Acute allergic reactions in the emergency department

Hitti, Eveline; Zaitoun, Fares; Harmouche, Elie; Saliba, Miriam; Mufarrij, Afif

doi:10.1097/mej.0000000000000155

Cited by 18 publications

(17 citation statements)

References 29 publications

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“… 10 , 14 Radiocontrast agents are the leading cause in at least one hospital-based study in South Korea, and also feature prominently in recent studies from Australia and Canada. 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 Similarly, a recent US report found that radiocontrast agents caused more fatal drug anaphylaxis than penicillin and cephalosporins combined. 6 This suggested that radiocontrast administration may carry a relatively high “per injection” fatality risk compared with these frequently used antibiotics.…”

Section: Fatal Drug Anaphylaxismentioning

confidence: 99%

Fatal Anaphylaxis: Mortality Rate and Risk Factors

Turner

Jerschow

Umasunthar

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

397

269

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Up to 5% of the US population has suffered anaphylaxis. Fatal outcome is rare, such that even for people with known venom or food allergy, fatal anaphylaxis constitutes less than 1% of total mortality risk. The incidence of fatal anaphylaxis has not increased in line with hospital admissions for anaphylaxis. Fatal drug anaphylaxis may be increasing, but rates of fatal anaphylaxis to venom and food are stable. Risk factors for fatal anaphylaxis vary according to cause. For fatal drug anaphylaxis, previous cardiovascular morbidity and older age are risk factors, with beta-lactam antibiotics, general anesthetic agents, and radiocontrast injections the commonest triggers. Fatal food anaphylaxis most commonly occurs during the second and third decades. Delayed epinephrine administration is a risk factor; common triggers are nuts, seafood, and in children, milk. For fatal venom anaphylaxis, risk factors include middle age, male sex, white race, cardiovascular disease, and possibly mastocytosis; insect triggers vary by region. Upright posture is a feature of fatal anaphylaxis to both food and venom. The rarity of fatal anaphylaxis and the significant quality of life impact of allergic conditions suggest that quality of life impairment should be a key consideration when making treatment decisions in patients at risk for anaphylaxis.

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Section: Fatal Drug Anaphylaxismentioning

confidence: 99%

Fatal Anaphylaxis: Mortality Rate and Risk Factors

Turner

Jerschow

Umasunthar

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

397

269

View full text Add to dashboard Cite

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“…Delayed injection of epinephrine has been reported in yet another large series of anaphylaxis-related fatalities in which only 23 % of the 92 individuals received it before cardiac arrest [ 93 ]. Although epinephrine injection rates remain low in many EDs [ 94 ], use of protocols or order sets can significantly improve injection rates [ 95 ].…”

Section: Introductionmentioning

confidence: 99%

“…In many countries, EAIs are still unavailable [ 94 ]. Where they are available, they remain under-prescribed and under-used; as an example, only 11 % of 261 individuals with a history of confirmed anaphylaxis had used an EAI during their most recent episode, and 52 % reported that they had never received an EAI prescription [ 8 , 105 ].…”

Section: Introductionmentioning

confidence: 99%

2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines

Simons

Ebisawa

Sánchez‐Borges

et al. 2015

World Allergy Organization Journal

459

344

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The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis provide a unique global perspective on this increasingly common, potentially life-threatening disease. Recommendations made in the original WAO Anaphylaxis Guidelines remain clinically valid and relevant, and are a widely accessed and frequently cited resource. In this 2015 update of the evidence supporting recommendations in the Guidelines, new information based on anaphylaxis publications from January 2014 through mid- 2015 is summarized. Advances in epidemiology, diagnosis, and management in healthcare and community settings are highlighted. Additionally, new information about patient factors that increase the risk of severe and/or fatal anaphylaxis and patient co-factors that amplify anaphylactic episodes is presented and new information about anaphylaxis triggers and confirmation of triggers to facilitate specific trigger avoidance and immunomodulation is reviewed. The update includes tables summarizing important advances in anaphylaxis research.

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“…Moreover, the elicitors may vary according to age, sex and geographical area [ 1 , 3 ]. First line treatment of anaphylaxis is adrenaline [ 1 , 12 ], but previous studies have reported that only a low proportion of anaphylaxis patients receive this treatment [ 6 , 9 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…The acute onset of anaphylaxis, the variable symptoms and its transient and unpredictable nature may complicate prospective studies. As a consequence most of the current knowledge on anaphylaxis is derived from retrospective or register based studies [ 1 – 4 , 6 – 12 ]. To our knowledge, only few studies have assessed anaphylaxis prospectively [ 5 , 13 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Anaphylaxis in an emergency care setting: a one year prospective study in children and adults

Oropeza

Lassen

Halken

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundCurrent 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).MethodsProspective 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.ResultsWe 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.DiscussionThis 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.ConclusionThe 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.

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Acute allergic reactions in the emergency department

Cited by 18 publications

References 29 publications

Fatal Anaphylaxis: Mortality Rate and Risk Factors

Fatal Anaphylaxis: Mortality Rate and Risk Factors

2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines

Anaphylaxis in an emergency care setting: a one year prospective study in children and adults

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