Clinical Features Of Anaphylaxis Research Articles

The etiology, risk factors, and clinical features of anaphylaxis: The single-center retrospective cohort study of the tertiary university hospital

Background/Aim: Anaphylaxis presents in multiple ways, making its diagnosis challenging. Delayed diagnosis can lead to a postponement in administering crucial adrenaline treatment. The prevalence of anaphylaxis varies by geographical region and gender. However, there has been no comprehensive regional analysis of anaphylaxis data within our country. Despite an increasing incidence, our understanding of anaphylaxis etiology, risk factors, and clinical features remains limited, particularly within our nation. This study aims to assess the frequency, etiology, risk factors, and clinical findings of anaphylaxis among patients seen at the allergy clinic of a tertiary university hospital. Additionally, it seeks to compare regional data with existing literature. Methods: This retrospective cohort study reviewed the medical records of 8,295 patients who visited the allergy outpatient clinic at Sivas Cumhuriyet University Hospital between July 2, 2018, and December 10, 2019. The hospital’s data system retrospectively analyzed records using the ICD code T78.2 (anaphylaxis). Only cases where patients were prescribed an adrenaline auto-injector were included. The study evaluated anaphylaxis frequency, etiologies, demographics, and clinical features. Results: The study identified 77 patients (n=77) with a mean age of 40.29 (3.77) years, consisting of 47 females and 30 males. The frequency of anaphylaxis among allergy outpatient admissions was less than 1% (0.009%). Single-type atopic diseases included venom allergy (23%), drug allergy (14%), inhalant allergens (n=6), food allergens (n=4), and skin allergic diseases (n=3). Multiple allergic diseases were present in 40% (n=31) of cases. Prick tests were performed on 56 (72%) patients, with 25 (44%) yielding negative results. Among positive prick test cases, venom was the main cause of anaphylaxis (82%), while drug allergy was more prevalent (68.2%) among negative test results (P=0.016). Inhalant allergen sensitivity and allergen polisensitivity did not significantly influence the anaphylaxis cause (P<0.001). Causes of anaphylaxis included drug allergy (47%), venom allergy (31%), food allergens (16%), food-dependent exercise-induced reactions (n=2), idiopathic cases (n=2), and cold urticaria (n=1). Non-steroidal anti-inflammatory drugs (NSAIDs) (44%) and beta-lactams (10%) were the primary culprits. In cases where neither drugs nor venom were involved, food allergies were the cause (P<0.001). With venom allergy, the cause was venom, and without venom, drug allergy was the cause (P<0.001). Female patients showed significantly higher drug- and food-related anaphylaxis rates than males (P=0.032 and P=0.042, respectively). History of Apis mellifera-related anaphylaxis was significantly more common than Vespula vulgaris-related cases (P=0.028). Anaphylaxis severity included grade 2 (30%), grade 3 (48%), and grade 4 (12%) reactions. Recurrent anaphylaxis episodes occurred in 55% (n=42) of patients. Initial hospital administrations involved epinephrine injections in only 25% (n=19) of cases. Cutaneous symptoms were present in 94%, respiratory symptoms in 88%, cardiovascular symptoms in 63%, neurological symptoms in 57%, and gastrointestinal symptoms in 12% of patients. Conclusion: This study identified drug allergy as the leading cause of anaphylaxis in the examined cases. Preventable factors contributing to drug-induced anaphylaxis included insufficient patient and physician knowledge and widespread over-the-counter drug use without medical consultation. Despite 55% of patients experiencing recurrent attacks, only a quarter received epinephrine administration. These findings emphasize the need to educate patients with recurrent anaphylaxis about avoidance strategies and to enhance healthcare providers’ understanding of anaphylaxis treatment.

Anaphylaxis in Omani Patients: A Study from a Tertiary Care Center.

ObjectivesAnaphylaxis is an acute and potentially fatal allergic reaction. No studies have yet been conducted to evaluate the spectrum of anaphylactic reactions among Omani patients. As such, this study aimed to describe the clinical features, causes, investigation, and management of anaphylaxis among patients presenting to a tertiary care center in Oman.MethodsThis retrospective study took place between August 2005 and June 2020 at the allergy and immunology clinic of Sultan Qaboos University Hospital, Muscat, Oman. All patients diagnosed with anaphylaxis during the study period were included. Data were collected from electronic medical records.ResultsOne hundred patients were diagnosed with anaphylaxis during the study period. Of these, 52.0% were male. The mean age was 15.9±16.2 years, with 70.0% aged < 18 years old. The eosinophil count ranged from 0.0–16.9 × 109/L, with a mean of 0.8±2.2 × 109/L and a median of 0.3 (0.1–0.6) × 109/L. Total immunoglobulin (Ig) E levels ranged from 25–8706 kIU/L, with a mean of 935.1±1369.5 kIU/L and a median of 500.4 (186.0–972.5) kIU/L. The majority of patients had a family history of allergies (72.0%), and other had concomitant allergic conditions (66.0%). All were prescribed epinephrine (100%). The most common cause of anaphylaxis was food (65.0%). The second most frequent trigger was insect venom (32.0%). Most patients had one category cause (81.0%); two or more causes were present in 12.0% of patients. Clinical symptoms manifested most frequently as cutaneous (92.0%) and respiratory (85.0%). The majority of patients (87.0%) demonstrated the involvement of more than one bodily system. Mean total IgE levels were significantly higher in patients with concomitant presence of other allergic conditions (1193.8 kIU/L) than patients without another concomitant allergic disease (503.6 kIU/L; p =0.030). In addition, concomitant allergic disease is significantly higher in patients < 18 years of age (75.4%) compared to patients > 18 years of age (45.2%; p =0.010).ConclusionsDue to its life-threatening nature, knowledge of the epidemiology and clinical features of anaphylaxis in different populations is necessary to deliver rapid treatment. This study found that the clinical features of anaphylactic patients in Oman were similar to those reported elsewhere. Further research is needed to determine the true incidence of anaphylaxis in Oman to minimize associated morbidity and mortality.

Clinical features of anaphylaxis in children.

Background: Despite the considerable increase in anaphylaxis frequency, there are limited studies on clinical features of anaphylaxis in children in developing countries. Objective: We aimed to analyze the demographic and clinical features of anaphylaxis in children in Turkey by comparing different age groups and triggers. Methods: Medical records of 147 children, ages 0-18 years, diagnosed with anaphylaxis between 2010 and 2019 were retrospectively analyzed. Results: The mean ± standard deviation age at first anaphylaxis episode was 5.9 ± 5.2 years, with a male predominance (63.9%); 25.2% were infants and 52.4% were < 6 years of age at their first anaphylaxis episode; 78.2% were atopic, with the highest frequency in children with food-induced anaphylaxis (FIA). The home (51.7%) was the most frequent setting. The overall leading cause of anaphylaxis was food (44.2%), which was more frequent at < 6 years of age, followed by drugs (28.6%) and bee venom (22.4%), both were more frequent among older children (>6 years). The patients with venom allergy had the highest rate of rapid onset of symptoms (p < 0.001). Gastrointestinal symptoms were observed significantly more in infants (48.6%) and in children with FIA (38.5%); cardiovascular symptoms were more frequently observed in children > 6 years of age (48.6%) and in children with drug-induced anaphylaxis (64.3%). Although recurrent anaphylaxis was reported for 23.1% of the patients, it was highest in the patients with FIA (35.9%). Overall, only 47.6% of the patients received epinephrine in the emergency department (ED) and 27.3% were referred to an allergy specialist, with the patients with FIA having the lowest rate for both, 32.3% and 10.8%, respectively. Children with drug-induced anaphylaxis had the highest rate of severe anaphylaxis (57.1%). Conclusion: There is a need to improve anaphylaxis recognition and management in all children regardless of age and trigger. Inadequate treatment was most evident in infants and patients with FIA.

A Prospective Observation of Psychological Distress in Patients With Anaphylaxis.

PurposeAnaphylaxis is an immediate allergic reaction characterized by potentially life-threatening, severe, systemic manifestations. While studies have evaluated links between serious illness and posttraumatic stress disorder (PTSD), few have investigated PTSD after anaphylaxis in adults. We sought to investigate the psychosocial burden of recent anaphylaxis in Korean adults.MethodsA total of 203 (mean age of 44 years, 120 females) patients with anaphylaxis were recruited from 15 university hospitals in Korea. Questionnaires, including the Impact of Event Scale-Revised-Korean version (IES-R-K), the Korean version of the Beck Anxiety Inventory (K-BAI), and the Korean version of the Beck Depression Inventory (K-BDI), were administered. Demographic characteristics, causes and clinical features of anaphylaxis, and serum inflammatory markers, including tryptase, platelet-activating factor, interleukin-6, tumor necrosis factor-α, and C-reactive protein, were evaluated.ResultsPTSD (IES-R-K ≥ 25) was noted in 84 (41.4%) patients with anaphylaxis. Of them, 56.0% had severe PTSD (IES-R-K ≥ 40). Additionally, 23.2% and 28.1% of the patients had anxiety (K-BAI ≥ 22) and depression (K-BDI ≥ 17), respectively. IES-R-K was significantly correlated with both K-BAI (r = 0.609, P < 0.0001) and K-BDI (r = 0.550, P < 0.0001). Among the inflammatory mediators, tryptase levels were lower in patients exhibiting PTSD; meanwhile, platelet-activating factor levels were lower in patients exhibiting anxiety and depression while recovering from anaphylaxis. In multivariate analysis, K-BAI and K-BDI were identified as major predictive variables of PTSD in patients with anaphylaxis.ConclusionsIn patients with anaphylaxis, we found a remarkably high prevalence of PTSD and associated psychological distresses, including anxiety and depression. Physicians ought to be aware of the potential for psychological distress in anaphylactic patients and to consider psychological evaluation.

The Etiology and Clinical Features of Anaphylaxis in a developing country: A nationwide survey in Turkey.

Despite the increasing frequency of anaphylaxis, there is inadequate information on the etiology and clinical features in various countries, regions and age groups, especially in developing countries. Our aim is to assess the etiology and clinical findings of anaphylaxis in Turkey. Gathering reliable data about the etiology and clinical findings of anaphylaxis in the general population will decrease the related morbidity and mortality. We obtained the names and phone numbers of individuals who had been prescribed an epinephrine auto-injector with a diagnosis of anaphylaxis from ministry of health. Demographic data, clinical history of the first episode of anaphylaxis including the triggering agent, clinical findings, course of hospitalization, and the management of anaphylaxis were obtained by phone survey. A total of 843 patients with a mean age of 21.4±17.3 years were evaluated. There was a significant male predominance among children younger than 10 years of age but a female predominance in older subjects. The most common causes of anaphylaxis were foods(40.1%) in children and bee venom(60.8%) in adults. The biphasic reaction rate was 4.3% and the median length of stay at an emergency department was 4.0 hours. Almost 60% of the patients had recurrent anaphylaxis episodes. Only 10.7% of the cases were prescribed an epinephrine auto-injector at their first anaphylaxis episode and only 59.2% of the patients were referred to an allergist during discharge from the emergency department. In Turkey, bee venom was the most common cause of anaphylaxis, followed by food and drug. While more than a half of patients reported recurrent attacks; only 10% had been prescribed epinephrine auto-injector kit after their first episode. Strategies to improve the anaphyalxis management are therefore urgently required.

Clinical features of anaphylaxis according to age in a single university hospital in Korea.

Prevalence of anaphylaxis is increasing steadily, but there is scant information about anaphylaxis. To identify the prevalence of anaphylaxis and evaluate the cause and features of anaphylaxis according to age. The relevance of gender, age, history of allergic diseases, causes and clinical symptoms in the treatment and prognosis of anaphylaxis were retrospectively evaluated in patients diagnosed with anaphylaxis in Pusan National University Hospital from January 2009 to June 2014. The 161 patients included 30 children and 131 adults. The prevalence of anaphylaxis in both children and adults increased during the study period. The most common triggers were food in children, especially in those <5 years of age, and drugs in adults. All of the children with episodes of anaphylaxis presented with cutaneous symptoms and 90% had respiratory symptoms. For adults, cardiovascular symptoms were more common. The prevalence of anaphylaxis increased in both children and adults, with a higher rate in children. The causes and symptoms of anaphylaxis may differ depending on age. Clinicians should understand the characteristics of anaphylaxis by age.

Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study

PurposeDifferences in definitions of the condition, relevant triggers, and the geographical locations of study centers, cause estimates of the prevalence of anaphylaxis to vary. Recent epidemiological data indicate that the incidence of anaphylaxis is rising.MethodsTo investigate the causes and clinical features of anaphylaxis in Korean adults, factors associated with the severity of the condition, and serious outcomes, a retrospective medical record review was performed on adult patients diagnosed with anaphylaxis between 2007 and 2011 in 15 University Hospitals of South Korea.ResultsA total of 1,806 cases (52% male, age 16-86 years) were reported. Cutaneous symptoms (84.0%), combined with respiratory (53.9%) and/or cardiovascular (55.4%) symptoms, were the most frequent presentations. Using a recognized grading system, 1,776 cases could be classified as either mild, 340; moderate, 690; or severe, 746. Although eliciting factors varied significantly by age, gender, and regional and seasonal factors, drugs (46.5%; including nonsteroidal anti-inflammatory drugs, antibiotics, and radiocontrast media) were the most common cause of anaphylaxis, followed by foods (24.2%), insect stings (16.4%), exercise (5.9%), and unknown etiology (7.0%). All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. Epinephrine auto-injectors were prescribed for 7.4% of reported cases.ConclusionsThe principal causes of anaphylaxis in Korean adults were drugs, food, and insect stings. Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes.

Epidemiological and Clinical Features of Anaphylaxis: Single Center Experience with 109 Children

There has been increasing data on pediatric anaphylaxis. In this study, we aim to determine demographics and atopic status of patients, etiology, and clinical feature of anaphylaxis, its management and follow-up over the 9-year period. We made a retrospective medical chart review of patients diagnosed as anaphylaxis in the Pediatric Allergy and Asthma Department of Gazi University Hospital between January 2003 and May 2012. Diagnosis of anaphylaxis was reviewed by 2 pediatric allergists and those compatible with the criteria according to the second symposium on the definition and management of anaphylaxis were included in the analysis. During the study period, 109 patients (66 male, 43 famale) were diagnosed with anaphylaxis. The median age was 72 months. Fourteen patients (12.8%) had more than one episode before diagnosis. Anaphylactic episode was severe in 28 patients (25.7%). Cutaneous symptoms were the most frequent symptoms (91.7%). Blood pressure measurement had been done in 47 patients (43.1%). Treatment of anaphylaxis included antihistamines in 105 patients (96.3%), corticosteroids in 101 patients (92.7%), and adrenaline in 50 patients (45.9%). The most common cause of anaphylaxis differed according to age groups: food in infants (85%), drugs in older children (43.8%). Sixty-six patients were prescribed autoinjector. In follow-up, 10 patients (9.2%) experienced a second episode of anaphylaxis. Nine of them had adrenaline autoinjector, 3 of them carried the autoinjector with them but only one patient used it. Major etiologic factors of anaphylaxis differed according to the age of children. There were inadequancies in management of anaphylaxis related to physicians, such as blood pressure measurement and acute treatment of anaphylaxis in medical centers and related to patients as uncompliances to carry and use adrenaline autoinjector.

Incidence of Intraoperative Anaphylaxis in A University General Hospital in Brazil

The epidemiology of intraoperative anaphylaxis is unknown in Brazil. We aimed to evaluate the incidence and clinical features of anaphylaxis during anesthesia in a University General Hospital in Sao Paulo, Brazil.

Anaphylaxis in a tertiary adult allergy clinic: a retrospective review of 516 patients

BackgroundAnaphylaxis is a life-threatening acute allergic reaction that can occur at any age. ObjectiveTo determine the frequency, triggering factors, and clinical features of anaphylaxis among adult patients who were referred to a tertiary health care facility. MethodsA retrospective medical chart review was performed including all patients referred to the outpatient clinic of the adult allergy department in our university hospital between January 1, 2008 and December 30, 2011 to determine cases involving anaphylaxis. ResultsA total of 516 (2.11%) patients among 24,443 admissions were diagnosed with anaphylaxis. Although the second highest frequency of anaphylaxis cases took place in 2008, a gradual rise in the frequency was determined from 2009 to 2011. Drugs (90.7%) were the most frequent cause, followed by Hymenoptera stings (5.4%), foods (1.6%), latex (0.4%), and exercise (0.2%) respectively. The clinical manifestations during anaphylaxis reported by patients were cutaneous (n = 292, 56.6%), respiratory (n = 253, 49%), cardiovascular (n = 212, 41%), neuropsychiatric (n = 60, 11.6%), and gastrointestinal (n = 52, 10.1%), respectively. Approximately one fifth of the patients received epinephrine, whereas 43% of patients did not receive epinephrine during their treatment in the emergency room. An epinephrine auto-injector was prescribed to 42 patients (8.1%). ConclusionIn this study, the second pattern of National Institute of Allergy and Infectious Disease (NIAID) and the Food Allergy and Anaphylaxis Network (FAAN) diagnostic criteria for anaphylaxis predominated among adult patients. Drugs were the leading triggering factor, followed by Hymenoptera stings, foods, latex, and exercise, respectively. Atopy, asthma, and allergic rhinitis were rarely detected.

Clinical Features of Patients with Anaphylaxis at a Single Hospital

Purpose:The studies concerning the clinical features of patients with anaphylaxis, who meet the newly established diagnostic criteria, are reported in Korea, but comparative studies regarding the clinical features of children and adult patients with anaphylaxis are lacking. The purpose of this study is to compare the clinical features of the children and adults with anaphylaxis, who meet the new diagnostic criteria at a single hospital. Methods:We reviewed the medical records of patients who were diagnosed with anaphylaxis, anaphylactic shock, urticaria, and angioedema, including inpatients, outpatients and emergency room visited patients, at the National Medical Center from July, 2005 to August, 2011. The clinical characteristics of children and adults, who met the new diagnostic criteria for anaphylaxis, were analyzed. Results:We identified 91 patients with anaphylaxis. Sixteen were children and 75 were adults. The sex ratio (male:female) and the mean age were 1:1.7 and 9.6 years among children, respecti- vely, and 1:2.3 and 42.3 years, respectively, among adults. The most common cause of anaphylaxis based on clinical history was foods in 15 children (93.7%) and 35 adults (46.7%). Twelve children (75%) and 36 adults (48%) were rediagnosed with anaphylaxis. Patients with cardiovascular symp- toms and severe severity were 1 (6.3%) and 1 (6.3%), respectively, among children, and 28 (37.3 %) and 23 (30.3%), respectively, among adults. Conclusion:We rediagnosed some cases of anaphylaxis, using the new diagnostic criteria and most of the cases were diagnosed initially as urticaria or angioedema. The adults had more severe and more cardiovascular symptoms than children. In the future, a nationwide, multiinstitutional research will be necessary for the prevalence and the clinical features of anaphylaxis by the new diagnostic criteria in Korea.(Pediatr Allergy Respir Dis(Korea) 2012;22:232-238)

Triggers, clinical features and management of anaphylaxis in children

This article describes the clinical features of anaphylaxis in children and young people. The acute management of anaphylaxis in hospital and community is described and various prevention strategies are discussed.

Anaphylaxis in Israel: Experience with 92 hospitalized children

Little is known about the courses, causes, and clinical features of anaphylaxis in children outside the USA and Europe. Our objective was to evaluate the events of anaphylaxis in children admitted to the Schneider Children's Medical Center of Israel, a major tertiary facility, over a 12-year period. Ninety-two children with anaphylaxis (50 boys, 42 girls) aged 14 days to 18 yr (mean, 7.4 yr) were hospitalized during the study period. The event occurred at home in 52 children (56%), in a medical institution in 24 (26%), outdoors in 13 (15%), at school in 2 (2%), and in an unspecified location in 1 (1%). The main causes were foods (43%), mainly milk and nuts, medications (22%), and hymenoptera venom (11%); in five children, anaphylaxis occurred during general anesthesia, and in 5, the causative agent could not be determined. Food-induced anaphylaxis tended to occur in younger children. Forty-eight children (52%) had a history of atopy (mainly asthma). Hospital treatment consisted of corticosteroids (85%), antihistamines (75%), epinephrine (72%), and β2 agonists (42%). Seven patients were admitted to intensive care units. There were no fatalities. EpiPen was used by only one of the 16 patients with more than one episode of anaphylaxis, indicating that patient and parent education in the application of the EpiPen needs to be improved.

Anaphylaxis in referred pediatric patients: demographic and clinical features, triggers, and therapeutic approach

Anaphylaxis remains under-diagnosed and under-treated. A better knowledge of patterns and triggers of anaphylaxis might contribute to a better management. In this study we evaluated the demographic and clinical features of anaphylaxis in pediatric patients, as well as its triggers and therapeutic approach. From May 1st 2004 until April 30th 2006 we prospectively collected data on all patients referred for investigation of anaphylaxis to the pediatric department of the University Hospital Gasthuisberg Leuven and to two private pediatric practices. Data were stored in a MYSQL database by use of an online encrypted web form. Sixty-four cases of anaphylaxis occurred in 48 children, aged 6 months to 14.8 years. Twenty-seven episodes (42.2%) occurred at home. The symptoms were dermatologic in 62 (96.9%) episodes, respiratory in 57 (89.1%), gastrointestinal in 19 (29.7%), cardiovascular in 14 (21.8%), and neurological or behavioural in 19 (29.7%). Antihistamines were administered in 41/57 (71.9%) cases, corticosteroids in 26/57 (45.6%), beta-2-mimetics in 14/57 (24.6%), and adrenaline in 11/57 (19.3%). Out of nine cases where Epipen was available at the moment of anaphylaxis, it was administered in one case only. Food was the cause of anaphylaxis in 42/55 (76.4%) cases with identified trigger, while medication, insect stings, latex, and birch pollen triggered 5 (9.1%), 4 (7.3%), 3 (5.5%), and 1 (1.8%) case(s), respectively. Allergy to the trigger was known prior to anaphylaxis in 19/55 (34.5%) cases. In conclusion, anaphylaxis in pediatric patients generally presents with dermatologic and respiratory symptoms, while in 1/5 episodes cardiovascular symptoms occur. Food is by far the most frequent trigger. Allergy to the trigger is known in 1/3 cases only. Anaphylaxis is under-treated, even when appropriate medication is available.

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.

Anaphylaxis: A 7-Year Follow-up Survey of 46 Children

Cianferoni A, Novembre E, Pucci N, Lombardi E, Bernardini R, Vierucci A. Ann Allergy Asthma Immunol . 2004;92:464–468 To follow children with a previous history of anaphylaxis to determine the clinical course of this syndrome. A total of 76 children referred between 1994 and 1996 with clinical features of anaphylaxis, which included at least …

Clinical features of anaphylaxis in children: 7 years' followup of 46 cases

Clinical features of anaphylaxis in children: 7 years' followup of 46 cases