Life-threatening Systemic Hypersensitivity Reaction Research Articles

Descriptive Profile of Anaphylactic Reaction Patients Hospitalized at RSUP Prof. DR. I.G.N.G Ngoerah Period 2018-2023

Introduction: Anaphylactic reaction is a severe, potentially life-threatening systemic hypersensitivity reaction caused by a specific allergen. This study aimed to evaluate the clinical profile of anaphylactic patients hospitalized in Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar. Method: This was a cross-sectional descriptive study of anaphylactic patients hospitalized in our center from January 2018 to December 2023. Patients diagnosed with anaphylactic reactions were included in this study. All the data (demographic, clinical manifestations, potential trigger) were attained from medical records for descriptive analysis. Result: 292 patients were enrolled in this study; half were women (54,4%), and the median age was 38,50 years (interquartile range 24). The most common potential triggers were drugs (57%), followed by food (18,5%), blood products (14,1), insect bites, and other triggers (4,8%). Almost all patients experience skin and mucosal manifestations (99%). Anaphylactic shock occurs in only 22% of patients. Discussion: Previous studies have found similar results to our findings, and anaphylactic reaction caused by drugs was associated with a more severe reaction. The effect of estrogen hormones on more severe reactions has been reported in female mice, but human research is still limited. Conclusion: Further studies are needed to investigate the correlation between demographic characteristics or specific clinical manifestations with a severe reaction.

Anaphylaxis biomarkers: present and future.

Anaphylaxis is a severe, rapidly developing, and life-threatening systemic hypersensitivity reaction. The diagnosis of anaphylaxis is primarily clinical. Numerous studies on the mechanisms and the biomarkers of the disease are initiated every year. The biomarkers of anaphylaxis may become an important tool for the diagnosis, prevention, repeated risk assessment, severity stratification, and new therapeutic strategies for treatment of the disease. Various immune and non-immune mediators produced and released by effector cell populations are currently considered as biomarkers of anaphylaxis. Here, we review the current data on potential biomarkers of anaphylaxis and the possibilities and perspectives for their use in future clinical practice.

Trends in anaphylaxis management during COVID-19

BackgroundAnaphylaxis is an acute, potentially life-threatening systemic hypersensitivity reaction that commonly occurs in the community setting and is best managed with epinephrine. ObjectiveThe purpose of this study was to examine the effects of the COVID-19 pandemic on trends in acute at home anaphylactic events including Emergency Room (ER) visits and treatment for anaphylaxis. MethodsWe used data from two sources: survey data from the Food Allergy Research & Education (FARE) Patient Registry; and electronic medical records of patients who presented to Tampa General Hospital ER with a diagnosis of anaphylaxis. We collected data from events during the Covid epidemic and before and after vaccine availability. Data was analyzed using descriptive statistics. Results190 FARE survey responses were completed. Sixty-three patients reported that the COVID-19 pandemic changed how they responded to the allergic reaction. Of these 63 patients, 71% avoided seeking medical care outside the home, 30% used self-medication more quickly than usual, and 14% delayed the use of medication. Only 87 events (46%) were treated with epinephrine. 4358 presented to TGH ER from April 1, 2018, to March 31, 2022, with an ICD-10 diagnosis code of anaphylaxis or allergic reaction. Only 718 received epinephrine in the ER. 867 patients presented 1 year prior to March 1, 2020 (before vaccine availability) and 1,833 patients presented 1 year after April 1, 2021 (after vaccine availability). ConclusionsOnly 16% of patients received epinephrine by survey and ER data capture. After COVID vaccine availability there were more ER visits for anaphylaxis among patients seen in a tertiary care teaching hospital.

Features of the clinical course and treatment of anaphylaxis in children in the Ryazan region according to survey data

Anaphylaxis is a life-threatening systemic hypersensitivity reaction with the rapid development of critical changes in hemodynamics and /or disorders of the respiratory system, which can lead to death. Despite the trend towards the spread of anaphylaxis among children, there are difficulties in monitoring statistical data, since there is no generally accepted cipher “Anaphylaxis” in the ICD-10, and designations from allergic urticaria to anaphylactic shock appear as a diagnosis. Epidemiological studies on anaphylaxis in the Russian Federation are isolated, so the assessment of data from each region is relevant.Objective: to study the clinical features and medical care for anaphylaxis in children of the Ryazan region in real clinical practice.Materials and methods: A retrospective analysis of medical documentation was carried out in 300 children who had suffered an “acute allergic reaction” over the past 5 years, followed by a telephone survey of patients’ parents about the disease, and based on the clinical criteria for the diagnosis of anaphylaxis presented by the World Organization of Allergists (WAO) in 2020 and in the Federal Clinical Guidelines for the Diagnosis and Treatment of anaphylaxis, 57 patients were selected for anaphylactic shock of the Russian Federation in 2022, whose data were compared in a spreadsheet and analyzed using SPSS V24.0, including descriptive statistics.Results: It was revealed that the average age of first—time anaphylaxis is 3.5 years. Clinical manifestations from the skin and mucous membranes were present in 67.2 % of patients, symptoms from the respiratory system in 11.8 % of cases. The leading trigger for the occurrence of anaphylaxis in children is the nutritional factor (n = 27 (40 %), (χ2 = 4.56; p = 0.033)). In 29 % of cases, the causally significant allergen remained unknown. The most common drugs in the treatment of anaphylaxis in real clinical practice were glucocorticosteroids (n = 48 (84.2 %)) and antihistamines of the first and second generation (n = 47 (82.5 %)). The frequency of epinephrine use was only 3 cases (5 %).Conclusion: The epidemiological study of anaphylaxis in the Ryazan region was a pilot project for our region. It showed difficulties both in the organization and in the interpretation of the data obtained. According to preliminary results, food allergy is a frequent trigger of anaphylaxis in children of the Ryazan region. Regional studies of anaphylaxis in children in real clinical practice make it possible to identify not only the features of this urgent pathology, but also to note the problems of providing primary medical care in order to improve it. Further study of population models of anaphylaxis, apparently, should be based on the creation of a unified questionnaire of the pediatric community, following the example of the ISAAC questionnaires or the creation of registers, which will more accurately help determine the true prevalence of anaphylaxis, determine the need to identify anaphylactogenic relevant molecules in the pediatric population, and improve the provision of assistance to children with these conditions.

Simulation Training in Teaching Pediatricians the Skills of Providing Emergency Care for Anaphylaxis Using the ABCDE Algorithm

Anaphylaxis is the most severe, potentially life-threatening systemic hypersensitivity reaction, which in children ranges from 10.5 to 70 cases per 100,000 person-years, with the highest incidence at the age of 5-17 years. As before, late diagnosis remains in pediatrics — in 50% of cases, the diagnosis of anaphylaxis is not actually made, which makes it necessary to develop skills in diagnosis and treatment tactics. The results of the training on one of the life-threatening conditions on the basis of the Multidisciplinary Simulation Center of the Tyumen State Medical University for five years are described.

Evaluation of the triggers and the treatment models of anaphylaxis in pediatric patients.

Anaphylaxis is an acute, life-threatening systemic hypersensitivity reaction. We aimed to evaluate the demographic and clinical characteristics of patients presenting with anaphylaxis, as well as triggers and risk factors, and to determine the rate of adrenaline auto-injector (AAI) usage. The study was planned in the pediatric allergy outpatient clinic over a 1-year period. The data of children diagnosed with anaphylaxis were evaluated retrospectively; demographic characteristics, causes of anaphylaxis, and treatment modalities were recorded in the created study form. Eighty children (29 females) with a median age of 6.5 years (range: 1 month-17 years) were evaluated. The most common triggers were foods under 2 years of age (73%), and drugs (70%) above 2 years of age. Nearly half of the anaphylaxis episodes (n=41, 51.3%) occurred at home. Cutaneous and respiratory symptoms were the most commonly reported complaints (98.8%). The median age of the patients at the first attack with severe anaphylaxis (n=29, 36.3%) was significantly higher than the rest (p:0.007). The age at onset of the reaction (p:0.006) and occurrence of the reaction in hospital conditions (p<0.001) were determined to be significant risk factors for severe anaphylaxis. Most of them received antihistamines (95.7%) and corticosteroids (91.3%), while 78.3% received adrenaline. Only 9.5% of patients with recurrent episodes of anaphylaxis used AAIs. Foods in infants and drugs in older children were the leading causative allergens of anaphylaxis. The most common clinical manifestations were respiratory and cutaneous symptoms. The older age at onset of the reaction and the occurrence of the reaction in hospital conditions were determined to be significant risk factors for severe anaphylaxis. It was determined that the frequency of AAI use was low among patients and their families.

Communication of perioperative anaphylaxis under general anaesthetic to patients and within the multidisciplinary team

Background: Anaphylaxis is defined as a severe, life-threatening systemic hypersensitivity reaction. Its incidence is estimated to be 1 in 10 000 anaesthetics.1 The 6th National Audit Project (NAP6) on perioperative anaphylaxis revealed that one-third of patients experienced harm after the event, with anxiety about future anaesthetics being the most commonly reported consequence. The objective of this study is to assess the effectiveness of (1) communication of perioperative anaphylaxis and (2) emotional support provided to patients, and their consequent impacts on feelings towards future anaesthetics. This study also evaluates the current procedure for allergy referral after perioperative anaphylaxis. Methods: Thirty-four patients who experienced general anaesthetic-induced perioperative anaphylaxis in Addenbrooke’s Hospital, Cambridge between 5 January 2017 and 2 December 2020 were identified using electronic medical records. The subjective experiences of the communication of the anaphylactic event and the allergy testing results were evaluated in a telephone survey of 26 of these patients. The telephone survey also explored patients’ perception of the emotional support received after anaphylaxis and any negative impact on their feelings towards a subsequent general anaesthetic. In addition, the responsible person for making an Allergy department referral in all cases was investigated. Results: Communication of the anaphylactic event was considered excellent by 69% of patients, with a rating of 5/5 on a 1–5 rating scale. Of the 17 patients that were referred to the Allergy department for allergen testing, 16 felt communication of the test result was clear. Emotional support from hospital staff after anaphylaxis was considered excellent by 38% of patients, whereas 33% felt emotional support was poor on a 1–5 rating scale. Negative feelings towards a subsequent general anaesthetic were reported by 50% of patients. There is also a lack of consistency regarding who makes an allergy referral (surgeon or anaesthetist). Conclusions: The study data show that improvements in the process of referring patients to the Allergy department, and patient experience in terms of communication and emotional support after a traumatic anaphylactic event, should be made. This is in concordance with the findings of the NAP6 report. There need to be clearer local guidelines regarding which clinician is responsible for making an anaphylaxis referral to the Allergy department. Patients should be sent a letter explaining their anaphylaxis, the significance of it and the sources of support available if required. Anaesthetists and the Allergy department should be made aware of emotional support available to recommend to patients. We have presented our findings to the Anaesthetics and Allergy departments of Addenbrooke’s Hospital and are in the process of making changes to the practice. We will review again in 3–5 years’ time. 1.Harper NJN, Cook TM, Garcez T, et al. Br J Anaesth 2018: 121: 159–71

Level of knowledge among healthcare professionals regarding anaphylaxis.

Anaphylaxis is defined as a severe, life-threatening systemic hypersensitivity reaction. Healthcare professionals must recognize the symptoms, apply correct treatment immediately, and provide epinephrine auto-injectors (EAI) to patients who experience anaphylaxis. In this study, we aimed to investigate the knowledge of healthcare professionals regarding anaphylaxis. This cross-sectional study, which was conducted between February 2022 and March 2022, included healthcare professionals working in various hospitals in Turkey. A survey consisting of 21 questions which concerned with the demographic data, personal experience and level of knowledge about anaphylaxis was applied to healthcare professionals. The study included a total of 301 participants, comprising 160 specialist physicians (53.16%), 86 resident physicians (28.57%), 31 family physicians (10.3%), and 24 allied health personnel (7.97%). Most of the healthcare professionals (93%) chose epinephrine as the first-line treatment for anaphylaxis. Two hundred ten participants (69.77%) knew the correct dose of epinephrine in the treatment of anaphylaxis, and allied healthcare professionals had least knowledge (p = 0.009). The participants who received anaphylaxis training and had experience with anaphylaxis had a higher knowledge about epinephrine dosing (p < 0.001 and p = 0.003, respectively). Only 49.17% of the participants knew the epinephrine doses of EAIs, and only 19% of participants had prescribed an EAI. Our results showed that healthcare professionals' knowledge about epinephrine doses in the treatment of anaphylaxis was not sufficient. Furthermore, the prescribing rate of EAIs was still inadequate. There is a need for national training programs to increase and update the knowledge of healthcare professionals to reduce anaphylaxis mortality.

Anafilassi: riconoscimento e gestione in pronto soccorso pediatrico

Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction. Despite the global incidence shows an increasing trend for anaphylaxis, few cases appear to be promptly recognized and correctly managed, showing a significant underuse of epinephrine injections. The most recent state of the art highlights the need for unanimously accepted diagnostic criteria and the essential role of intramuscular epinephrine as the only first-line treatment when a patient is experiencing an acute anaphylactic reaction. On the other hand, evidence emphasize that glucocorticoids have a limited role in the acute management of anaphylaxis and support the use of antihistamines with the only aim to relieve cutaneous symptoms. This review aims to present the latest guidelines concerning management and therapeutic approach to anaphylaxis in the Emergency Department, with a practical slant, underlying the utmost importance of epinephrine administration both in a domestic and hospital setting.

Recurrent anaphylaxis owing to chronic cholecystitis

Anaphylaxis is a severe, life-threatening systemic hypersensitivity reaction, triggered by variable allergic and nonallergic exposures.1 Here, we report a case of recurrent anaphylaxis coinciding with flares of chronic cholecystitis. We hypothesize that in rare cases, inflammatory mediators released during episodes of cholecystitis can trigger anaphylaxis.

Knowledge of healthcare providers in the management of anaphylaxis

IntroductionAnaphylaxis is defined as a severe, life-threatening systemic hypersensitivity reaction. Early diagnosis and treatment of a severe allergic reaction requires recognition of the signs and symptoms, as well as classification of severity. It is a clinical emergency, and healthcare providers should have the knowledge for recognition and management. The aim of the study is to evaluate the level of knowledge in the management of anaphylaxis in healthcare providers. MethodsIt is an observational, descriptive, cross-sectional study conducted among healthcare providers over 18 years old via a Google Forms link and shared through different social media platforms. A 12-item questionnaire was applied which included the evaluation of the management of anaphylaxis, from June 2020 to May 2021. ResultsA total of 1023 surveys were evaluated; 1013 met inclusion criteria and were included in the statistical analysis. A passing grade was considered with 8 or more correct answers out of 12; the overall approval percentage was 28.7%. The group with the highest percentage of approval in the questionnaire was health-care providers with more than 30 years of work experience. There was a significant difference between the proportions of approval between all specialty groups, and in a post-hoc analysis, allergy and immunology specialists showed greater proportions of approval compared to general medicine practitioners (62.9% vs 25%; p=<0.001). ConclusionsIt is important that healthcare providers know how to recognize, diagnose, and treat anaphylaxis, and later refer them to specialists in Allergy and Clinical Immunology in order to make a personalized diagnosis and treatment.

Developing an Evidence-Based Nursing Protocol Using Early Epinephrine Administration for Anaphylaxis Caused by Computed Tomography Contrast Agents

The objective of this study is to develop an evidence-based nursing practice protocol to cope with anaphylaxis by identifying the effect of early administration of epinephrine on the recovery of patients when anaphylaxis occurs due to computed tomography (CT) contrast agents, and to evaluate its feasibility. Anaphylaxis caused by CT contrast agents is a life-threatening systemic hypersensitivity reaction compared to normal allergic reactions, requiring immediate administration of epinephrine and other emergency drugs; however, no practical guidelines have been established for such emergency management, requiring the development of evidence-based nursing practice protocols. The study design is a methodological and cross-sectional study that aims to develop an evidence-based nursing practice protocol. An evidence-based nursing practice protocol for anaphylaxis management generated by contrast agents was developed in accordance with the 3-step (12 more specific steps) development of clinical practice guideline based on the literature of the final 12 selected (including 2 guidelines). It was applied to practice after implementing the training of the medical staff on the final protocol developed, and evaluated the effectiveness of anaphylaxis management for 6 months before and after the application of the protocol. Based on the analysis of the evidence, we make six recommendations for managing anaphylaxis caused by contrast agents based on early administration of epinephrine and apply the protocol to clinical practice. After protocol application, awareness of anaphylaxis and onset time of epinephrine administration was accelerated, but significant differences were not confirmed. In the case of anaphylaxis due to CT contrast agents, evidence-based coping protocols were created. The developed protocol should be continued for use in practice, with continued assessment of its effectiveness.

Proteomic and Biological Analysis of an In Vitro Human Endothelial System in Response to Drug Anaphylaxis.

Anaphylaxis is a life-threatening systemic hypersensitivity reaction. During anaphylaxis, mediator release by effector cells causes endothelial barrier breakdown, increasing vascular permeability and leakage of fluids, which may lead to tissue edema. Although endothelial cells (ECs) are key players in this context, scant attention has been paid to the molecular analysis of the vascular system, and further analyses of this cell type are necessary, especially in humans. The protein expression pattern of human microvascular ECs was analyzed in response to sera from anaphylactic patients (EC-anaphylaxis) and sera from non-allergic subjects (EC-control) after 2 hours of contact. Firstly, a differential quantitative proteomic analysis of the protein extracts was performed by mass spectrometry using an isobaric labeling method. Second, the coordinated behavior of the identified proteins was analyzed using systems biology analysis (SBA). The proteome of the EC-anaphylaxis system showed 7,707 proteins, of which 1,069 were found to be significantly altered between the EC-control and EC-anaphylaxis groups (p-value < 0.05). Among them, a subproteome of 47 proteins presented a high rate of change (|ΔZq| ≥ 3). This panel offers an endothelial snapshot of the anaphylactic reaction. Those proteins with the highest individual changes in abundance were hemoglobin subunits and structural support proteins. The interacting network analysis of this altered subproteome revealed that the coagulation and complement systems are the main biological processes altered in the EC-anaphylactic system. The comprehensive SBA resulted in 5,512 functional subcategories (biological processes), 57 of which were significantly altered between EC-control and EC-anaphylaxis. The complement system, once again, was observed as the main process altered in the EC system created with serum from anaphylactic patients. Findings of the current study further our understanding of the underlying pathophysiological mechanisms operating in anaphylactic reactions. New target proteins and relevant signaling pathways operating in the in vitro endothelial-serum system have been identified. Interestingly, our results offer a protein overview of the micro-EC-anaphylaxis environment. The relevance of the coagulation, fibrinolytic, contact and complement systems in human anaphylaxis is described. Additionally, the untargeted high-throughput analysis used here is a novel approach that reveals new pathways in the study of the endothelial niche in anaphylaxis.

Predictors of serious outcomes among patients with anaphylaxis seen in the Philippine national tertiary hospital.

BackgroundAnaphylaxis is a severe and life-threatening systemic hypersensitivity reaction. The incidence of anaphylaxis has increased significantly in recent years.ObjectiveTo identify predictors of serious outcomes among patients with anaphylaxis seen in the national tertiary hospital of the Philippines from 2015 to 2019.MethodsData was collected retrospectively through search of the medical records section and census reports on all patients diagnosed with anaphylaxis seen at the national tertiary hospital from 2015 to 2019. The patients’ clinical profile, management, and outcome were extracted. Multiple logistic regression analysis was used to determine the association of clinical characteristics and physicians’ management with the development of serious outcomes. Variable selection procedure through backward elimination method was used to determine significant predictors of serious outcomes of anaphylaxis. Data analysis was done using Stata 14 software.ResultsThere were 300 patients with anaphylaxis seen at the Philippine national tertiary hospital from 2015 to 2019. Of the 300 patients, 179 were female (57.9%). The median age of the patients was 26 years old, with an interquartile range of 33 years. Only 75 patients (25%) had a past history of allergic disease. Majority of the patients (70%) had comorbidities. Drugs were the most common trigger of anaphylaxis (81.3%). Antibiotics were the most common type of drugs implicated (27%). Serious outcomes were noted in a total of 31 patients (10.3%). The significant predictors of serious outcomes in anaphylaxis are age (p = 0.034) and cofactors including use of beta-blockers and presence of acute infection (p < 0.001).ConclusionIn the Philippine national tertiary hospital, the incidence of anaphylaxis increased by 240% in the past decade. Predictors of serious outcome in anaphylaxis include increased age and presence of cofactors such as beta-blocker use and presence of acute infection.

Comorbidities and Cofactors of Anaphylaxis in Patients with Moderate to Severe Anaphylaxis. Analysis of Data from the Anaphylaxis Registry for West Pomerania Province, Poland.

Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction that is still rarely diagnosed. For safety reasons, patients should visit an allergologist to identify potential causes and cofactors of this reaction. This paper presents the analysis of data from the Anaphylaxis Registry gathered over ten years at the Allergy Clinic, Pomeranian Medical University (PMU). A questionnaire-based survey was used for patients visiting the Allergy Clinic to identify potential augmentation factors/comorbidities and/or cofactors of anaphylaxis in patients with a history of moderate to severe anaphylaxis. The registry comprised patients with grade II or higher anaphylaxis. The gathered data concerned chronic comorbidities (cardiovascular diseases, respiratory diseases, and others), recurrence of anaphylaxis, and potential cofactors in anaphylaxis. In the analyzed group, the incidence rate of anaphylaxis was the highest for women aged 19–60 years. Most common comorbidities in patients with moderate to severe anaphylaxis included: cardiovascular diseases, respiratory tract diseases, features of atopy, and thyroid diseases. More than 30% of drug-induced reactions were anaphylactic reactions due to the re-exposure to the same drug, which points to the need for educational initiatives in this area. The incidence rate of anaphylaxis induced by Hymenoptera stings was comparable in patients who had a previous generalized reaction and those who had good tolerance to the previous sting. It is important to take these cofactors into consideration when evaluating patients with anaphylaxis as they may play a role in future anaphylactic reactions.

A Proposal from the Montpellier World Health Organization Collaborating Centre for Better Management and Prevention of Anaphylaxis

Since the first description of anaphylaxis in 1902, its clinical importance as an emergency condition has been recognized worldwide. Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction characterized by rapid onset and the potential to endanger life through respiratory or circulatory compromise. It is usually, although not always, associated with skin and mucosal changes. Although the academic/scientific communities have advocated to promote greater awareness and protocols for the management of anaphylaxis based on best evidence, there are few efforts documenting feedback as to the success of these efforts. In this article, we review the key unmet needs related to the diagnosis and management of anaphylaxis, and propose a public health initiative for prevention measures and a timetable action plan that intends to strengthen the collaboration among health professionals and especially primary care physicians dealing with anaphylaxis, which can encourage enhanced quality of care of patients with anaphylaxis. More than calling for a harmonized action for the best management of anaphylaxis to prevent undue morbidity and mortality, the Montpellier World Health Organization Collaborating Centre here proposes an action plan as a baseline for a global initiative against anaphylaxis. We strongly believe that these collaborative efforts are a strong public health and societal priority that is consistent with the overarching goals of providing optimal care of allergic patients and best practices of allergology.

Anaphylaxis in primary care: Systematic review to support quality of management and optimization of health-care pathways

Anaphylaxis is a severe, life-threatening systemic hypersensitivity reaction characterized by rapid onset and the potential to endanger life. Most of cases of anaphylaxis are first seen by general practitioners (GPs) or emergency doctors. This systematic review is intended to provide evidence-based decision support tools to GPs confronted with anaphylactic patients. We searched MEDLINE, EMBASE, Cochrane Controlled Register of Trials, Lilacs databases from inception from 1988, for manuscripts concerning anaphylaxis and primary care, without language restrictions. We screened studies, extracted data, and assessed risk of bias independently in duplicate. The manual review was performed by two independent ratters. The degree of inter-rater agreement was assessed using Cohen’s kappa. Main outcomes included clinical history, clinical examination, treatment, use of epinephrine and timing to refer the patient to the specialist. We selected 56 studies, comprising 37 original articles, 15 reviews and 4 guidelines. Twenty-three (41%) were focused on specific aetiology: food-induced anaphylaxis (FA) (52%), drug allergy (DA) (35%) and venom allergy (VA) (13%). With a kappa value of 0.67, there was a high agreement on the classification procedures between the two raters. Data showed that in the presence of respiratory and/or cardiovascular symptoms, patients should be promptly treated and sent to the emergency room. Structured clinical history was reported as being mandatory for the diagnosis of anaphylaxis, mainly based on 5 key points: type of manifestations, type of trigger, chronology between reaction and suspected allergen, reproducibility and risk factors. Most documents (44%) covered food-induced anaphylaxis occurring in childhood, with suspected IgE-mediated reaction. Most anaphylaxis in adults were related to DA or VA (48%). Data still stress lack of the recognition of manifestations (48%), treatment with anti-histamines and systemic corticosteroids (26%), delayed application of epinephrine (35%) and highlight the need of decision aids to support diagnosis and anaphylaxis by GPs (38%). GPs should advise an emergency plan and prescribe adrenaline auto-injectors. Reasons for referring to specialists based on the literature are: to investigate aetiology, to undergo specific treatment, such as allergen immunotherapy, severe cases or in suspicion of underlying condition, such as mastocytosis. Evidence presented supports the construction of a decision tree in order to improve management of anaphylaxis. This intends to optimize the life-time of these patients across the health care pathways and prevent avoidable deaths. It is intended that the resultant decision support tool will undergo field-testing for validation.

Clinical Manifestations and Causes of Anaphylaxis. Analysis of 382 Cases from the Anaphylaxis Registry in West Pomerania Province in Poland.

Anaphylaxis is most commonly defined as an acute, severe, potentially life-threatening systemic hypersensitivity reaction. Current expert consensus has defined anaphylaxis as a serious reaction that is rapid in onset and can be fatal, and is a severe, potentially life-threatening systemic hypersensitivity reaction that is still rarely diagnosed. For safety reasons, patients should visit an allergologist to identify potential causes of this reaction. There are no data from other health care centres in Poland presenting characteristics of anaphylactic reactions. Clinical manifestations of anaphylaxis should be analysed, because some patients (10–30%) with anaphylaxis can present without cutaneous findings. This lack of skin/mucosa involvement can lead to misdiagnosis or delayed diagnosis of anaphylaxis. Objectives—to gather epidemiological data on anaphylactic reactions, to identify clinical manifestations of anaphylaxis (organ systems involved), to present diagnostic methods useful for the identification of anaphylaxis triggers, and most importantly, to find causes of anaphylaxis. In this retrospective analysis, we used a questionnaire-based survey regarding patients visiting the Clinical Allergology Department, Pomeranian Medical University (PMU) in Szczecin, between 2006 and 2015. The registry comprised patients with grade II (Ring and Messmer classification) or higher anaphylaxis. Patients with grade I anaphylaxis (e.g., urticaria) were not included in the registry. The incidence of anaphylaxis was higher in women. Clinical manifestations included cutaneous and cardiovascular symptoms, but more than 20% of patients did not present with cutaneous symptoms, which may create difficulties for fast and correct diagnosis. Causes of anaphylaxis were identified and confirmed by means of detailed medical interview, skin tests (STs), and measurement of specific immunoglobulin E (sIgE) and tryptase levels. In the analysed group, the most common cause of anaphylaxis (allergic and nonallergic) was Hymenoptera stinging (wasp), drugs (nonsteroidal anti-inflammatory drugs, NSAIDs) and foods (peanuts, tree nuts, celery). The incidence of anaphylaxis is low, but because of its nature and potentially life-threatening consequences it requires a detailed approach. Comprehensive management of patients who have had anaphylaxis can be complex, so partnerships between allergy specialists, emergency medicine and primary care providers are necessary. Monitoring its range is very important to monitor changes in allergy development.

Future doctors and anaphylaxis: What do they know? what should we do?

Aim: Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction. Previous studies reveal that there are many potential deficiencies in the knowledge of doctors regarding the diagnosis and management of anaphylaxis in different health-care settings.The main purpose of this study was to assess the knowledge of 4th-6th-year medical students regarding the diagnosis and management of anaphylaxis. Material and Methods: The study was designed as a cross-sectional survey. The total number of 4th-, 5th-, and 6th-grade medical students at Trakya University Medical School was 651, and 172 (26%) agreed to participate in the study. The participants were asked to answer the questionnaire forms were including the questions assessing students’ knowledge about the diagnosis and management of anaphylaxis, before and after a training session about anaphylaxis. Results:Awareness of students about symptoms indicating anaphylaxis other than cutaneous and respiratory symptoms was between 40% and 77% in the initial test. Although the majority of participants (94%) chose epinephrine as the first-line drug for the treatment of anaphylaxis, correct answers about dosage, concentration, and the route for administration of epinephrine were low when compared with the final test (p < 0.001 for each item). While 14% stated they felt they could diagnose and treat anaphylaxis in the initial test, this increased 83% after the training (p < 0.001). Conclusion: The study revealed that, knowledge of medical students relating diagnosis and treatment of anaphylaxis is unsatisfactory. Much more attention is needed in medical-school education concerning anaphylaxis management to prevent anaphylaxis-related mortalities in the future.

ASSESSMENT OF RESIDENT KNOWLEDGE REGARDING ANAPHYLAXIS USING AN ELECTRONIC EDUCATIONAL MODULE AND PRE/POST QUESTIONNAIRE

Introduction Anaphylaxis is an acute, life-threatening systemic hypersensitivity reaction that is frequently underdiagnosed, underreported, and undertreated by medical professionals. There is limited graduate medical education (GME) curriculum dedicated to allergy/immunology (A/I) topics, including anaphylaxis. We hypothesized that providing an electronic educational learning module would improve resident knowledge regarding anaphylaxis diagnosis and treatment. Methods Participants included pediatric, internal medicine, family medicine, and emergency medicine residents of all training levels. Participants watched a pre-recorded 15-minute video module reviewing high yield topics regarding the diagnosis and management of anaphylaxis. General knowledge regarding the diagnosis and management of anaphylaxis was evaluated by a 10-point questionnaire before and 5 weeks following completion of the module. Results The pre-test questionnaire and educational module was completed by 78 residents, whose training level was either PGY-1, PGY-2, PGY-3 or higher. Over half of the participants (60%) had prior clinical experience diagnosing and treating anaphylaxis, yet only 15% had completed a rotation in A/I. Overall, the number of questions answered correctly in the post-test questionnaire (88%) was higher than the pre-test questionnaire (80%) (p-value Conclusions Residents from various levels of training and specialties improved their knowledge in diagnosis and treatment of anaphylaxis after participation in an electronic educational module.