Idiopathic anaphylaxis

Bilò, Maria Beatrice; Martini, Matteo; Tontini, Chiara; Mohamed, Omar E; Krishna, Mamidipudi Thirumala

doi:10.1111/cea.13402

Cited by 41 publications

(36 citation statements)

References 64 publications

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“…It usually occurs as a response to an allergen exposure, which leads to the activation of mast cells and basophils, although, in some cases, the cause of anaphylaxis remains unknown. 3 Anaphylaxis can be unpredictable, and it has an adverse impact on the health-related quality of life of people, irrespective of the cause. 4 Epidemiological figures on the incidence of anaphylaxis are probably underestimated worldwide.…”

Section: Introductionmentioning

confidence: 99%

Fatal anaphylaxis in Italy: Analysis of cause‐of‐death national data, 2004‐2016

Bilò

Corsi

Martini

et al. 2020

Allergy

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Background: Epidemiological data on fatal anaphylaxis are underestimated worldwide. Few Italian data do exist. The aims of the study are to determine the anaphylaxis mortality rate in Italy and its associations with demographic characteristics (gender, age, and geographical distribution), and to investigate which are the most common triggers of fatal anaphylaxis. Material and methods: This is a descriptive study analyzing data reported to the National Register of Causes of Death database and managed by the Italian National Institute of Statistics for the years 2004-2016. An analytical method was developed to identify all the ICD-10 codes related to anaphylaxis deaths, which were divided into two classes: "Definite anaphylaxis deaths" and "Possible anaphylaxis deaths." Results: From 2004 through 2016, 392 definite anaphylaxis deaths and 220 possible anaphylaxis deaths were recorded. The average mortality rate for definite anaphylaxis, from 2004 to 2016, was 0.51 per million population per year. Definite fatal anaphylaxis was mostly due to the use of medications (73.7%), followed by unspecified causes (20.7%) and hymenoptera stings (5.6%). Concerning possible anaphylaxis deaths, the most common cause was venom-stinging insect (51.4%). We did not find any data on food fatal anaphylaxis. Unspecified anaphylaxis accounted for 21%-28% of all cases, underlining the difficulty in accurately ascertaining the causes of fatal anaphylaxis and therefore in assigning the proper ICD-10 code. Conclusion: This is the first study of anaphylaxis-related mortality coming from an official database of the whole Italian population. However, the actual number of deaths by anaphylaxis, and their related triggers, is probably underreported, mostly due to limitations of the current recording system, and to a poor allergy education.

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Section: Introductionmentioning

confidence: 99%

Fatal anaphylaxis in Italy: Analysis of cause‐of‐death national data, 2004‐2016

Bilò

Corsi

Martini

et al. 2020

Allergy

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“…As described above, the diagnosis was made only on the basis of history and clinical findings, because, though major allergen Arg r 1 has been isolated, allergen extracts for detection of s-IgEs are not commercially available for in vivo or in vitro tests. In conclusion, pigeon tick bites may explain cases of nocturnal anaphylaxis, otherwise generally diagnosed as idiopathic anaphylaxis [10]. Because of the growing number of pigeons in Middle and Southern Europe, A. reflexus should be taken into consideration by allergists as a cause of anaphylactic reactions.…”

Section: Discussionmentioning

confidence: 96%

Near-fatal anaphylaxis with Kounis syndrome caused by Argas reflexus bite: a case report

Boni

Incorvaia

2020

Clin Mol Allergy

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Background: The pigeon tick Argas reflexus is a temporary parasite of pigeons. It bites during night hours and lies briefly on its prey, as long as it takes the blood meal. When pigeons are not accessible, ticks look for other hosts, invading nearby flats and biting humans. Case presentation: We present the case of a woman aged 46 years who experienced severe anaphylaxis during the night which required emergency medical treatment, tracheal intubation and hospitalization in intensive care unit. Kounis syndrome was documented by transient ST depression and elevation of troponin. The allergological work up ruled out hypersensitivity to drugs, latex and foods containing alpha-gal, which is a cause of anaphylaxis. Basal serum tryptase was in normal range (8.63 ng/ml). When questioned about the presence of ticks, the patient brought into view various specimens of ticks that were recognized by an entomologist as Argas reflexus. Conclusions: An in vitro diagnosis of allergy to Argas reflexus is currently not feasible because, though the major allergen Arg r 1 has been isolated, allergen extracts are not commercially available. Therefore, the diagnosis of anaphylaxis from Argas reflexus, when other causes of anaphylaxis are excluded, must rely only on history and clinical findings, as well as on the presence of pigeons and/or pigeon ticks in the immediate domestic environment.

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“…In this regard, monosensitization to Hev b 8 (profilin) suggests cross-re-active and asymptomatic sensitization, whereas markers of genuine allergy like Hev b 1, Hev b 3, Hev b 5, and Hev b 6, may potentially induce severe reactions, thus making it necessary to apply avoidance measures (114). A diagnosis of idiophatic anaphylaxis (IA) is based on exclusion of known triggers of anaphylaxis, as well as conditions that can masquerade as anaphylaxis (115). The diagnostic utility of an allergen microarray (ImmunoCAP ISAC) in the detection of possible allergenic triggers in patients with unexplained anaphylaxis has been evaluated, showing evidence of sensitization to newly identified allergens (mainly wheat, shrimp and peanut) that had not been detected during routine allergy workup, even tough an allergen challenge procedure to confirm the diagnosis was not performed (116).…”

Section: Component Resolved Diagnosis (Crd)mentioning

confidence: 99%

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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Idiopathic anaphylaxis

Cited by 41 publications

References 64 publications

Fatal anaphylaxis in Italy: Analysis of cause‐of‐death national data, 2004‐2016

Fatal anaphylaxis in Italy: Analysis of cause‐of‐death national data, 2004‐2016

Near-fatal anaphylaxis with Kounis syndrome caused by Argas reflexus bite: a case report

Anaphylaxis

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