during winter infection season. We need to ensure efficient throughput to allow us to provide access to as many patients as we can," senior researcher Dr. David Schnadower, director of emergency medicine at Cincinnati Children's, said in a news release.
"An important value of this study is that it was large enough that the results can give clinicians confidence that discharging patients showing no concerning symptoms in less than two hours is going to be safe for most children," he added.
More information
Johns Hopkins Medicine has more on allergic reactions in children.
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Most kids don't need overnight care after allergic reactions
Researchers said most children with allergic reactions can be safely treated with an epinephrine injection and discharged. Photo by Adobe Stock/HealthDay News Many kids are spending a lot of unnecessary time under observation in a hospital following a sudden allergic emergency, a new study concludes. About 17% of kids are admitted for overnight observation following a scary allergic reaction to food, medicine or insect bites, researchers reported. But 95% of children treated for allergic reactions can be safely discharged within two hours after receiving a dose of epinephrine, according to results published in The Lancet: Child and Adolescent Health. That number rises to 98% if doctors err on the side of caution and keep kids under observation for four hours, researchers found. "For most patients, we are probably observing them too long," said researcher Dr. Kenneth Michelson, a pediatric emergency specialist at Ann & Robert H. Lurie Children's Hospital of Chicago. "This might sound minor, but if you brought your toddler in for a scary allergic reaction, it's the difference between going home at 11 p.m. versus going home at 1 a.m. or 3 a.m.," he said in a news release. "Our finding gives us more confidence that after a couple of hours, if symptoms are improving in specific ways, we can probably send the child home." Most kids who'd had an allergic reaction can be routinely treated with an epinephrine jab and sent home, researchers said in background notes. However, about 5% experience a "biphasic reaction," meaning their symptoms can return despite that first dose of epinephrine, researchers said. For this study, researchers gathered data from more than 5,600 ER visits at 31 hospitals in the U.S. and Canada where allergic reactions were treated with an epinephrine injection. About 90% of the kids had experienced an allergic reaction to foods like peanuts, eggs, milk, shellfish, sesame, gluten or soy, researchers said. Another 6% reacted to medication and 3% to insect stings. Only about 5% of the kids needed a second dose of epinephrine within two hours of their initial injection, researchers found. Likewise, only 2% needed the second jab after four hours. Most kids admitted to hospital beds never needed a second epinephrine shot or intensive care, the study concluded. This means these kids and their parents are undergoing additional hassle for no real benefit, researchers said. "We have seen patients and their families avoid or delay going to the emergency department because they didn't want to sit there for hours of observation," researcher Dr. Hugh Sampson, an allergist at Icahn School of Medicine at Mount Sinai in New York City, said in a news release. "Such delays can prove dangerous. This study's findings support discharging patients more expeditiously, which will likely reduce patient reluctance to seek necessary help." Holding kids needlessly also ties up crucial hospital resources, the team added. "Pediatric emergency departments can get crowded quite quickly, especially during winter infection season. We need to ensure efficient throughput to allow us to provide access to as many patients as we can," senior researcher Dr. David Schnadower, director of emergency medicine at Cincinnati Children's, said in a news release. "An important value of this study is that it was large enough that the results can give clinicians confidence that discharging patients showing no concerning symptoms in less than two hours is going to be safe for most children," he added. More information Johns Hopkins Medicine has more on allergic reactions in children. Copyright © 2025 HealthDay. All rights reserved.
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