Predictors of severe systemic anaphylactic reactions in patients with Hymenoptera venom allergy: Importance of baseline serum tryptase—a study of the European Academy of Allergology and Clinical Immunology Interest Group on Insect Venom Hypersensitivity

Ruëff, Franziska; Przybilla, Bernhard; Bilò, Maria Beatrice; Müller, Ulrich; Scheipl, Fabian; Aberer, Werner; Birnbaum, J.; Bodzenta-Łukaszyk, Anna; Bonifazi, F.; Bucher, Christoph; Campi, Paolo; Darsow, Ulf; Egger, Cornelia; Haeberli, Gabrielle; Hawranek, Thomas; Körner, Michael; Kucharewicz, Iwona; Küchenhoff, Helmut; Lang, Roland; Quercia, O; Reider, Norbert; Severino, Maurizio; Sticherling, Michael; Sturm, Gunter J.; Wüthrich, B

doi:10.1016/j.jaci.2009.08.027

Cited by 397 publications

(296 citation statements)

References 34 publications

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“…However, the significance of these mechanisms for triggering anaphylaxis is still a matter of debate. A recent multicenter study failed to confirm that treatment with beta-adrenoceptor antagonists is a predictive parameter for the occurrence of severe anaphylactic reactions in a cohort of hymenoptera venom allergic patients (9).…”

Section: Other Drugs Relevant To Anaphylaxismentioning

confidence: 97%

“…Meanwhile, physical exercise is the best studied cofactor of anaphylaxis and 'food-dependent exercise-induced anaphylaxis' (FDEIA) is accepted as a defined clinical entity. Other well-documented cofactors of anaphylaxis are nonsteroidal anti-inflammatory drugs (NSAID) like acetylsalicylic acid (ASA), alcohol consumption, and infectious diseases in general (5)(6)(7)(8)(9)(10)(11)(12). According to the anaphylaxis registries of different European countries, next to exercise, alcohol consumption is a relevant cofactor in up to 15.2% of anaphylactic events and drugs such as ASA were registered as a cofactor in 6.1-9% of severe anaphylactic reactions (Table 1).…”

mentioning

confidence: 99%

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About the role and underlying mechanisms of cofactors in anaphylaxis

Wölbing

Fischer

Köberle

et al. 2013

Allergy

178

163

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Anaphylaxis is the systemic and most severe presentation of type I allergy. A number of conditions were identified that modulate the onset of anaphylaxis such as co-or augmentation factors, which significantly lower the allergen dose necessary for triggering anaphylaxis. Next to physical exercise or alcohol consumption, co-administration of nonsteroidal anti-inflammatory drugs (NSAID) or concomitant infectious diseases are well-documented cofactors of anaphylaxis. Registries for anaphylaxis document a role for cofactors in about 30% of anaphylactic reactions. Some disease entities such as 'wheat-dependent exercise-induced anaphylaxis' (WDEIA) are explicitly characterized by elicitation of anaphylaxis only in the presence of at least one such cofactor. Using WDEIA as a model disease, studies demonstrated that exercise increases skin prick test reactivity to and bioavailability of the allergen. Additional data indicate that alcohol consumption and NSAID administration display similar effects. Modulation of the cellular activation threshold is another mechanism underlying cofactor-induced anaphylaxis, most likely also functional when infectious diseases orchestrate elicitation of anaphylaxis. Cofactors are increasingly accepted to play a fundamental role in eliciting anaphylaxis. Consequently, to improve patient management modalities, a better understanding of the underlying mechanisms is warranted. This review aims to update clinicians and clinical scientists on recent developments.

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Section: Other Drugs Relevant To Anaphylaxismentioning

confidence: 97%

mentioning

confidence: 99%

About the role and underlying mechanisms of cofactors in anaphylaxis

Wölbing

Fischer

Köberle

et al. 2013

Allergy

178

163

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“…Consequently, the severity of anaphylaxis in older and elderly patients is due not only to the more marked presence of cardiorespiratory diseases or more frequent comorbidity, but also to other age-related factors. Several authors have also reported that older age is an independent risk factor that increases severity of anaphylaxis in their adjusted models [4][5][6][7]. One possible explanation for age as an independent risk factor is that the effects of comorbid conditions are more marked in older patients.…”

Section: Discussionmentioning

confidence: 99%

“…The classic risk factors for more severe anaphylaxis are older age, cardiovascular and respiratory disease, antihypertensive drugs (principally ß-blockers and ACE inhibitors), drugs, venom, and uncontrolled asthma [4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Publications on the risk factors associated with the most severe presentations of anaphylaxis focus only partially on specific factors (eg, the importance of respiratory disease) [9], results are inconsistent (eg, aggravation of anaphylaxis by ß-blockers, differences with respect to the most severe type of anaphylaxis) [5][6][7][8], or the principal outcome measures are different (eg, admissions for anaphylaxis, need for mechanical ventilation) [4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Profile of Patients With Severe Anaphylaxis Hospitalized in the Spanish Hospital System: 1997-2011

Nieto-Nieto

Tejedor-Alonso

Farias-Aquino

et al. 2017

J Investig Allergol Clin Immunol

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Background: Studies assessing the severity of anaphylaxis lack a comprehensive approach to collecting data on comorbidities that may worsen prognosis. Objective: Using the Elixhauser score (a systematic index associated with longer stay, hospital charges, and mortality), we determined which comorbidities were associated with more severe anaphylaxis. Methods: We based our study on the Spanish Ministry of Health database of hospital discharges in Spain between 1997 and 2011. We constructed logistic regression models in which the dependent variables were outcomes related to greater severity (death, cardiac arrest, need for invasive mechanical ventilation or vasopressor drugs, admission to the intensive care unit, and length of stay) and the independent variables were the 30 comorbidities that comprise the Elixhauser score, age, sex, and main causes of anaphylaxis. Results: We found that a higher risk of severe anaphylaxis was associated (3 or more logistic regressions) with age >50 years or having experienced cardiac arrhythmia, coagulation disorder, associated fluid-electrolyte imbalance, chronic pulmonary disease, or Echinococcus anaphylaxis. Likewise, in the adjusted analysis, a higher Elixhauser score was associated with most of the outcomes analyzed for severity of anaphylaxis. Conclusions: Cardiovascular and respiratory diseases increase the severity of anaphylaxis, and the resulting poor health status (represented as a higher Elixhauser score) is associated with more severe anaphylaxis.

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