Clinical Analysis of Anaphylaxis Patients in an Emergency Medical Center

Abstract

Clinical analysis was conducted for 26 patients who were transferred and admitted for emergency treatment of anaphylaxis in a secondary healthcare setting in Toho University Omori Medical Center during the two years between September 2003 and August 2005. Possible triggering factors for anaphylaxis were foods in 12 patients, drugs in 11 patients, and other factors (bee sting and rat and hamster bites) in three patients. The foods included fish for seven patients; meat, soba or buckwheat noodles, and citrus fruits for one patient each; and other foods for two patients. Five of the patients tested had positive results for a specific radioallergosorbent test (RAST). Drugs were all oral agents including non-steroidal anti-inflammatory drugs (NSAID) in eight patients and antibiotics in three patients. The results from a drug lymphocyte stimulation test (DLST) were positive for only two of the patients. All patients experienced cutaneous and respiratory symptoms. Seven patients experienced symptoms of disturbance of consciousness, and nine patients experienced symptoms of shock, either drug-induced (five patients) or food-induced (four patients). No significant difference was observed between the two groups. Nineteen of the 26 patients had a history of allergies. Although the rate is significantly higher than the general population, the patients experiencing symptoms of shock included three cases of drug-induced shock without a history of allergies. This reaffirms the importance of paying special attention to drug-induced anaphylactoid reactions that may cause sudden symptoms of shock in a patient without a history of allergies. Thirteen patients were treated with epinephrine (0.5±0.4mg) and 24 patients with corticosteroids. The outcome was good for all patients, and no biphasic anaphylaxis was observed. Although corticosteroids are not a first-line agent, they may play a role in the prevention of biphasic anaphylaxis.