Improving Throughput, Twelve Trials of Christmas!

Day 8 of Christmas- Dexamethasone for Allergic Reactions

Welcome to the Twelve Trials of Christmas series on EMinFocus! This is the eighth of twelve posts in a series where I ramble on various topics for which I would love to see an EM study done. I’ve taken morsels of prior studies (case series, small trials, etc) and highlight reasons on why I believe this study would benefit EM. Some may pan out, some may not. All of them I would be highly interested in assisting with in any way possible to continue to advance our fine specialty.

We’ve seen that two dose dexamethasone is as effective for pediatric asthma exacerbations as prednisone. In fact, there are fewer missed school days for children and adults return to work sooner with two days of decadron rather than 5 days of prednisone with similar relapse rates.  There is decent evidence here and here that a single intramuscular dose of dexamethasone for young asthmatics (<8 yrs, mean age 36 months) is sufficient.  To wit, 40% of children missed >30% of the oral prednisone dose vs receiving all of the IM dexamethasone dose despite parental efforts, with 70% of parents in both the oral prednisone and the IM dexamethasone group would choose IM dexamethasone to treat their child’s next asthma exacerbation.

With all of this information, why not apply it to allergic reactions? We know that biphasic reactions are rare and rarely life threatening. One or two doses of decadron plus an epiPen to go with over the counter diphenhydramine for mild breakthrough pruritis should likely do the trick. Easy trial to do, yet amazingly no literature for dexamethasone in allergic reactions.

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