The Risk of Recurrent Anaphylaxis

O’Keefe, Andrew; Clarke, Ann E.; Pierre, Yvan St.; Mill, Jennifer; Asai, Yuka; Eisman, Harley; Vieille, Sébastien La; Alizadehfar, Reza; Joseph, Lawrence; Morris, Judy; Gravel, Jocelyn; Ben‐Shoshan, Moshe

doi:10.1016/j.jpeds.2016.09.028

Cited by 37 publications

(35 citation statements)

References 19 publications

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“…In the present study of at‐risk patients, we calculated an incidence of 140% per year for all recurrent reactions but only of 20% per year for anaphylaxis recurrent reactions. The proportion of children with a history of anaphylaxis enrolled in follow‐up studies and experiencing recurrent anaphylaxis reactions is similar in most reports, accounting for around a quarter of patients as observed in ours . O'Keefe et al determined a similar anaphylaxis recurrence rate as ours in 200 children admitted in three emergency departments in Canada.…”

Section: Discussionsupporting

confidence: 86%

“…The proportion of children with a history of anaphylaxis enrolled in follow‐up studies and experiencing recurrent anaphylaxis reactions is similar in most reports, accounting for around a quarter of patients as observed in ours . O'Keefe et al determined a similar anaphylaxis recurrence rate as ours in 200 children admitted in three emergency departments in Canada. A total of 65 episodes of anaphylaxis were observed among 47 children resulting in a recurrence rate of 17.6% (95% CI: 13.6‐22.5) per year.…”

Section: Discussionmentioning

confidence: 99%

“…Data about the recurrence are scarce, and little is known about the medical follow‐up after an anaphylaxis reaction. Recurrence of anaphylaxis might affect 27%‐54% of patients during a follow‐up of 1.5‐25 years, and its incidence rate could be as high as 98 episodes per 100 children per year …”

Section: Introductionmentioning

confidence: 99%

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Anaphylaxis admissions in pediatric intensive care units: Follow‐up and risk of recurrence

Pouessel

Cerbelle

Lejeune

et al. 2019

Pediatric Allergy Immunology

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Background Data about the risk of anaphylaxis recurrence in children are lacking. We assessed anaphylaxis recurrence and medical follow‐up in a cohort of children previously hospitalized in a French pediatric intensive care unit (PICU) for anaphylaxis. Methods We conducted a telephone survey of 166 children (≤18 years) hospitalized from 2003 to 2013. Results In all, 106 (64%) completed the survey (boys, 59%; mean age [SD]: 15.3 years [5.5]). The main index triggers were drugs (45%) and foods (37%). The mean duration follow‐up was of 7.7 years (SD: 2.4). Thirty‐eight (36%) children experienced 399 new allergic reactions during a follow‐up period of 282 patient‐years (incidence rate: 1.4/100 patients/y; 95% CI: 0.64‐2.04). Twelve children experienced 19 anaphylaxis reactions including five requiring PICU admission (anaphylaxis recurrence rate: 0.20/100 patients/y; 95% CI non‐calculable). Food was the trigger for 79% of recurrent reactions and drugs for 8%. The food trigger was previously known in 83%, the same as the index trigger in 69%. Overall, 1.5% of the recurrent reactions were treated with adrenaline injection and 8% an emergency hospital admission. Patients with recurrence had more likely a history of food allergy (P < 10−4), asthma (P < 0.005), atopic dermatitis (P < 0.05) than those without. 31% of the 50 children with food allergy did not see an allergist, 23% had no adrenaline auto‐injector, and 26% lacked a school individual healthcare plan. Conclusions Following a PICU admission for anaphylaxis, recurrence is high in children with food allergy compared with drug allergy. Allergic comorbidities increase the risk. Medical follow‐up has to be improved for these at‐risk children.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Anaphylaxis admissions in pediatric intensive care units: Follow‐up and risk of recurrence

Pouessel

Cerbelle

Lejeune

et al. 2019

Pediatric Allergy Immunology

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“…Lee et al reported a recurrence rate of 8% in their study population that included adults and children. The recurrence rate in our pediatric population was similar to the 17.6% rate reported by O'Keefe et al . Their study was based in Canada and relied on telephone surveys for patients discharged after their initial ED visit for anaphylaxis.…”

Section: Discussionsupporting

confidence: 87%

“…Biphasic reactions were reported at between 1% and 21%, with the more recent studies reporting lower rates, closer to 4.5% . Recurrent anaphylaxis rates varied between 3% and 76%, with the larger studies reporting rates between 3% and 17.6% . All studies that looked at recurrent anaphylaxis rates were limited to the emergency department (ED) and did not include other patient settings, such as inpatient or outpatient.…”

mentioning

confidence: 99%

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

Chaaban

Stuart

Watley

et al. 2019

Int Forum Allergy Rhinol

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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.

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Implantable device with magnetically rotating disk for needle‐free administrations of emergency drug

Kim

Han

Kim

et al. 2023

Bioengineering & Transla Med

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Prompt administration of first‐aid drugs can save lives during medical emergencies such as anaphylaxis and hypoglycemia. However, this is often performed by needle self‐injection, which is not easy for patients under emergency conditions. Therefore, we propose an implantable device capable of on‐demand administration of first‐aid drugs (i.e., the implantable device with a magnetically rotating disk [iMRD]), such as epinephrine and glucagon, via a noninvasive simple application of the magnet from the outside skin (i.e., the external magnet). The iMRD contained a disk embedded with a magnet, as well as multiple drug reservoirs that were sealed with a membrane, which was designed to rotate at a precise angle only when the external magnet was applied. During this rotation, the membrane on a designated single‐drug reservoir was aligned and torn to expose the drug to the outside. When implanted in living animals, the iMRD, actuated by an external magnet, delivers epinephrine and glucagon, similar to conventional subcutaneous needle injections.

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The Risk of Recurrent Anaphylaxis

Cited by 37 publications

References 19 publications

Anaphylaxis admissions in pediatric intensive care units: Follow‐up and risk of recurrence

Anaphylaxis admissions in pediatric intensive care units: Follow‐up and risk of recurrence

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

Implantable device with magnetically rotating disk for needle‐free administrations of emergency drug

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