Anaphylaxis during pregnancy

Simons, F. Estelle R.; Schatz, Michael

doi:10.1016/j.jaci.2012.06.035

Cited by 135 publications

(100 citation statements)

References 60 publications

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“…When cardiopulmonary resuscitation is indicated in a fully gravid woman, continuous chest compressions can be difficult. Emergency cesarean delivery is sometimes necessary [59]. …”

Section: Management Of Anaphylaxis In Health Care Settingsmentioning

confidence: 99%

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Simons

Ardusso

Dimov

et al. 2013

Int Arch Allergy Immunol

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244

181

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The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis are a widely disseminated and used resource for information about anaphylaxis. They focus on patients at risk, triggers, clinical diagnosis, treatment in health care settings, self-treatment in the community, and prevention of recurrences. Their unique strengths include a global perspective informed by prior research on the global availability of essentials for anaphylaxis assessment and management and a global agenda for anaphylaxis research. Additionally, detailed colored illustrations are linked to key concepts in the text [Simons et al.: J Allergy Clin Immunol 2011;127:593.e1-e22]. The recommendations in the original WAO Anaphylaxis Guidelines for management of anaphylaxis in health care settings and community settings were based on evidence published in peer-reviewed, indexed medical journals to the end of 2010. These recommendations remain unchanged and clinically relevant. An update of the evidence base was published in 2012 [Simons et al.: Curr Opin Allergy Clin Immunol 2012;12:389-399]. In 2012 and early 2013, major advances were reported in the following areas: further characterization of patient phenotypes; development of in vitro tests (for some allergens) that help distinguish clinical risk of anaphylaxis from asymptomatic sensitization; epinephrine (adrenaline) research, including studies of a new epinephrine auto-injector for use in community settings, and randomized controlled trials of immunotherapy to prevent food-induced anaphylaxis. Despite these advances, the need for additional prospective studies, including randomized controlled trials of interventions in anaphylaxis is increasingly apparent. This 2013 Update highlights publications from 2012 and 2013 that further contribute to the evidence base for the recommendations made in the original WAO Anaphylaxis Guidelines. Ideally, it should be used in conjunction with these Guidelines and with the 2012 Guidelines Update.

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“…When cardiopulmonary resuscitation is indicated in a fully gravid woman, continuous chest compressions can be difficult. Emergency cesarean delivery is sometimes necessary [59]. …”

Section: Management Of Anaphylaxis In Health Care Settingsmentioning

confidence: 99%

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Simons

Ardusso

Dimov

et al. 2013

Int Arch Allergy Immunol

Self Cite

244

181

View full text Add to dashboard Cite

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“…A study in the USA suggested an incidence of 2.7 cases per 100 000 deliveries 7. It has been proposed that anaphylaxis is increasing in the general population 8, 9. This is of particular concern as case reports indicate that maternal and neonatal outcomes of anaphylaxis in pregnancy are severe 10, 11.…”

Section: Introductionmentioning

confidence: 99%

The incidence, characteristics, management and outcomes of anaphylaxis in pregnancy: a population‐based descriptive study

McCall

Bunch

Brocklehurst

et al. 2018

BJOG

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ObjectiveThe aim of this study was to estimate the incidence of anaphylaxis in pregnancy and describe the management and outcomes in the UK.DesignA population‐based descriptive study using the UK Obstetric Surveillance System (UKOSS).SettingAll consultant‐led maternity units in the UK.PopulationAll pregnant women who had anaphylaxis between 1 October 2012 and 30 September 2015. Anaphylaxis was defined as a severe, life‐threatening generalised or systemic hypersensitivity reaction.MethodsProspective case notification using UKOSS.Main outcome measuresMaternal mortality, severe maternal morbidity, neonatal mortality and severe neonatal morbidity.ResultsThere were 37 confirmed cases of anaphylaxis in pregnancy, giving an estimated incidence of 1.6 (95% CI: 1.1–2.2) per 100 000 maternities. Four cases of anaphylaxis were in women with known penicillin allergies: two received co‐amoxiclav and two cephalosporins. Twelve women had anaphylaxis following prophylactic use of antibiotics at the time of a caesarean delivery. Prophylactic use of antibiotics for Group B streptococcal infection accounted for anaphylaxis in one woman. Two women died (5%), 14 (38%) women were admitted to intensive care and seven women (19%) had one or more additional severe maternal morbidities, which included three haemorrhagic events, two cardiac arrests, one thrombotic event and one pneumonia. No infants died; however, in those infants whose mother had anaphylaxis before delivery (n = 18) there were seven (41%) neonatal intensive care unit admissions, three preterm births and one baby was cooled for neonatal encephalopathy.ConclusionsAnaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration. This study highlights the seriousness of the outcomes of this condition for the mother. The low incidence is reassuring given the large proportion of the pregnant population that receive prophylactic antibiotics during delivery.Tweetable abstractAnaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration.

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“…The patient should be placed in the supine position, and the legs should be lifted to prevent circulatory collapse. The passive leg-raising maneuver was implemented in our patient to place him in the sitting position; otherwise, the empty inferior vena cava/empty ventricle syndrome can cause cardiac arrest (5). Epinephrine (0.3-0.5 mg IM 1/1000 solution) is the first-use drug in acute anaphylaxis, but at Pumphrey's study they found that only 14% of patients are administered epinephrine before cardiac arrest (6).…”

Section: Discussionmentioning

confidence: 99%