A Model for Consolidating High-Risk Allergy Procedures in Clinic

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Figure .
Overview of procedures performed in the high-risk allergy procedure clinic. AIT, aeroallergen immunotherapy; ED, emergency department; epi, epinephrine.

Table 1.

Demographic Characteristics of Patients Presenting for High-Risk Allergy Procedures, n=596

Variable	Number of Patients
Pediatric (<18 years)	286 (48.0)
Adult (≥18 years)	310 (52.0)
Age
Mean, years	25
Range	7 months to 86 years
Sex
Female	277 (46.5)
Male	319 (53.5)
Race
Caucasian or White	412 (69.1)
African American or Black	138 (23.2)
American Indian or Alaskan native	7 (1.2)
Asian	25 (4.2)
Other	5 (0.8)
Unknown	9 (1.5)

Table 2.

Types of Challenges Performed, n=596

Challenge Type	Number
Food challenge	305 (51.2)
Aeroallergen immunotherapy rush induction	103 (17.3)
Drug challenge	75 (12.6)
Ultrarush induction of venom immunotherapy	66 (11.1)
Drug desensitization	12 (2.0)
Vaccine challenge (COVID-19, influenza, Tdap)	14 (2.3)
Miscellaneous nonvaccine challenges (pressure or cold challenge, latex challenge, perioperative anaphylaxis testing, radiocontrast media testing, penicillin skin testing, prick-to-prick with food, venom skin testing, hair dye skin tests, and topical medicine skin tests)	21 (3.5)

Table 3.

Food Challenge Outcomes, n=305

	Food Challenge
Outcome	Baked Egg, n=67	Egg, n=55	Baked Milk, n=17	Milk, n=17	Peanut, n=47	Fish, n=13	Shellfish, n=42	Tree Nut, n=25	Other, n=22	Total, n=305
Epinephrine administration	8 (11.9)	9 (16.4)	1 (5.9)	1 (5.9)	2 (4.3)	1 (7.7)	5 (11.9)	3 (12.0)	2 (9.1)	32 (10.5)
Ended early by patient or provider (no epinephrine)	12 (17.9)	10 (18.2)	2 (11.8)	4 (23.5)	7 (14.9)	1 (7.7)	0	2 (8.0)	1 (4.5)	39 (12.8)

Table 4.

Drug Challenge Outcomes, n=75

	Drug Challenge
Outcome	Amoxicillin, n=22^a	NSAID, n=29	Anesthetic, n=7	Other, n=17^b	Total, n=75
Epinephrine administration	1 (4.5)	1 (3.4)	0	0	2 (2.7)
Ended early by patient (no epinephrine)	0	0	2 (28.6)^c	1 (5.9)^d	3 (4.0)

↵^aSeventeen patients had a skin test; all were negative.
↵^bThe following drugs were challenged: 2 ranitidine, 1 azithromycin, 1 betamethasone, 1 prednisone, 1 orphenadrine, 3 cefdinir, 1 penicillin VK, 1 benzylpenicillin, 3 acetaminophen, 1 trimethoprim/sulfamethoxazole, 1 sublingual dust mite tablet, and 1 omalizumab.
↵^cBoth patients had the subjective sensation of their throat closing after the administration of lidocaine.
↵^dThe patient was challenged with cefdinir and experienced foot and trunk pruritus.
Note: Data are presented as n (%).
NSAID, nonsteroidal anti-inflammatory drug.