The following is the summary of “Predictors of Acute Care Reutilization in Pediatric Patients With Amoxicillin-Associated Reactions” published in the November 2022 issue of Allergy and Clinical Immunology by Xie, et al.

There is a significant impact on healthcare spending from amoxicillin-associated responses (AARs), with a reutilization rate of 10% in the pediatric emergency department (ED) and urgent care (UC) settings. Examining patients’ clinical characteristics and physicians’ handling of AARs, we hope to discover determinants of ED/UC reutilization. Researchers conducted a retrospective chart analysis of 668 patients with AARs over a 2-year period, looking at rash phenotype, systemic symptoms (fever, angioedema, joint involvement, gastrointestinal symptoms), and physicians’ management as potential predictors of ED/UC reutilization (pharmacologic treatment and counseling). 

Next, researchers used backward model selection steps to build a statistical model to foresee future ED/UC readmissions. The prevalence of male gender (P=.008), fever (P=.0001), angioedema (P<.0001), joint involvement (P<.0001), and gastrointestinal symptoms (P=.0001) among AAR re-visitors to the ED/UC was also significantly higher. Comparing rash phenotypes across groups, researchers find that ED/UC reusers are more likely to have urticaria (P<.0001). However, at the outset of care in the ED/UC, there were no variations in clinical management between groups. Their statistical model also found that patients younger than 2 were more likely to re-use ED/UC resources if their physicians did not document explicit return precautions (odds ratio, 3.6; 95% CI, 1.7-7.7).

 Improved anticipatory counseling and early allergy consultation are 2 examples of treatments that can be used to optimize care for children presenting with AARs by addressing the clinical characteristics and treatment gaps related to ED/UC reutilization. Further prospective research is required to ascertain whether or not these treatments will decrease subsequent visits to the ED/UC and improve access to timely allergy testing.

Source: sciencedirect.com/science/article/abs/pii/S2213219822006985