Medline ® Abstracts for References 22,23,96,97
of 'Anaphylaxis: Emergency treatment'
Anaphylaxis--a practice parameter update 2015.
Lieberman P, Nicklas RA, Randolph C, Oppenheimer J, Bernstein D, Bernstein J, Ellis A, Golden DB, Greenberger P, Kemp S, Khan D, Ledford D, Lieberman J, Metcalfe D, Nowak-Wegrzyn A, Sicherer S, Wallace D, Blessing-Moore J, Lang D, Portnoy JM, Schuller D, Spector S, Tilles SA
Ann Allergy Asthma Immunol. 2015;115(5):341.
World Allergy Organization anaphylaxis guidelines: summary.
Simons FE, Ardusso LR, BilòMB, El-Gamal YM, Ledford DK, Ring J, Sanchez-Borges M, Senna GE, Sheikh A, Thong BY, World Allergy Organization
J Allergy Clin Immunol. 2011;127(3):587.
Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Canada. email@example.com
Anaphylaxis: risk factors for recurrence.
Clin Exp Allergy. 2003;33(8):1033.
BACKGROUND: There are few studies on the incidence or recurrence of anaphylaxis.
OBJECTIVE: To examine the incidence of anaphylaxis and risk factors for recurrence.
METHODS: A prospective study of 432 patients referred to a community-based specialist practice in the Australian Capital Territory with anaphylaxis, followed by a survey to obtain information on recurrence.
RESULTS: Of 432 patients (48% male, 73% atopic, mean 27.4 years, SD 19.5, median 26) with anaphylaxis, 260 patients were seen after their first episode; 172 experienced 584 previous reactions. fifty-four percent of index episodes were treated in hospital. Aetiology was identified in 91.6% patients: food (61%), stinging insects (20.4%) or medication (8.3%). The minimum occurrence and incidence of new cases of anaphylaxis was estimated at 12.6 and 9.9 episodes/100,000 patient-years, respectively. Follow-up data were obtained from 304 patients (674 patient-years). One hundred and thirty experiencedfurther symptoms (45 serious), 35 required hospitalization and 19 administered adrenaline. Accidental ingestion of peanut/tree nut caused the largest number of relapses, but the highest risk of recurrence was associated with sensitivity to wheat and/or exercise. Rates of overall and serious recurrence were 57 and 10 episodes/100 patient-years, respectively. Of those prescribed adrenaline, 3/4 carried it, 2/3 were in date, and only 1/2 patients faced with serious symptoms administered adrenaline. Five patients each developed new triggers for anaphylaxis, or re-presented with significant psychiatric symptoms.
CONCLUSION: In any 1 year, 1/12 patients who have suffered anaphylaxis will experience recurrence, and 1/50 will require hospital treatment or use adrenaline. Compliance with carrying and using adrenaline is poor. Occasional patients develop new triggers or suffer psychiatric morbidity.
University of Canberra (Associate Professor), Canberra, University of Sydney (Senior Lecturer), Sydney, Australian National University (Clinical Senior Lecturer), Canberra, Australia. firstname.lastname@example.org
Rate of recurrent anaphylaxis and associated risk factors among Olmsted County, Minnesota, residents: A population-based study.
Lee S, Bashore C, Lohse CM, Bellolio MF, Chamberlain A, Yuki K, Hess EP, Campbell RL
Ann Allergy Asthma Immunol. 2016 Dec;117(6):655-660.e2.
BACKGROUND: The rate and risk factors for recurrence of anaphylaxis are not well known.
OBJECTIVE: To measure the rate and risk factors for recurrent anaphylaxis in a population-based cohort in Olmsted County, Minnesota.
METHODS: We conducted a population-based cohort study using the Rochester Epidemiology Project, a comprehensive medical records linkage system, to obtain records of patients who presented to medical centers within the Olmsted County area with anaphylaxis from January 1, 2001, through December 31, 2010. We evaluated the rate and associations of risk factors with anaphylaxis recurrence.
RESULTS: Among the 611 patients with anaphylaxis, 50 (8%) experienced a total of 60 recurrences within the 10-year period, resulting in a recurrence rate of 2.6 per 100 person-years. A history of atopic dermatitis (hazard ratio [HR], 5.6; 95% confidence interval [CI], 2.0-16.1; P = .001), presenting symptoms of cough (HR, 4.7; 95% CI, 2.1-10.7; P<.001) oral pruritus (HR, 9.9; 95% CI, 4.3-23.2; P<.001), and receiving corticosteroids (HR, 5.2; 95% CI, 2.3-11.7; P<.001) were associated with an increased risk of recurrence. The cardiovascular symptom of chest pain (HR, 0.24; 95% CI, 0.07-0.79; P = .02) was associated with a decreased risk of recurrence.
CONCLUSION: In this epidemiologic study, the rate of recurrence was 8% during the 10-year study period (recurrence rate of 2.6 per 100 person-years). Those with atopic dermatitis and mucocutaneous or respiratory symptoms were more likely to have a recurrent anaphylactic event. Our findings underscore the importance of early patient access to self-injectable epinephrine and referral to an allergist/immunologist for additional testing and education.
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota; Department of Emergency Medicine, Mayo Clinic Health System, Mankato, Minnesota. Electronic address: Lee.Sangil@mayo.edu.