Epinephrine scripts and referral to allergist after ED admission; and a challenging case of periorbital eyelid swelling

November 27, 2017

There are two additional special articles that I call your attention to in the November issue of the Annals of Allergy, Asthma and Immunology that should be of benefit to you in the care of your patients. The first, authored by Megan Motosue, MD, and colleagues, examine the likelihood of patients admitted to the Emergency Department (ED) for episodes of anaphylaxis to be prescribed an epi-pen and referred to an allergy-immunology specialist for follow up. In a sample of almost 8,000 affected patients in a 4-year span, less than half had an epi pen prescribed and a little over a fourth were referred to AI specialist.  Those least likely to have epi pens and AI referral were patients over age 65 with an ingested medication as the suspected trigger. Those most likely to have both epi pen and referral were children less than 5 and food or venom exposure as suspected triggers. These data support the notion that more needs to be communicated with our ED colleagues about optimal treatment and referral patterns in this patient population.

Another interesting article is a provocative MOC CME case study from Misu Paul, MD, and colleagues who presented a challenging case of periorbital eyelid swelling initially thought to be due to infection for which she received two courses of antibiotics without relief. Ophthalmology referral was not helpful and when sent to the author’s AI clinic for further evaluation was now thought to have some type of ocular allergy. A thorough AI workup is described and the patient was ultimately diagnosed with blepharochalisis. This case nicely reminds us of the need for a well-defined differential diagnosis beyond allergy syndromes in our patients with histories that do not fit standard paradigms.

These and other interesting features await your inspection in the pages of the November Annals. I welcome your comments.