Recurrent anaphylaxis in the United States: time of onset and risk factors

Abstract

Background Studies have not yet examined the trends and risk factors of biphasic and recurrent anaphylaxis in the United States using International Classification of Diseases, tenth revision (ICD‐10) CM codes. The goal of this study is to examine the trends of biphasic and recurrent anaphylaxis in all patient care settings (inpatient, outpatient, emergency department, and observation). Methods We used the Clinformatics database from 2015 to 2017. Our main outcome measure was recurrent anaphylactic events occurring within 1 year after the initial event. We used Cox proportional hazards modeling to assess the factors associated with recurrent anaphylaxis and the Kaplan‐Meier method to estimate time to recurrence. Results There were a total of 19,039 patients with incident anaphylaxis in 2016 and, of these, 2017 had a recurrent anaphylaxis event in the 12‐month period after the index date (10.6%). The most common trigger for recurrent anaphylaxis is venom followed by food allergens. Pediatric patients aged <18 years were more likely to develop recurrent anaphylaxis compared with patients aged 18 to 64 years (hazard ratio [HR], 1.53). Patients with allergic rhinitis and asthma were more likely to develop recurrent anaphylaxis compared to those without these comorbidities (HR, 1.15 and 1.27, respectively). Conclusion This is the first national study using ICD‐10 CM codes looking at rates of biphasic and recurrent anaphylaxis in all patient care settings. Recurrent anaphylaxis is more common in the first 3 days after the initial event, in younger patients (<18 years), and in patients with allergic rhinitis and/or asthma. Physicians need to prescribe epinephrine auto‐injectors and educate their patients about the risk of recurrence.

Recurrence of anaphylaxis: A systematic review of observational studies

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To the Editor, Some patients with anaphylaxis experience recurrences even when a trigger is identified in the initial reaction. [1][2][3][4][5][6] However, recurrence has received less attention than other epidemiological parameters associated with this condition. [1][2][3][4][5][6] We carried out a systematic review of the international literature to investigate the frequency, severity, and time to onset of recurrence.Details of the methodology of the review are provided in the additional material.After ruling out 3,527 articles, we eventually selected 35 for quantitative analysis (Figure A1).

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“…[1][2][3][4][5][6] However, recurrence has received less attention than other epidemiological parameters associated with this condition. [1][2][3][4][5][6] We carried out a systematic review of the international literature to investigate the frequency, severity, and time to onset of recurrence.…”

Approaches of Surgical and Internal Branch Resident Physicians to Anaphylaxis

“…Since the findings of biphasic anaphylactic reaction in patients may be more serious than the initial findings 30 , it is extremely important for physicians to know the correct follow-up period of the anaphylaxis patient. In the literature; recurrence of anaphylaxis within 1 year in patients with anaphylaxis was reported as 10.6% 31 . Physicians should prescribe adrenaline autoinjectors and educate patients with anaphylaxis regarding the use of adrenaline autoinjectors because of the risk of recurrent anaphylaxis.…”

Efficacy and Safety of Modified Yupingfeng Nasal Spray in Controlling the Recurrence of Persistent and Moderate-Severe Allergic Rhinitis: Study Protocol for a Multicenter, Open-Label, Randomized, and Parallel-Arm Trial

“…Furthermore, their long-term use can cause side effects, including epistaxis, mucosal dryness, and other adverse reactions, reducing patient compliance. Globally, while the standard pharmacotherapy of AR is relatively mature, the prevalence of AR is still rising [ 6 , 7 ], and the recurrence rate is still high [ 8 ], making it urgent to find new therapies to solve this problem.…”