Anaphylaxis in an emergency care setting: a one year prospective study in children and adults
Tóm tắt
Current data on anaphylaxis is based on retrospective and register based studies. The objective of this study was to describe the epidemiology of anaphylaxis in a 1 year prospective study at the emergency care setting, Odense University Hospital, Denmark (2013–2014). Prospective study at the emergency care setting, Odense University Hospital, Denmark (2013–2014). To identify anaphylaxis cases, records from all patients with clinical suspicion on anaphylaxis or a related diagnosis according to the International Classification of Diseases 10 and from patients treated at the emergency care setting or at prehospital level with adrenaline, antihistamines or glucocorticoids were reviewed daily. The identified cases were referred to the Allergy Center, where a standardized interview regarding the anaphylactic reaction was conducted. International guidelines were applied for the assessment of anaphylaxis and its pharmacological treatment. Severity of the anaphylactic reaction was evaluated according to Sampson’s severity score. We identified 180 anaphylactic patients. Anaphylaxis represented 0.3%–0.4% of all contacts in the emergency care setting with an incidence rate of 26.8 cases per 100,000 person years (95% CI: 14.3–45.8) in children and 40.4 cases per 100,000 person years (95% CI: 32.8–49.3) in adults. Moderate to severe anaphylaxis was registered in 96% of the cases. Skin (96%) and respiratory (79%) symptoms were the most frequent registered, but 7% of cases in adults occurred without skin manifestations. The most common elicitor in children was food (61%), while drugs (48%) and venom (24%) were the main suspected elicitors in adults. Adrenaline was administered in 25% of the cases and it was significantly less administered than glucocorticoids (83%) and antihistamines (91%). The mortality rate during our study period was 0.3 cases per 100,000 person years. This is one of the first prospective studies on the epidemiology of anaphylaxis in children and adults, where the patients are identified not only based on diagnosis codes but also on history, symptoms and treatment and thereafter classified according to international diagnosis criteria for anaphylaxis. A limitation of this study is that only patients who gave consent to participate in the study were included. Furthermore, patients may have attended other hospitals during the study period. Therefore, the estimates are minimum figures. The prospective study design with a broad search profile yield a higher incidence than previously reported. Adrenaline was administered in a low proportion of the patients with moderate to severe anaphylaxis. Standardized diagnosis criteria among physicians treating anaphylaxis are needed.
Tài liệu tham khảo
Simons FE, Ardusso LR, Bilo MB, El-Gamal YM, Ledford DK, Ring J, et al. World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011;4(2):13–37.
Lieberman P, Camargo Jr CA, Bohlke K, Jick H, Miller RL, Sheikh A, et al. Epidemiology of anaphylaxis: findings of the American college of allergy, asthma and immunology epidemiology of anaphylaxis working group. Ann Allergy Asthma Immunol. 2006;97(5):596–602.
Panesar SS, Javad S, de Silva D, Nwaru BI, Hickstein L, Muraro A, et al. The epidemiology of anaphylaxis in Europe: a systematic review. Allergy. 2013;68(11):1353–61.
Lee S, Hess EP, Lohse C, Gilani W, Chamberlain AM, Campbell RL. Trends, characteristics, and incidence of anaphylaxis in 2001–2010: A population-based study. J Allergy Clin Immunol. 2017;139:182–8.
Mostmans Y, Blykers M, Mols P, Gutermuth J, Grosber M, Naeije N. Anaphylaxis in an urban Belgian emergency department: epidemiology and aetiology. Acta Clin Belg. 2016;71(2):99–106.
Hitti EA, Zaitoun F, Harmouche E, Saliba M, Mufarrij A. Acute allergic reactions in the emergency department: characteristics and management practices. Eur J Emerg Med. 2015;22(4):253–9.
Hochstadter E, Clarke A, De Schryver S, LaVieille S, Alizadehfar R, Joseph L, et al. Increasing visits for anaphylaxis and the benefits of early epinephrine administration: a 4-years study at a pediatric emergency department in Montreal, Canada. J Allergy Clin Immunol. 2016;137(6):1888–90.e4.
Simons FE, Ardusso LR, Bilo MB, Dimov V, Ebisawa M, El-Gamal YM, et al. 2012 update: world allergy organization guidelines for the assessment and management of anaphylaxis. Curr Opin Allergy Clin Immunol. 2012;12(4):389–99.
Worm M, Eckermann O, Dolle S, Aberer W, Beyer K, Hawranek T, et al. Triggers and treatment of anaphylaxis: an analysis of 4,000 cases from Germany. Austria Switzerland Dtsch Arztebl Int. 2014;111(21):367–75.
Brown SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol. 2004;114(2):371–6.
Worm M, Edenharter G, Rueff F, Scherer K, Pfohler C, Mahler V, et al. Symptom profile and risk factors of anaphylaxis in Central Europe. Allergy. 2012;67(5):691–8.
Muraro A, Roberts G, Worm M, Bilo MB, Brockow K, Fernandez Rivas M, et al. Anaphylaxis: guidelines from the European academy of allergy and clinical immunology. Allergy. 2014;69(8):1026–45.
Beyer K, Eckermann O, Hompes S, Grabenhenrich L, Worm M. Anaphylaxis in an emergency setting - elicitors, therapy and incidence of severe allergic reactions. Allergy. 2012;67(11):1451–6.
Alvarez-Perea A, Tomas-Perez M, Martinez-Lezcano P, Marco G, Perez D, Zubeldia JM, et al. Anaphylaxis in adolescent/adult patients treated in the emergency department: differences between initial impressions and the definitive diagnosis. J Investig Allergol Clin Immunol. 2015;25(4):288–94.
Loprinzi Brauer CE, Motosue MS, Li JT, Hagan JB, Bellolio MF, Lee S, et al. Prospective validation of the NIAID/FAAN criteria for emergency department diagnosis of anaphylaxis. J Allergy Clin Immunol Pract. 2016;4(6):1220–6.
Mikkelsen S, Kruger AJ, Zwisler ST, Brochner AC. Outcome following physician supervised prehospital resuscitation: a retrospective study. BMJ Open. 2015;5(1):e006167.
Sampson HA. Anaphylaxis and emergency treatment. Pediatrics. 2003;111(6 Pt 3):1601–8.
Ruiz Oropeza A, Mikkelsen S, Bindslev-Jensen C, Mortz CG. Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study. Scand J Trauma Resusc Emerg Med. 2017;25(1):4.
Ward MJ, Kripalani S, Zhu Y, Storrow AB, Dittus RS, Harrell Jr FE, et al. Incidence of emergency department visits for ST-elevation myocardial infarction in a recent six-years period in the United States. Am J Cardiol. 2015;115(2):167–70.
Sorensen HT, Nielsen B, Ostergaard NJ. Anaphylactic shock occurring outside hospitals. Allergy. 1989;44(4):288–90.
Jeppesen AN, Christiansen CF, Froslev T, Sorensen HT. Hospitalization rates and prognosis of patients with anaphylactic shock in Denmark from 1995 through 2012. J Allergy Clin Immunol. 2016;137(4):1143–7.
Bohlke K, Davis RL, DeStefano F, Marcy SM, Braun MM, Thompson RS. Epidemiology of anaphylaxis among children and adolescents enrolled in a health maintenance organization. J Allergy Clin Immunol. 2004;113(3):536–42.
Sole D, Ivancevich JC, Borges MS, Coelho MA, Rosario NA, Ardusso LR, et al. Anaphylaxis in Latin America: a report of the online Latin American survey on anaphylaxis (OLASA). Clinics (Sao Paulo). 2011;66(6):943–7.
Wang J, Sampson HA. Food anaphylaxis. Clin Exp Allergy. 2007;37(5):651–60.
Nwaru BI, Hickstein L, Panesar SS, Muraro A, Werfel T, Cardona V, et al. The epidemiology of food allergy in Europe: a systematic review and meta-analysis. Allergy. 2014;69(1):62–75.
Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy. 2000;30(8):1144–50.
Bock SA, Munoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol. 2007;119(4):1016–8.