Effects of Glucocorticoids on Hospitalized Children With Anaphylaxis

Abstract

Background 

The benefits of glucocorticoid treatment and recent trends of adjunctive treatments during episodes of anaphylaxis remain unclear.

Objectives 

The aims of this study were to investigate the recent practice patterns and compare the effects of glucocorticoid for children hospitalized with anaphylaxis.

Methods 

Using the Japanese Diagnosis Procedure Combination inpatient database, we compared the length of hospital stay, risk of 10-day readmission, and total hospitalization cost between the steroid and nonsteroid groups. We also evaluated recent trends of adjunctive treatments for anaphylaxis.

Results 

From 2010 to 2014, the proportions of H₁-receptor antagonist use increased from 65.1% to 71.8% (P_trend = 0.02). The proportions of H₂-receptor antagonist use showed an upward trend, ranging from 12.8% to 16.7% (P_trend = 0.01). No significant change in glucocorticoid use was observed (from 86.7% to 82.6%; P_trend = 0.08). Stabilized inverse probability-weighting analyses showed that the total length of hospital stay was 0.39 days longer in the steroid group than in the nonsteroid group (95% confidence interval, 0.29–0.49 days). Total hospitalization cost was greater in the steroid group than in the nonsteroid group (difference, ¥3896; 95% confidence interval, ¥2464–¥5562). No significant difference in risk of 10-day readmission was observed between the groups. Instrumental variable analyses showed similar results to stabilized inverse probability-weighting analyses.

Conclusions 

We observed increasing trends of H₁- and H₂-receptor antagonist use. Length of hospital stay and total hospitalization cost were greater in the steroid group than in the nonsteroid group, whereas readmission risks were similar between the 2 groups.