Aetiology of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka

Abstract

BackgroundThe aetiology of anaphylaxis differs according to types of foods consumed, fauna and foliage and cultural practices. Although the aetiology of anaphylaxis in Western countries are well known, the causes in South Asian countries have not been reported. We sought to determine the causes of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka.Methods238 episodes of anaphylaxis were reviewed in 188 patients who were referred and skin prick tests and in vitro tests (ImmunoCap) were carried out to assess the presence of allergen specific IgE. Clinical features and severity of anaphylaxis was also recorded along with treatment received.ResultsAnaphylaxis to food either following direct exposure 90/238 (37.5%) or after exercise in the form of food dependent exercise induced anaphylaxis 29/238 (12.2%) was the predominant cause of anaphylaxis. Allergy to cow’s milk and red meat, after immediate exposure, accounted for 66/238 (27.7%) of instances of all episodes of anaphylaxis and 66/90 (73.33%) of anaphylaxis due to food. Vaccines accounted for 28/238 (11.8%) of instances of anaphylaxis, especially among children. Of those who developed anaphylaxis to the MMR (n = 14), 71.4% of them had specific IgE to cow’s milk and 35.7% of them had specific IgE to beef. Of those who developed anaphylaxis to insect stings, 27/42 of these episodes occurred following stings of ants (family Formicidae). The predominant cause of anaphylaxis changed with the age, with food allergy being the most frequent trigger of anaphylaxis in childhood, while drug allergy and idiopathic anaphylaxis being more frequent after 30 years of age.ConclusionsIn this cohort, anaphylaxis to red meat appears to be the predominant cause of food induced anaphylaxis and presence of beef specific IgE and cow’s milk, appears to be a predisposing factor for vaccine induced anaphylaxis.

Challenges of managing food allergy in the developing world

“…Likewise, peanut (0.43%) and tree nut allergies (0.3%) were infrequently reported in Philippine schoolchildren, 74 but the prevalence of fish allergy was relatively higher (2.29%) 75 . Peanut allergy was also rarely observed in South Asian countries such as Sri Lanka, Bangladesh, and India 99 , 100 …”

“…Beef allergy was the most common anaphylaxis trigger in children and adults seen in an immunology clinic in Colombo, Sri Lanka 100 . Sensitization to galactose-α-1,3-galactose (α-Gal) typically manifests with delayed onset allergic reactions upon exposure to all red-meats with raised α-Gal IgE and low specific IgE to beef.…”

Evidence update on vaccine allergy

“…The first case report of anaphylaxis following the pneumococcal conjugate vaccine was reported in 2016. Carrier protein CRM 197 was suggested to be the trigger [17]. This was further supported by skin testing and the basophil activation test.…”

Alergia a la proteína de la leche de vaca o intolerancia a lactosa: un estudio transversal en estudiantes universitarios

“…Según el área geográfica, los alimentos que con más frecuencia se relacionan con anafilaxia son la LV, los pescados y mariscos y los frutos secos. 22,25,26,27 En este estudio, la prevalencia de anafilaxia inducida por LV fue de 0.25 %, que contrasta notoriamente con los hallazgos observados previamente en México, Cuadro 2. Manifestaciones clínicas asociadas con alergia a la proteína de la leche de vaca e intolerancia a la lactosa (n = 158) 23 en adultos jóvenes no se documentaron casos de anafilaxis relacionada con el consumo de LV.…”