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

Abstract

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.

Intervention in anaphylaxis: the experience of one paediatric centre based on NORA reports

“…since we worked at the tertiary reference centre for diagnostics and immunotherapy for children with allergy to insect venom. However, the majority of the paediatric data including the prospective ones, indicated food as the most common factor triggering anaphylaxis in children [1,3,[14][15][16][17][18]. Nevertheless, the allergy profile in different age groups of our patients corresponded well with the rest of the registry; food allergy was predominant in the preschool group, insect venom was more prevalent in school children.…”

IgE-Mediated Food Allergy

“…In a prospective study published in 2017, anaphylaxis cases were evaluated from 2013 to 2014. Upon review, in 180 anaphylactic patients identified, 83% received glucocorticoids while only 25% received adrenaline [44]. There is an overall lack of evidence for clear benefit of glucocorticoids, but it is frequently used.…”

Adherence to adrenaline autoinjector prescriptions in patients with anaphylaxis

“…In a prospective study (APOTECA), 226 patients with suspected anaphylaxis were seen at the Emergency Department (ED), Odense University Hospital (OUH), during 1st of May 2013 through 30th of April 2014 [4 ]. In the study the suspected allergic reaction at the ED was classified according to the EAACI diagnostic criteria for anaphylaxis.…”