Association Between Severity of Anaphylaxis and Co-occurrence of Respiratory Diseases: A Systematic Review and Meta-analysis of Observational Studies

Tejedor-Alonso, Miguel A; Farias-Aquino, E; Pérez‐Fernández, Elia; Moro‐Moro, Mar; Rosado-Ingelmo, A; Masgrau, Nuria Alberti; Pérez-Codesido, Sabela

doi:10.18176/jiaci.0462

Cited by 10 publications

(10 citation statements)

References 27 publications

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“…This study is unfortunately affected by methodological inconsistencies and high risk of bias, but remains the only report identified which has attempted a more discriminatory approach to asthma control. It was included in a 2021 meta‐analysis which—in contrast to our meta‐analysis—did find a weak association between asthma and severity (OR 1.89, 95% CI 1.26–2.83) 52 . This might be due to the inclusion of studies at medium‐high risk of bias in the 2021 meta‐analysis, and also that only two of the 13 studies included were specific to food.…”

Section: Methodscontrasting

confidence: 64%

“…We identified 32 primary research studies and one systematic review evaluating the relationship between asthma and severity (Table ) 10,13–18,27–52 . Evidence for asthma as a risk factor was contradictory, even within the same dataset when severity is assessed using different criteria 41,42 .…”

Section: Methodsmentioning

confidence: 99%

“…Heterogeneity (I 2 values) are reported in Table 2 95% CI 1.26-2.83). 52 This might be due to the inclusion of studies at medium-high risk of bias in the 2021 meta-analysis, and also that only two of the 13 studies included were specific to food.…”

Section: Evidencementioning

confidence: 99%

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Risk factors for severe reactions in food allergy: Rapid evidence review with meta‐analysis

Turner

Arasi

Ballmer‐Weber

et al. 2022

Allergy

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This rapid review summarizes the most up to date evidence about the risk factors for severe food-induced allergic reactions. We searched three bibliographic databases for studies published between January 2010 and August 2021. We included 88 studies and synthesized the evidence narratively, undertaking meta-analysis where appropriate. Significant uncertainties remain with respect to the prediction of severe reactions, both anaphylaxis and/or severe anaphylaxis refractory to treatment. Prior anaphylaxis, an asthma diagnosis, IgE sensitization or basophil activation tests are not good predictors. Some molecular allergology markers may be helpful. Hospital presentations for anaphylaxis are highest in young children, yet this age group appears at lower risk of severe outcomes. Risk of severe outcomes is greatest in adolescence and young adulthood, but the contribution of risk taking behaviour in contributing to severe outcomes is unclear. Evidence for an impact of cofactors on severity is lacking,

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Section: Methodscontrasting

confidence: 64%

Section: Methodsmentioning

confidence: 99%

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Risk factors for severe reactions in food allergy: Rapid evidence review with meta‐analysis

Turner

Arasi

Ballmer‐Weber

et al. 2022

Allergy

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“…Our findings also reinforce that the lack of cutaneous symptoms, as observed in 4% of patients, does not exclude the diagnosis of anaphylaxis. Several studies suggest that asthma diagnosis is a risk factor for severity of anaphylaxis [1,3,5,10,46].Although, as stated, one of the limitations of this studywas the absence of a classification of the degree of severity, patients with asthma did not show a higher frequency of more severe symptoms, such as laryngeal oedema, cardiovascular symptoms or loss of consciousness, and no differences were observed in terms of ED visits or adrenaline administration. In 80% of the reported cases patients were admittedtothe ED, and 20% required hospitalization.…”

Section: Discussionmentioning

confidence: 66%

Anaphylaxis: A Decade of a Nationwide Allergy Society Registry

Gáspár

Santos

Faria

et al. 2022

J Investig Allergol Clin Immunol

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“…In a large observational cohort study performed in the United States from 2005 to 2014, age of 65 years or older, medication as a trigger, and presence of comorbid conditions (specifically cardiac and lung disease) were associated with significantly higher odds of severe anaphylaxis (35). On the other hand, evidence showing that respiratory disease increases the severity of anaphylaxis according to a recent a systematic review and metaanalysis is low to moderate, although studies do not usually assess the importance of severity of asthma (36). A genetic diversity should be also included among the host factors influencing anaphylaxis in some cases of food and drug allergy (37,38).…”

Section: Risk Factors and Co-factorsmentioning

confidence: 98%

Anaphylaxis

Bilò

Martini

Tontini

et al. 2020

Eur Ann Allergy Clin Immunol

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Anaphylaxis is the most severe systemic hypersensitivity reaction, and it can be life-threatening or even fatal. It involves the activation of multiple immune and non immune pathways beyond IgE, thus exhibiting different phenotypes. New symptoms of hypersensitivity caused by chemotherapy drugs, monoclonal antibodies, and biological agents have been suggested to be recognized as anaphylaxis phenotypes. No biomarker has been described that allows an unequivocal diagnosis of anaphylaxis. Moreover, more biomarkers for specific endotypes are needed to stratify severity, to predict risk, and to optimaze tretament choice in the individual patient. Food, drugs and stinging insects represent the most commly identified triggers. Idiopathic anaphylaxis is a diagnosis of exclusion and it can hide a clonal mast cell disorder. Individual risk factors and co-factors may influence the severity of anaphylaxis or its onset, and they should be identified to implement the appropriate measures to prevent recurrence. Prompt recognition and treatment are critical in anaphylaxis, adrenaline being the first-line saving therapy. Individualized anaphylaxis action plan should include avoidance measures, prescription of an adrenaline autoinjector, education, optimal management of relevant comorbidities, venom specific immunotherapy, food oral immunotherapy, and drug desensitization, when appropriate. However, the quality of acute and long-term anaphylaxis management is variable influencing the poor outcomes experienced by many patients. Clinical practice guidelines have the potential to improve outcomes, but they often prove challenging to implement in routine clinical care.

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Association Between Severity of Anaphylaxis and Co-occurrence of Respiratory Diseases: A Systematic Review and Meta-analysis of Observational Studies

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 10 publications

References 27 publications

Risk factors for severe reactions in food allergy: Rapid evidence review with meta‐analysis

Risk factors for severe reactions in food allergy: Rapid evidence review with meta‐analysis

Anaphylaxis: A Decade of a Nationwide Allergy Society Registry

Anaphylaxis

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