Different phenotypes of drug‐induced anaphylaxis—Data from the European Anaphylaxis Registry

Abstract

Background: Drugs are a frequent cause of severe anaphylactic reactions. Here, we analyze a large dataset on drug induced anaphylaxis regarding elicitors, risk factors, symptoms, and treatment. Methods: Data from the European Anaphylaxis Registry (2007-2019) with 1815 reported cases of drug-induced anaphylaxis were studied accordingly.Results: Drugs are the third most frequent cause of anaphylaxis reported in the Anaphylaxis Registry. Among the eliciting groups of drugs analgesics and antibiotics were far most often reported. Female and senior patients were more frequently affected, while the number of children with DIA was low. DIA patients had symptoms affecting the skin and mucous membranes (n = 1525, 84.02%), the respiratory (n = 1300, 71.63%), the cardiovascular (n = 1251, 68.93%) and the gastrointestinal system (n = 549, 30.25%). Drugs caused significant more severe reactions, occurred more often in medical facilities and led to increased hospitalization rates in comparison to food and insect venom induced anaphylaxis. Adrenaline was used more often in patients with DIA than in anaphylaxis due to other causes. Patients with skin symptoms received more antihistamines and corticosteroids in the acute treatment, while gastrointestinal symptoms led to less adrenaline use. Conclusion:The study contributes to a better understanding of DIA, with a large number of cases from Europe supporting previous data, e.g., analgesics and antibiotics being the most frequent culprits for DIA. Female gender and higher age are relevant risk factors and despite clear recommendations, the emergency treatment of DIA is not administered according to the guidelines.

Cow's milk and hen's egg anaphylaxis: A comprehensive data analysis from the European Anaphylaxis Registry

“…Grade III R&M severity of reaction, most common in both trigger groups, turns out to be 1.5 times higher than in the paediatric EAR reports on all allergens, including food, 1 but it is similar to EAR results dedicated to a specific allergen, 11 while different to French study results, where R&M grade II predominated (54%) both in infants and pre-schoolers. 7 In detailed clinical presentation published by other authors, the frequency of the leading symptoms (skin 70%-99%; respiratory 48%-84%, except Swedish study, where they equalled 16%), followed by GI presentation (30%-49%) 1,4,7,[13][14][15] occurring in the course of anaphylaxis, was similar to some extent to the results of this study.…”

“…Grade III R&M severity of reaction, most common in both trigger groups, turns out to be 1.5 times higher than in the paediatric EAR reports on all allergens, including food, 1 but it is similar to EAR results dedicated to a specific allergen, 11 while different to French study results, where R&M grade II predominated (54%) both in infants and pre‐schoolers 7 …”

“…Regardless of specific allergen components, a product with a higher density might have a greater potential to cause a reaction, which is also supported by the results of studies on anaphylaxis to peanuts, where the most reactions were caused by the volume of the allergen up to one teaspoon. 11 Further study is needed to examine to what extent differences of the clinical profiles are related to matrix and/or absorption effects and/or the allergen itself.…”

“…Nevertheless, for children in whom the symptoms persist there is still a high risk of severe anaphylaxis 10 . Earlier data from the EAR database on food allergens, such as peanut‐induced anaphylaxis in children and teenagers, or wheat‐induced anaphylaxis in adults, suggest the impact of a given eliciting food on the anaphylaxis phenotype 11,12 …”

“…10 Earlier data from the EAR database on food allergens, such as peanut-induced anaphylaxis in children and teenagers, or wheat-induced anaphylaxis in adults, suggest the impact of a given eliciting food on the anaphylaxis phenotype. 11,12 These data, and the fact that there are no studies directly evaluating the differences between cow's milk anaphylaxis (CMA) and hen's egg anaphylaxis (HEA) symptomatology, prompted us to perform a comprehensive analysis of CMA and HEA in children, to obtain new insights into their clinical profiles and treatment strategies.…”