Randomized blinded pilot trial of corticosteroid after mild-moderate anaphylaxis to prevent recurrence

Corticosteroid appears associated with shortened hospital stay for anaphylaxis in hospital-admitted children but whether Emergency Department (ED)-discharged patients will benefit is uncertain. Unnecessary routine corticosteroid use can have adverse effects. Pilot blinded randomized trial of children 3 months to 14 years presenting with anaphylaxis, comparing ED predischarge 0.3 mg/kg oral dexamethasone solution, 1 mg/mL, maximum 10 mg, or an equal volume of blinded identical placebo, to determine if revisit for recurrence to any health care facility within 7 days would be reduced. Covid-19 resource reallocation resulted in early recruitment suspension. One hundred fifty two patients were randomized, 68 dexamethasone and 75 placebo recipients analyzed. Only 5/75 (6.7%) of placebo recipients required returning, compared to 3/68 (4.4%) for dexamethasone, absolute risk reduction 2.3%, number needed to treat 44 (95% confidence interval, 12 to an infinite), P = .7. Uncommon recurrence and high number needed to treat after ED anaphylaxis treatment suggests against routine ED predischarge corticosteroid without a clinical rationale.