Characteristics of Anaphylactic Reactions: A Prospective Observational Study in Japan

Oya, Seiro; Kinoshita, Kosaku; Daya, Mohamud; Kinoshita, Hirohisa

doi:10.1016/j.jemermed.2020.07.004

Cited by 6 publications

(1 citation statement)

References 23 publications

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“…The anaphylactic reaction can start with urticaria and quickly progresses to airway symptoms, cardiovascular symptoms, and/or gastrointestinal symptoms, sometimes resulting in organ failure and cardiac arrest [1,2]. The symptoms and severity of the anaphylaxis depend on which organ systems are involved, the patient's age, and the eliciting agent [3][4][5]. Anaphylaxis is not always accompanied by cutaneous symptoms, which may make diagnosing difficult [1,2,6].…”

Section: Introductionmentioning

confidence: 99%

Prehospital and In-Hospital Treatment with Adrenaline and Related Prognosis in Anaphylaxis Patients

Holst Gudichsen,

Aggerholm Bækdal,

Mikkelsen

et al. 2024

Int Arch Allergy Immunol

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Introduction: Although intramuscular adrenaline is the recommended first-line treatment for anaphylaxis, not all patients receive this treatment. The consequences in daily clinical practice are sparsely described. This study aimed to investigate the treatment administered to anaphylactic patients and the related prognosis. Methods: A retrospective register-based study of patients with anaphylaxis referred to the allergy centre, Odense University Hospital (2019–2021). Each patient’s medical records were reviewed for contacts with the emergency departments and the prehospital emergency medical service in the Region of Southern Denmark. The World Allergy Organization (WAO) grading system was used to assess the severity of prehospital and in-hospital anaphylaxis. Furthermore, the treatment administered to the patients was registered. Results: In total, 315 patients were included. The prehospital system had contact with 256 of these patients (two were released prehospitally following treatment and 12 patients had insufficient data to assess anaphylaxis). Of the remaining 242 patients, 115 had anaphylaxis prehospitally (WAO grades 3–5); 59% (67/115) received adrenaline. Among the 67 patients who received prehospital adrenaline, 9 patients (13.4%; 95% CI: 6.3–24.0%) still had anaphylaxis at arrival at the emergency department. Of the 48 patients that were not treated with prehospital adrenaline, 17 patients (35.5%; 95% CI: 22.1–50.5) had anaphylaxis at the arrival to the emergency department. Among the 127 patients without prehospital anaphylaxis (WAO grades 0–2), 22 patients (18.2%; 95% CI: 11.8–26.2%) who did not receive prehospital adrenaline had anaphylaxis at arrival to the emergency department, while none of the 6 patients treated prehospitally with adrenaline had anaphylaxis. Conclusion: Omission of prehospital adrenaline in anaphylactic patients is associated with more severe anaphylactic symptoms at arrival to the hospital. Adrenaline treatment remains suboptimal since only half of the patients received prehospital adrenaline and only 1 out of 4 patients, with clinical signs of anaphylaxis, received adrenaline inside the hospital.

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Section: Introductionmentioning

confidence: 99%

Prehospital and In-Hospital Treatment with Adrenaline and Related Prognosis in Anaphylaxis Patients

Holst Gudichsen,

Aggerholm Bækdal,

Mikkelsen

et al. 2024

Int Arch Allergy Immunol

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Anaphylaxis: first clinical presentation, subsequent referral practise, and suspected elicitor—an observational study

Gudichsen,

Bækdal,

Jessen

et al. 2024

Intern Emerg Med

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Anaphylaxis is an allergic manifestation characterised by rapid onset and progression. Rapid treatment may be challenging in patients with atypical symptoms or no previous history of anaphylaxis. This study aimed to describe the clinical prehospital presentation of first-time anaphylactic patients. To help target educational initiatives, we sought to identify which groups of medical professionals are most likely to encounter first-time anaphylactic patients and investigated the referral pattern for suspected anaphylactic patients for specialised treatment. A retrospective register-based study from the Region of Southern Denmark. Patients referred to the Allergy Centre, Odense University Hospital, from 2019 to 2021 were included. The medical records were manually reviewed for first contact with the emergency departments or the emergency medical service. 444 patients with suspected anaphylaxis were referred. 226 patients had grade 3–5 systemic allergic reactions as classified by the World Allergy Organisation; 90% had cutaneous symptoms, 63% symptoms from the central nervous system, 42% gastrointestinal symptoms, 40% cardiovascular symptoms, 36% had upper-airway symptoms, and 36% had lower-airway symptoms. Patients treated prehospitally had a significantly more severe degree of anaphylaxis than patients only treated within the hospital. More than half of the patients with suspected anaphylaxis were referred to the Allergy Centre from the emergency departments. Patients with allergies progressing to severe anaphylaxis most often are treated prehospitally before transport to emergency departments. From the emergency departments, they are referred to the allergy centre. Education concerning the immediate treatment of severe anaphylaxis should primarily be targeted towards prehospital care providers.

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Use of multiple epinephrine doses in anaphylaxis: A systematic review and meta-analysis

Patel

Chong

Ierodiakonou

et al. 2021

Journal of Allergy and Clinical Immunology

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Background: Regulatory bodies recommend that all patients at risk of anaphylaxis be prescribed 2 epinephrine autoinjectors, which they should carry at all times. This is in contrast to some guidelines. The proportion of anaphylaxis reactions that are treated with multiple doses of epinephrine has not been systematically evaluated. Objective: Our aim was to undertake a systematic review and meta-analysis of published studies reporting epinephrine treatment for anaphylaxis in which data relating to the number of doses administered were available. Methods: We searched the Medline, Embase, and Cochrane databases for relevant studies reporting at least 10 anaphylaxis events (due to food or venom) from 1946 until January 2020. Data were extracted in duplicate for the metaanalysis, and the risk of bias was assessed. The study was registered under the PROSPERO identifier CRD42017069109. Results: A total of 86 studies (36,557 anaphylaxis events) met the inclusion criteria (20 of the studies [23%] were prospective studies; 64 [74%] reported reactions in the community, and 22 [26%] included food challenge data). Risk of bias was assessed as low in 50 studies. Overall, 7.7% of anaphylaxis events from any cause (95% CI 5 6.4-9.1) were treated with multiple doses of epinephrine. When only epinephrine-treated reactions for which subsequent doses were administered by a health care professional were considered, 11.1% of food-induced reactions (95% CI 5 9.4-13.2) and 17.1% of venom-induced reactions (95% CI 5 11.3-25.0) were treated with at least 1 epinephrine dose. Heterogeneity was moderate to high in the meta-analyses, but at sensitivity analysis it was not affected by study design or anaphylaxis definition. Conclusion: Around 1 in 10 anaphylaxis reactions are treated with at least 1 dose of epinephrine. (J Allergy Clin Immunol 2021;nnn:nnn-nnn.)

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Characteristics of Anaphylactic Reactions: A Prospective Observational Study in Japan

Cited by 6 publications

References 23 publications

Prehospital and In-Hospital Treatment with Adrenaline and Related Prognosis in Anaphylaxis Patients

Prehospital and In-Hospital Treatment with Adrenaline and Related Prognosis in Anaphylaxis Patients

Anaphylaxis: first clinical presentation, subsequent referral practise, and suspected elicitor—an observational study

Use of multiple epinephrine doses in anaphylaxis: A systematic review and meta-analysis

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