Epidemiology of life‐threatening and lethal anaphylaxis: a review

Abstract

Severe anaphylaxis is a systemic reaction affecting two or more organs or systems and is due to the release of active mediators from mast cells and basophils. A four‐grade classification routinely places ‘severe’ anaphylaxis in grades 3 and 4 (death could be graded as grade 5). Studies are underway to determine the prevalence of severe and lethal anaphylaxis in different populations and the relative frequencies of food, drug, latex and Hymenoptera anaphylaxis. These studies will also analyse the risk arising from the lack of preventive measures applied in schools (personalized management protocols) and from the insufficient use of self‐injected adrenalin. Allergy‐related conditions may account for 0.2–1% of emergency consultations. Severe anaphylaxis affects 1–3 per 10 000 people, but for the United States and Australia figures are even higher. It is estimated to cause death in 0.65–2% of patients, i.e. 1–3 per million people. An increased prevalence has been revealed by monitoring hospitalized populations by reference to the international classification of disease (ICD) codes. The relative frequency of aetiological factors of allergy (food, drugs, insects and latex) varies in different studies. Food, drug and Hymenoptera allergies are potentially lethal. The risk of food‐mediated anaphylaxis can be assessed from the number of personalized management protocols in French schools: 0.065%. Another means of assessment may be the rate of adrenalin prescriptions. However, an overestimation of the anaphylaxis risk may result from this method (0.95% of Canadian children). Data from the literature leads to several possibilities. First, a definition of severe anaphylaxis should be agreed. Secondly, prospective, multicentre enquiries, using ICD codes, should be implemented. Moreover, the high number of anaphylaxis cases for which the aetiology is not identified, and the variation in aetiology in the published series, indicate that a closer cooperation between emergency specialists and allergists is essential.

Cissampelos sympodialis Eichl. (Menispermaceae) inhibits anaphylactic shock reaction in murine allergic model

“…Anaphylactic shock reaction is a serious and potentially lethal systemic reaction caused by immediate allergic response (Moneret-Vautrin et al, 2005). It is well described that food, drugs and insect bits might evoke fatal anaphylaxis in sensitized subjects, and the number of death related to allergic response has increased in the last years (Scott;Donald, 2004).…”

The Anesthesiologist's Role in the Prevention of Surgical Site Infections

“…46,52 Regardless, these patients must be taken at their word when they present for surgery, given the significant morbidity associated with perioperative anaphylaxsis. 53 The question then becomes how best to approach a presumed ␤-lactam-allergic patient.…”

A Case Report: Anaphylactic Reaction due to Ranitidine

“…[2] Anafilaksinin ilaçlar arasın-da en sık antibiyotikler ve radyokontrast maddelere karşı geliştiği ifade edilmiştir. [7,8] H2RA ve proton pompa inhibitörle-rinin her ikisine birlikte anafilaksi insidansının %0,3-0,7 arasında olduğu belirtilmektedir. [3] Ranitidinin hipersensitiviteye hangi mekanizma yol açtığı tam olarak bilinmemekle birlikte, IgE aracılıklı reaksiyonlar ve nonimmünolojik mekanizmalar suçlanmaktadır.…”

“…[9] Klinik bulguların şiddetine göre anafilaksi, Evre 1; deri bulguları, Evre 2; deri tutulum, arteriyel hipotansiyon, solunum güçlüğü veya öksürük, Evre 3; hayati tehdit eden kardiyovasküler kollaps, taşikardi veya bradikardi, aritmi ve şid-detli bronkospazm, Evre 4; dolaşım yetmezliği, kardiyak arrest ve/veya respiratuvar arrest olarak sınıflandırılmaktadır. [7] Buna ek olarak, alerjik reaksiyon sırasında salınan inflamatuar mediatörler tarafından indüklenen mast hücre aktivasyonuna bağlı AKS, koroner arter spazmı (Kounis sendromu) olarak adlandırılmaktadır. [10] Anafilaktik reaksiyonda, öncelikli olan hipotansiyon ve solunum yolu problemlerinin çözümlenmesi, gerekirse hastanın entübe edilerek ileri hava yolu desteğinin sağlanmasıdır.…”