Patients with urticaria are at a higher risk of anaphylaxis: A nationwide population‐based retrospective cohort study in Taiwan

Abstract

The clinical features of urticaria and anaphylaxis are similar, and they share common causal immune-mediated pathways. We aimed to investigate the risk of anaphylaxis among patients with urticaria. A 12-year population-based retrospective cohort study was conducted. Investigated subjects were identified from the Taiwan National Health Insurance Research Database by the International Classification of Disease, Ninth Revision, Clinical Modification. We included 126 031 subjects with newly diagnosed urticaria and 252 062 matched controls between 2000 and 2013. Risk of anaphylaxis among patients with urticaria was calculated by calculating adjusted hazards ratios (HR) after matching for confounding comorbidities. Urticaria was more common in women than it was in men (58% vs 42%), with a peak onset age of 20-40 years. The number of comorbidities including asthma, allergic rhinitis, herpes zoster, hepatitis B and C, rheumatoid arthritis and gout were higher in patients with urticaria than that in age- and sex-matched controls. The crude HR for anaphylaxis among urticaria subjects was 2.883 (95% confidence interval [CI], 2.787-2.982; P < 0.001). After adjustment for potential confounders which have been proposed to increase the risk of anaphylaxis, patients with urticaria were found to be at a significantly high risk of anaphylaxis with an adjusted HR of 2.529 (95% CI, 2.442-2.619; P < 0.001). We conclude that the incidence rate of anaphylaxis is significantly high in patients with urticaria in Taiwan.

Impact of chronic urticaria on systemic lupus erythematosus: A nationwide population‐based study in Taiwan

“…However, the mechanism by which patients with urticaria are susceptible to SLE still remains obscure. Likewise, our previous study demonstrated that the incidence rate of anaphylaxis is significantly high in patients with urticaria in Taiwan; both share common causal immune‐mediated pathways …”

“…Likewise, our previous study demonstrated that the incidence rate of anaphylaxis is significantly high in patients with urticaria in Taiwan; both share common causal immune-mediated pathways. 25 Additionally, urticaria must be differentiated from hypocomplementemic urticarial vasculitis in SLE patients. This manifestation generally has a fixed location and may be associated with pain or with a burning sensation that may result in hyperpigmentation, but has been rarely reported in children.…”

α-Glucosidase Inhibitor Can Effectively Inhibit the Risk of Tuberculosis in Patients with Diabetes: A Nested Case-Control Study

“…Our study demonstrates that the use of oral DM medications in patients with DM reduces the risk of TB infection. However, we could not derive the survival time of patients with DM; nevertheless, we adjusted for the length of hospital stay as the basis for the patient health index [50]. Through rigorous pairing, we adjusted for cumulative drug concentrations as well as observation time for DM and TB.…”

Re. Identification and Validation of Anaphylaxis Using Electronic Health Data in a Population-based Setting

“…Second, the lack of a well-defined intervention makes the identification of appropriate adjustment strategies difficult, deviating from the exchangeability assumption. 3 In order to obtain unbiased estimates, investigators must ask "what exactly are the potential confounders for losing weight?" As mentioned, the authors state that weight loss may be achieved by diet, or by increased physical activity, but the confounding factors for these 2 interventions are not the same.…”

“…2 Second, since the aim of this study is to evaluate the accuracy of algorithms based on ICD-10 diagnosis codes, we strongly suggest that more details of algorithms should be provided. 3 Moreover, ICD-10 codes assigned to each anaphylaxis event (e.g., T78.0, T78.2, T80.5, T88.6, etc.) should be categorized, so the positive predictive values (PPVs) of distinct anaphylaxis codes could be estimated separately since there might be different PPVs for individual code.…”