{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T05:52:30Z","timestamp":1782885150944,"version":"3.54.5"},"reference-count":28,"publisher":"Oceanside Publications Inc.","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["allergy asthma proc"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Anaphylaxis is a life-threatening allergic reaction that requires prompt epinephrine and post-treatment management. Guidelines recommend prescribing epinephrine at discharge from the emergency department (ED), yet results of studies show lower-than-recommended\n prescribing rates and variable ED lengths of stay (LOS). Large-scale analyses of adult anaphylaxis care in U.S. EDs remain limited.\n                    <jats:bold>Objective:<\/jats:bold>\n                    The objective was to estimate the proportion of adults discharged from U.S. EDs with an epinephrine prescription, characterize\n ED LOS, and identify predictors of these outcomes.\n                    <jats:bold>Methods:<\/jats:bold>\n                    We analyzed 2013\u20102015 and 2018\u20102022 National Hospital Ambulatory Medical Care Survey\u2010ED visits for adults ages \u2265 18 years diagnosed with anaphylaxis who were discharged home. Outcomes were\n (1) epinephrine prescription at discharge and (2) ED LOS &lt; 4 hours. Patients who arrived by emergency medical services (EMS) were excluded for LOS analysis. Multivariable log-binomial regression estimated risk ratios (RR) between outcomes and clinical predictors.\n                    <jats:bold>Results:<\/jats:bold>\n                    Among 609 ED visits, 14% resulted in an epinephrine prescription at discharge (95% confidence interval [CI], 10%\u201018%). The median (interquartile range) LOS was 138 minutes (80\u2010199 minutes), with 83% discharged within 4 hours (95% CI, 78%\u201087%). Older adults (\u226542\n years) and Hispanic patients were less likely to receive an epinephrine prescription (RR 0.47 [95% CI, 0.25\u20100.90]; RR 0.34 [95% CI, 0.12\u20100.95], respectively). Rural visits were more likely to have LOS &lt; 4 hours (RR 1.12 [95% CI, 1.02\u20101.23]).\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    Epinephrine prescribing at discharge was infrequent across the full cohort, whereas ED LOS was typically brief among the patients who did not arrive by EMS. Older adults and Hispanic patients were less likely to receive epinephrine, and rural visits had shorter LOS. These findings highlight\n potential disparities in discharge prescribing and ED management of adult anaphylaxis in U.S. EDs.\n                  <\/jats:p>","DOI":"10.2500\/aap.2026.47.260039","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:30:30Z","timestamp":1782361830000},"page":"264-273","source":"Crossref","is-referenced-by-count":1,"title":["Patterns of epinephrine prescribing at discharge and length of stay for adult anaphylaxis in U.S. emergency departments"],"prefix":"10.2500","volume":"47","author":[{"given":"Esther Y.","family":"Liu","sequence":"first","affiliation":[{"name":"Division of Allergy and Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cancan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trisha","family":"Ray","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari C.","family":"Nadeau","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Valenzuela-Vallejo","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadija","family":"Salifu","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth J.","family":"Samelson","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth J.","family":"Mukamal","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1355","reference":[{"key":"B1","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.anai.2023.09.015","article-title":"Anaphylaxis: a 2023 practice parameter update","volume":"132","author":"Golden","year":"2024","journal-title":"Ann Allergy Asthma Immunol"},{"key":"B2","article-title":"Anaphylaxis: recognition and management","author":"Pflipsen"},{"key":"B3","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1159\/000354543","article-title":"World Allergy Organization. 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