Rethinking Observation Times for Children with Allergic Reactions to Reduce Hospital Stay

Children experiencing sudden allergic reactions, whether due to foods like peanuts, eggs, or shellfish, or other triggers such as insect stings or medications, often face lengthy hospital stays that may not always be necessary. In the United States, emergency department visits for acute allergic reactions among children increased more than threefold between 2008 and 2016. Despite medical advances, many children remain hospitalized for extended periods, even overnight, after receiving initial treatment with epinephrine.

A recent large-scale study involving over 5,000 pediatric cases across 31 hospitals in the US and Canada, published in The Lancet: Child and Adolescent Health on June 10, 2025, suggests that most children could be safely discharged much sooner. The study found that while children often stay for long hours, 95% could be safely sent home within two hours, and 98% within four hours, after treatment if their symptoms are improving.

According to lead researcher Dr. Kenneth Michelson, pediatric emergency medicine specialist at Ann & Robert H. Lurie Children's Hospital of Chicago, this research demonstrates that the standard observation period for severe allergic reactions can be shortened. “For many children, we are observing longer than necessary. The difference between going home at 11 pm versus 1 am or 3 am can be significant for families,” he explained. The findings aim to reduce unnecessary hospital stays, saving time, reducing costs, and providing reassurance to parents.

Dr. Tim Dribin, emergency medicine physician at Cincinnati Children’s, emphasized that most pediatric anaphylaxis cases do not require prolonged hospitalization, especially when there’s no involvement of the cardiovascular system. The study indicated that only about 1% of children needed intensive interventions like ventilators, and the majority did not need a second dose of epinephrine after the initial treatment.

A major concern in current practice is the occurrence of biphasic reactions—where symptoms re-emerge hours after initial relief. About 5% of children experience such reactions, prompting many clinicians to keep children under observation for safety. However, the new research shows that the risk of repeat reactions is low after two to four hours, especially in children without signs of cardiovascular involvement.

The study highlights potential resource savings and better patient experience, advocating for a more tailored approach based on individual risk assessments. This can help alleviate overcrowding in pediatric emergency departments and lessen the emotional and physical burden on children and families.

In conclusion, this evidence supports revising current policies to enable early discharge for most children after allergic reactions, provided they display improving symptoms, ultimately improving care efficiency and patient outcome. Further discussions on implementing these findings are ongoing to ensure safe and effective management of pediatric allergy cases.

source: https://medicalxpress.com/news/2025-06-children-acute-allergic-reactions-unnecessary.html