Characteristics Of Anaphylaxis Research Articles

Characteristics of anaphylaxis from tertiary-care hospital in lower northern Thailand: A ten-year retrospective cross-sectional study.

The prevalence and etiology of anaphylaxis vary based on geographic regions, study design, and definition used. Anaphylaxis leading to emergency department visits and hospitalizations has increased worldwide. The prevalence and etiology of anaphylaxis vary based on geographic regions, study design, and definition used. Anaphylaxis leading to emergency department visits and hospitalizations has increased worldwide. A cross-sectional retrospective analysis of medical records from patients with ICD-10 confirmed anaphylaxis was performed at Naresuan University Hospital between March 2011 and February 2021. We identified 439 anaphylaxis episodes in 381 patients within 10 years. The average annual occurrence rates of anaphylactic episodes were 25.0 per 100,000 outpatient and emergency department visits and 11.2 per 100,000 inpatient visits. Both pediatric and adult anaphylaxis events increased annually, from 13.3 (children: 20.5, adults: 12.4) in 2012 to 46.6 (children: 52.6, adults: 46.1) episodes per 100,000 visits in 2021. Peak incidence was observed in adolescents and young adults. Food was the most common trigger, with shrimp and fried insects being predominant. Risk factors for severe anaphylaxis were underlying cardiovascular diseases, drug triggers, and wheezing. Epinephrine was administered in 98.4% of all episodes. Although, there were no fatalities, only 11.4% of patients received prescriptions for self-injectable epinephrine. The study underscores an increasing trend of anaphylaxis affecting both children and adults in lower northern Thailand, with shrimp and fried insects as common triggers.

Development of anaphylaxis upon oral food challenge and drug provocation tests in pediatric patients.

Background: The drug provocation test (DPT) and the oral food challenge (OFC) are considered as the criterion standard for the diagnosis of drug hypersensitivity reactions and food allergy. Severe allergic reactions may develop during these tests. Objective: To evaluate the frequency and features of anaphylaxis in pediatric patients undergoing OFCs and DPTs. Method: OFCs and DPTs performed in an open method in the pediatric allergy clinic of our institution between January 2014 and January 2021 were reviewed retrospectively. The characteristics of anaphylaxis that developed during these tests were evaluated. Results: A total of 3631 OFCs and/or DPTs were performed on 2588 pediatric patients. Reactions were recorded in 317 challenges (8.7%), including 42 (1.2%) in the form of anaphylaxis. Of the patients with anaphylaxis, 31 developed anaphylaxis during OFC and 11 during DPT. Anaphylaxis during OFCs was mostly triggered by yogurt (n = 8), hen's egg (n = 6), baked milk (n = 5), and baked egg (n = 4). Cases with anaphylaxis during DPT were recorded mostly with ibuprofen (54.5% [n = 6]). All patients who developed anaphylaxis during OFC had cutaneous manifestations, and 90.3% had respiratory symptoms. Gastrointestinal involvement was present in 32.3% of the patients. During DPT, cutaneous manifestations were observed in 90.9% in the patients who developed anaphylaxis and the respiratory tract was involved in 81.8%. In terms of concomitant allergic diseases, 51.6% of the patients who developed anaphylaxis during OFC had atopic dermatitis and 38.7% had asthma. All the patients with anaphylaxis triggered by nonsteroidal anti-inflammatory drug DPT had asthma. Of the anaphylaxis, 54.8% were mild, 35.7% were moderate, and 9.5% were severe. Severe anaphylaxis was recorded with baked milk (n = 2), baked egg and trimethoprim-sulfamethoxazole (n = 1, each). The patients did not require intensive care, and no death occurred. Conclusion: Anaphylaxis may develop during OFCs and DPTs. These tests should be carried out by experienced allergists in an appropriate setting where emergency equipment and medications, including epinephrine, are readily available.

Anaphylaxis in Chinese Children: Different Clinical Profile Between Children with and without a History of Asthma/Recurrent Wheezing.

PurposeAsthma and recurrent wheezing (RW) have been identified as risk factors for anaphylaxis; however, little is known about the characteristics of anaphylaxis in children with a history of asthma or RW in Chinese children.Patients and MethodsThis was a retrospective, observational chart review of children who were diagnosed with anaphylaxis in a tertiary children’s hospital between 2014 and 2021. Patients’ demographics, symptoms, triggers and presence of physician-diagnosed asthma/RW history were collected from medical charts.ResultsA total of 399 anaphylactic reactions in 264 patients were analyzed; 119 patients (45.1%) had a history of asthma/RW. Food was the most common cause (85.5%, 341/399). Compared with patients without a history of asthma/RW, buckwheat-induced anaphylaxis was significantly more common in the asthma/RW group (9.4% vs 0.5%, p < 0.001), patients with a history of asthma/RW had higher rates of oropharyngeal symptoms (17.3% vs 8.6%, p = 0.011) and wheezing (34.5% vs 15.9%, p < 0.001). Ninety-one reactions (22.8%, 91/399) presented as severe anaphylaxis, but no difference existed between asthma/RW and non-asthma/RW groups. Children with a history of asthma/RW were more likely to receive inhaled β agonists than children without a history of asthma/RW (11.8% vs 2.5%, p = 0.003). A larger proportion of children without asthma/RW history were treated with epinephrine (11.7%) than children with asthma/RW history (6.9%).ConclusionOur finding revealed that different clinical profiles of anaphylaxis in children with and without a history of asthma/RW. Our study did not find that children with a history of asthma/RW have more severe anaphylactic reactions compared with children without asthma/RW. Buckwheat-induced anaphylaxis was more common in the asthma/RW group, wheezing and oropharyngeal symptoms affected a higher proportion of the asthma/RW group.

Anaphylaxis in older adult patients: a 10-year retrospective experience

BackgroundDespite the worldwide increase in life expectancy and the elderly population, very little is known about the characteristics of anaphylaxis in older adults. MethodsA retrospective scan was made of the files of patients who presented at the Allergy Unit of our clinic between October 2011 and October 2021. The study included 971 patients aged ≥18 years who met the criteria for diagnosis of anaphylaxis. The patients were separated into 2 groups of adults (18–64 years) and older adults (≥65 years). ResultsThe adult group included 887 (91.3%) patients and the older adult group, 84 (8.7%) patients. Comorbid diseases were seen more frequently in the older adults than in the adult group (p < 0.001). Drugs were seen to be the most common trigger of anaphylaxis in both groups, and this was more common in the older adult group (p = 0.039). Food was a more common trigger of anaphylaxis in the adult group than in the older adult group (p = 0.017). In both groups, the skin was the organ most affected, and was less affected in the older adults than in the adults (p = 0.020). Cardiovascular symptoms were seen significantly more and respiratory symptoms significantly less in the older adult group (p < 0.001, p = 0.002, respectively). Admission to the hospital and the intensive care unit was more frequent in the older adult group and rates of adrenalin administration were higher compared to the adult group (p < 0.001 for all). ConclusionAnaphylaxis in the older adults is generally caused by drugs. Older adults were found to have more cardiovascular symptoms and more frequent adrenalin injections, hospitalizations and intensive care unit admissions.

Age-related differences in characteristics of anaphylaxis in Chinese children from infancy to adolescence

BackgroundLittle is known about anaphylaxis in Chinese children. This study aimed to determine the age-specific patterns of anaphylaxis in Chinese children. MethodsWe conducted a retrospective study of anaphylaxis cases attending an allergy department in a tertiary children's hospital. ResultsA total of 279 anaphylactic reactions in 177 patients were analyzed. Overall, 57.6% (102/177) of first anaphylaxis events occurred in infants (0–2 ys). Foods were the most common culprits (88.5%), followed by food + exercise/exercise (4.7%), and drugs (4.3%). The main food allergens were cow's milk (32.9%), egg (21.4%), and wheat (20.7%) in infants, compared with fruits/vegetables at 35.9% in preschool-age children (3–6 ys) and 31.6% in school-age children (7–12 ys). The most commonly implicated drug triggers were vaccines (n = 5, comprising DTaP n = 2, group A + C meningococcal polysaccharide vaccine n = 1, Sabin vaccine n = 1, and not specified n = 1). Among the 5 vaccine-induced anaphylaxis patients, 4 had severe cow's milk allergy. The clinical manifestations were mainly mucocutaneous (86.0%), followed by respiratory (68.8%), gastrointestinal (23.7%), neurological (10.4%), and cardiovascular (0.7%). Compared with patients of other ages, infants had higher rates of hives (0-2ys 77.4%, 3-6ys 50%,7-12ys 57.9%, 13-17ys 38.9%, p = 0.016) and vomiting (0-2ys 20.7%, 3-6ys 1.6%,7-12ys 8.8%, p < 0.001), while wheezing was more frequent in school-age children (0-2ys 21.4%, 3-6ys 25%, 7-12ys 38.6%, 13-17ys 5.6%, p = 0.017) and abdominal pain was more common in adolescents (0-2ys 2.1%,3-6ys 15.6%, 7-12ys 14.0%, 13-17ys 72.3%, p < 0.001). Regarding treatment, 9.3% of anaphylaxis events and 24.1% of life-threatening reactions were treated with epinephrine. ConclusionsWe observed age-related clinical patterns of anaphylaxis in this study, with hives and vomiting most commonly reported in infants and cardiovascular symptoms rarely reported in children. Wheat was the third most culprit food allergen after egg and milk in infancy. Education regarding more aggressive use of epinephrine in the emergency setting is clearly needed. Recognition of age-related symptoms in anaphylaxis can aid physicians in prompt diagnosis and acute management.

Epidemiology of anaphylaxis and biphasic reaction in Japanese children

AimAnaphylaxis is common, but can sometimes be fatal. However, data on the epidemiology and characteristics of anaphylaxis are limited. Although 0.9%–14.7% of anaphylactic reactions in children are biphasic, it is unclear what the characteristics of biphasic reaction are and how long patients with this reaction should be observed. The present study aimed to investigate the epidemiology of anaphylaxis and biphasic reactions and identify the characteristics of the latter.MethodsWe conducted an observational study of patients who visited the pediatric emergency department (PED) and were hospitalized for anaphylaxis between March 2010 and March 2017.ResultsOf the 264,689 children who visited our PED, 353 (1.3 per 1,000 patient) were hospitalized for anaphylaxis, and six (1.7%) had a biphasic reaction. Of the patients with a biphasic reaction, the median time from initial anaphylaxis to the biphasic reaction was 5.9 (interquartile range [IQR] = 3.3–7.6) hours. Symptoms of the initial episode and the biphasic reaction varied. One (0.3%) of the 353 patients developed a clinically important biphasic reaction that required epinephrine administration.ConclusionsThe rate of biphasic reactions was 1.7%, and that of clinically important biphasic reactions was 0.3%. Patients with anaphylaxis need to be carefully monitored because of the regular occurrence of biphasic reactions.

Prevalence and triggers of anaphylactic events in schools.

Prevention and management of anaphylaxis in schools is an area of active interest as allergy and asthma rates in children continue to increase. A greater understanding of the prevalence and characteristics of anaphylaxis can help guide preventive and management strategies both within and outside of the school setting, with the goal of reducing morbidity and mortality. This study was performed to elucidate the epidemiology of and management strategies for anaphylaxis in the school setting. A cross-sectional, Web-based survey was administered to schools that participated in an initiative that provides stock epinephrine autoinjectors (EAIs) to qualifying U.S. schools. Representatives from participating schools completed a questionnaire regarding anaphylactic reactions that occurred during the 2014-2015 school year. Weighted analyses were performed to account for differential responses between schools that completed the survey and those that did not. A total of 12,275 of the 45,819 invited schools responded to the survey. The occurrence of one or more anaphylactic events was reported by 1358 schools. Most events (89.8% [1803/2008]) occurred in students. High school students accounted for the largest proportion of anaphylactic reactions among students (40.1% [723/1802]). Food was the most commonly identified anaphylaxis trigger across grade levels, seasons, and geographic regions. The trigger was unknown to the individual who experienced anaphylaxis in 21.8% of the events (436/1998). No known history of allergy or asthma was present in 24.5% (491/2001) and 51.3% (1026/2000) of affected individuals, respectively. Transportation to the hospital or clinic for further treatment and/or management was reported for 72.6% of the individuals with anaphylactic events (1450/1997). Results from the weighted analyses were similar to those of the unweighted analyses. Anaphylaxis occurred across grade levels and in individuals with or without known risk factors, which reinforced the need for school preparedness in both management of anaphylaxis and stocking of EAIs.

Characteristics of Anaphylaxis in 907 Chinese Patients Referred to a Tertiary Allergy Center: A Retrospective Study of 1,952 Episodes.

PurposeComprehensive evaluation of anaphylaxis in China is currently lacking. In this study, we characterized the clinical profiles, anaphylactic triggers, and emergency treatment in pediatric and adult patients.MethodsOutpatients diagnosed with "anaphylaxis" or "severe allergic reactions" in the Department of Allergy, Peking Union Medical College Hospital from January 1, 2000 to June 30, 2014 were analyzed retrospectively.ResultsA total of 1,952 episodes of anaphylaxis in 907 patients were analyzed (78% were adults and 22% were children). Foods are the most common cause (77%), followed by idiopathic etiologies (15%), medications (7%) and insects (0.6%). In food-induced anaphylaxis, 62% (13/21) of anaphylaxis in infants and young children (0-3 years of age) were triggered by milk, 59% (36/61) of anaphylaxis in children (4-9 years of age) were triggered by fruits/vegetables, while wheat was the cause of anaphylaxis in 20% (56/282) of teenagers (10-17 years of age) and 42% (429/1,016) in adults (18-50 years of age). Mugwort pollen sensitization was common in patients with anaphylaxis induced by spices, fruits/vegetables, legume/peanuts, and tree nuts/seeds, with the prevalence rates of 75%, 67%, 61%, and 51%, respectively. Thirty-six percent of drug-induced anaphylaxis was attributed to traditional Chinese Medicine. For patients receiving emergency care, only 25% of patients received epinephrine.ConclusionsThe present study showed that anaphylaxis appeared to occur more often in adults than in infants and children, which were in contrast to those found in other countries. In particular, wheat allergens played a prominent role in triggering food-induced anaphylaxis, followed by fruits/vegetables. Traditional Chinese medicine was a cause of drug-induced anaphylaxis. Furthermore, exercise was the most common factor aggravating anaphylaxis. Education regarding the more aggressive use of epinephrine in the emergency setting is clearly needed.

Occurrence of Anaphylaxis By School Grade Level and Staff Training: Findings from the EpiPen4Schools Survey

M O N D A Y 684 EpiPen4Schools Survey: Characteristics of Anaphylaxis and Common Triggers Martha V. White, MD, FAAAAI, Diana Goss, Kelly Hollis, K. Millar, Suyapa Silvia, Peter Siegel, Mary Elizabeth Bennett, Ray A. Wolf, PharmD, Margaret Wooddell, Susan Hogue; Institute for Asthma and Allergy, RTI International, Clarity Consulting LLC, Mylan Specialty L.P., PA, Mylan Specialty. RATIONALE: The purpose of this study was to describe the characteristics of anaphylactic events and EAI use in children and adults in US schools. METHODS: This exploratory, cross-sectional, web-based survey of schools participating in the EpiPen4Schools program captured characteristics of anaphylactic events and EAI use during the 2013-2014 school year. RESULTS: A total of 5683 schools responded to questions on the occurrence of anaphylactic events. A total of 919 anaphylactic events were reported by 11%of schools (607/5683).Most schools (89%, n55076) reported no anaphylactic events, and 10% (n5543) reported 1 to 2 anaphylactic events. Most anaphylactic events occurred in students, 89% (n5757), 22% (n5187) of which occurred in those with no known allergies. In 9% (n575), allergy status was unknown. Of the 919 events, triggers were reported for 847 events (92%); most triggers, 62% (n5529), were listed as food, 10% (n581) were listed as insect stings, 7% (n556) as environmental/medication/health-related factors, and 1% (n59) as latex. Approximately 20% of events (n5172) had an unknown trigger. Although food allergy triggers were predominant throughout the year, prevalence of certain triggers varied seasonally. Insect stingswere relatively less frequent during winter, 4% (n55/143), vs fall, 13% (n531/243), and spring, 10% (n526/268) months, whereas unknown triggers reached a high of nearly 27% (n571/268) during spring. CONCLUSIONS: More than 1 in 10 schools reported an anaphylactic event in a single school year, many of whichwere associated with unknown triggers. These data indicate the unpredictable nature of anaphylaxis and the importance of anaphylaxis training for staff.

EpiPen4Schools Survey: Characteristics of Anaphylaxis and Common Triggers

EpiPen4Schools Survey: Characteristics of Anaphylaxis and Common Triggers

Comparison of Anaphylaxis and Angioedema with Oral Mucosal Involvement in a Single Pediatric Emergency Department

Objectives: We aimed to compare and distinguish the characteristics of anaphylaxis and angioedema, especially with oral mucosal involvement and treatment of patients who visited the Pediatric Emergency Department. Methods: We retrospectively analyzed patients under age 18-year-old who were diagnosed with anaphylaxis and angioedema with oral mucosal involvement and treated with epinephrine from May 2008 to May 2013 in a single Pediatric Emergency Department in Seoul, Korea. We evaluated their past history, possible triggering causes, symptoms, vital signs and treatment and discharge with education. Results: During the study period the total cases of anaphylaxis were 79 and angioedema with oral mucosal involvement were 218. The age of patients with anaphylaxis was significantly higher (6.6±4.9 years vs. 4.1±3.3 years). The heart rate relative to age was significantly higher in the anaphylaxis group (49.4% vs. 36.2%). After discharge from the Emergency Center, 3.8% of anaphylaxis patients were prescribed an epinephrine injection. Education to avoid the triggering factor was provided in 32.9% of anaphylaxis group and 17.4% in the angioedema group. Conclusion: Besides blood pressure, we should pay attention to the heart rate in pediatric patients with severe allergic reactions. More active follow-up of anaphylaxis and angioedema with oral mucosal involvement is needed to educate parents and prescribe emergency medication. (Ewha Med J 2015;38(1):14-21) Received July 30, 2014 Accepted October 8, 2014

Characteristics Of Anaphylaxis In a Pediatric Emergency Unit

Characteristics Of Anaphylaxis In a Pediatric Emergency Unit

Anaphylaxis in America: The prevalence and characteristics of anaphylaxis in the United States

Although anaphylaxis is recognized as an important life-threatening condition, data are limited regarding its prevalence and characteristics in the general population. We sought to estimate the lifetime prevalence and overall characteristics of anaphylaxis. Two nationwide, cross-sectional random-digit-dial surveys were conducted. The public survey included unselected adults, whereas the patient survey captured information from household members reporting a prior reaction to medications, foods, insect stings, or latex and idiopathic reactions in the previous 10 years. In both surveys standardized questionnaires queried anaphylaxis symptoms, treatments, knowledge, and behaviors. The public survey included 1,000 adults, of whom 7.7% (95% CI, 5.7% to 9.7%) reported a prior anaphylactic reaction. Using increasingly stringent criteria, we estimate that 5.1% (95% CI, 3.4% to 6.8%) and 1.6% (95% CI, 0.8% to 2.4%) had probable and very likely anaphylaxis, respectively. The patient survey included 1,059 respondents, of whom 344 reported a history of anaphylaxis. The most common triggers reported were medications (34%), foods (31%), and insect stings (20%). Forty-two percent sought treatment within 15 minutes of onset, 34% went to the hospital, 27% self-treated with antihistamines, 10% called 911, 11% self-administered epinephrine, and 6.4% received no treatment. Although most respondents with anaphylaxis reported 2 or more prior episodes (19% reporting ≥5 episodes), 52% had never received a self-injectable epinephrine prescription, and 60% did not currently have epinephrine available. The prevalence of anaphylaxis in the general population is at least 1.6% and probably higher. Patients do not appear adequately equipped to deal with future episodes, indicating the need for public health initiatives to improve anaphylaxis recognition and treatment.

Characteristics of anaphylaxis in a pediatric emergency department (ED): does management follow published guidelines?

There were 40 males (7.2 ± 4.9 (mean ± SD) years) and 35 females (6.7 ± 4.8 years). 36% of the first and 42% of the second episode were diagnosed as anaphylaxis. Symptoms included respiratory (84%), cutaneous (90%) and gastrointestinal (59%). No patient had hypotension, but the blood pressure was not documented in 25% of cases. Triggers were peanuts/nuts (46%), fish/seafood (6.9%), food-unknown (19.5%), food-other (11.6%), unknown/no agent (9.2%) and insect stings (3.4%). 39% of cases had asthma, 25% had atopic dermatitis, and 10% had allergic rhinitis. Time from exposure to symptoms was 31.9 ± 69.6 min. Epinephrine was administered to 34.5% of patients. Time from onset of symptoms to epinephrine administration was 70.0 ± 61.0 min and 15.4 ± 19.4 min from presentation to the ED. Length of stay in the ED was 209.0 ± 163.0 minutes. 37% of patients were observed in the ED for ≥ 4h ours. 24% of patients left the ED without access to an epinephrine auto-injector and 19.5% were not referred to an allergist. Conclusions There are gaps between anaphylaxis guidelines and actual management in a typical ED. Failure to diagnose anaphylaxis leads to suboptimal treatment that may lead to adverse outcomes. Adoption of standard protocols for anaphylaxis in the ED may improve outcomes of potentially life-threatening reactions.

Epidemiologic and clinical features of anaphylaxis in Korea

Little is known about the characteristics of anaphylaxis in Korea or even in Asia. To evaluate the incidence of anaphylaxis and the clinical features of patients with anaphylaxis in a Korean tertiary care hospital. We performed a retrospective review from January 1, 2000, through July 31, 2006, of 138 patients with anaphylaxis, including inpatients, outpatients, and emergency department visitors, in the Seoul National University Hospital. Among 978,146 patients, 138 (0.014%) had anaphylaxis. Two cardiopulmonary resuscitations were performed and 1 death occurred. The total mortality rate of anaphylactic patients was 0.0001%. The causes of anaphylaxes were drug (35.3%), food (21.3%), food-dependent exercise-induced (13.2%), idiopathic (13.2%), insect stings (11.8%), exercise induced (2.9%), blood products (1.5%), and latex (0.7%). Radiocontrast media and buckwheat were the leading causes of drug and food anaphylaxis, respectively. The organs most frequently involved in the anaphylaxis were cutaneous (95.7%), cardiovascular (76.8%), and respiratory (74.6%). The most common manifestations were dyspnea (71.3%), urticaria (81.9%), and angioedema (69.4%). Three of 138 patients (2.2%) had biphasic reactions. The incidence, mortality rate, and clinical features of Korean patients with anaphylaxis were similar to rates for patients from other countries, despite some differences in causative agents.