Clinical-anamnestic analysis of patients diagnosed as "Anaphylaxis" hospitalized in Moscow medical hospitals

Abstract

BACKGROUND: Anaphylaxis is a severe hypersensitivity reaction. The incidence of anaphylaxis remains underestimated and there remains a low level of vigilance among all specialties, leading to underdiagnosis and consequent lack of appropriate treatment. This work is the first systematized clinical and epidemiological study performed on a cohort of patients with a history of anaphylactic reactions over 18 years of age.
 AIM: To study the epidemiological features of anaphylaxis within one region of the Russian Federation, identification of its most frequent phenotypes, as well as analysis of the main errors in the management of patients with anaphylactic reactions.
 MATERIALS AND METHODS: The study was conducted based on the retrospective stage analysis of data from medical records of patients with anaphylactic reactions of the Unified Medical Information and Analytical System (EMIAS) of Moscow for the period from 2019 to 2022. The final sample comprised a cohort of 241 patients.
 RESULTS: In the analyzed cohort, females (n=150; 62.2%) were predominant compared to males (n=91; 37.8%). Medications (n=171; 71%) dominated the list of causative agents. The leading clinical phenotype of anaphylactic reactions in the analyzed hospitalized cohort was characterized by cardiovascular symptoms (73; 30.3%). The risks of severe course increased with age (older than 44 years) (p=0.006). Information on prehospital therapy was obtained in 183 patients (75.9%), with only 128 (70%) patients receiving epinephrine therapy. A correlation was found between the absence of epinephrine administration in the prehospital phase and the development of a biphasic course of anaphylactic reactions subsequently (p 0.001). Only 15 (38.5%) patients with an aggravated history of anaphylaxis were previously informed about the need to carry epinephrine solution.
 CONCLUSIONS: Anaphylaxis is a life-threatening pathology requiring emergency medical care, regardless of the severity of the initial symptoms. Variations in the clinical symptoms that constitute the diagnostic criteria for anaphylaxis, differences in algorithms, and limitations of existing coding systems make it difficult to summarize epidemiological data and compare study results. Older age remains a risk factor for the development of severe anaphylactic reactions confirmed in our cohort.