Anaphylaxis and Pregnancy: A Systematic Review and Call for Public Health Actions

Carra, Sophie; Schatz, Michael; Mertès, Paul-Michel; Torres, Marı́a José; Fuchs, Florence; Senna, Gianenrico; Castells, Mariana; Demoly, Pascal; Tanno, Luciana Kase

doi:10.1016/j.jaip.2021.07.046

Cited by 15 publications

(9 citation statements)

References 38 publications

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“…In addition, anaphylaxis-related maternal mortality in the obstetric setting is available from national or hospital data [2][3][4]11,12]. A recent systematic review of national databases covered maternal mortality and morbidity data highlights the need for guidelines and public health actions, including the diagnosis and management of anaphylaxis during pregnancy [13]. Because the total serum tryptase is only used to support an accurate diagnosis, we previously published the claim of biomarker utility to assess high-risk populations further; also, stratification of severity and risk prediction, necessitating additional exposure to potential anaphylactic triggers during obstetrical procedures [14].…”

Section: Introductionmentioning

confidence: 99%

Severe Anaphylaxis in Pregnancy: A Systematic Review of Clinical Presentation to Determine Outcomes

Simionescu

Danciu

Stănescu

2021

JPM

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Anaphylactic reactions during pregnancy can range from subjective cutaneous symptoms to anaphylaxis and lethal anaphylactic shock. The fetal and maternal outcomes are unpredictable. This study is the first systematic review of the clinical presentation of severe anaphylaxis in pregnancy as defined by the World Allergy Organization to determine maternal and fetal outcomes. We searched PubMed, the Web of Science, and Scopus databases for articles published between 1 January 1985 and 15 April 2021 using the following terms (((anaphylactic shock) AND (pregnancy)) OR ((anaphylaxis) AND (pregnancy))). In 42 studies involving 47 patients, 36.17% of patients were 31–35 years old, and 74.47% of cases occurred peripartum, mostly during cesarean section. Accurate diagnosis with valid and reliable outcome measures was reported for 71.74% of cases. Twenty-two allergens were identified: antibiotics (penicillins and cephalosporins), anesthetic drugs (suxamethonium, mepivacaine), latex, oxytocin, sodium and sucrose iron, laminaria, misoprostol, rubber from Foley catheter, oral phytomenadione, ranitidine, chamomile, and ant sting. Two cases of maternal death related to latex and intravenous iron sucrose, and six infants with neurological disease were reported, mostly related to antibiotics. This review of the currently available literature shows that favorable outcomes are attainable with a high degree of observation, multidisciplinary cooperation, and rapid treatment.

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Section: Introductionmentioning

confidence: 99%

Severe Anaphylaxis in Pregnancy: A Systematic Review of Clinical Presentation to Determine Outcomes

Simionescu

Danciu

Stănescu

2021

JPM

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“…Recent systematic review demonstrated that the frequency of anaphylaxis during maternity is estimated to be 1.5-3.8 per 100 000 pregnancies, 49-74% during caesarean section, and 75% are associated to drugs, mainly beta-lactam antibiotics and anaesthetic agents [32].…”

Section: Drug-induced Anaphylaxismentioning

confidence: 99%

Epidemiology of anaphylaxis: is the trend still going up?

Tanno,

Caminati,

Pouessel

et al. 2023

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review To understand the current global scale of anaphylaxis and identify possible strategies to increase the accuracy of epidemiological data. Recent findings Anaphylaxis mortality and morbidity statistics may gain new perspectives with the global implementation of the ICD-11. Improving the quality of epidemiological data related to anaphylaxis should clarify some areas of uncertainty about risk factors, leading to better targeting of strategies to protect those patients at risk, and support decision-making to facilitate health care planning and implementation of public health measures to prevent anaphylaxis. Summary The true rate of anaphylaxis is unknown due to a number of factors, such as misdiagnosis, miscoding and undernotification. Moreover, there is lack of information about anaphylaxis epidemiology in many countries. Difficulties on collecting accurate and comparable data should be acknowledged and anaphylaxis data can vary widely. Currently, most robust data are derived from hospitalization datasets and national mortality databases. Anaphylaxis accounts for up to 0.26% of overall hospital admissions. It is suggested that the number of hospital admissions for anaphylaxis is increasing in many countries, both with respect to all-causes of anaphylaxis and by trigger, but the mortality rate remains low. However, there are still great challenges in capturing quality anaphylaxis mortality and morbidity statistics. Better understanding of anaphylaxis trends should clarify some areas of uncertainty about risk factors and prospect effective prevention strategies. As the knowledge derived from populations is key information for more realistic decision-making, the construction of the new section addressed to anaphylaxis in the ICD-11 will allow the collection of more accurate epidemiological data to support high quality management of patients, and to better facilitate health care planning to implement public health measures, reduce the morbidity and mortality attributable to anaphylaxis.

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“…The study by Rama et al [28] combined data from adult and pediatric mastocytosis patients with respect to drug hypersensitivity to NSAIDs. Other unmet need regarding drug hypersensitivity and serum tryptase is pregnancy, with a systematic review finding that tryptase was not mentioned in any of the selected articles [54].…”

Section: Serum Tryptase and Drug Hypersensitivity: What Is Next?mentioning

confidence: 99%

Serum tryptase and drug hypersensitivity: why, how and what? A systematic review

Klingebiel

Belhocine

Vitte

2023

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review Serum tryptase, a mast cell marker, provides clues for the mechanism, severity, and management of drug hypersensitivity induced by immunoglobulin E dependent or independent mast cell activation. Recent findings The interpretation of serum tryptase levels has been challenged during the last 2 years by major advances in tryptase genetics and their rapid incorporation into clinical practice. On the contrary, new pathophysiological insight into nonmast cell-dependent immediate hypersensitivity has been gained. Summary This review provides up-to-date information on the pathophysiology and recommended use and interpretation of tryptase in the context of drug hypersensitivity reactions as a function of their endotype.

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Anaphylaxis and Pregnancy: A Systematic Review and Call for Public Health Actions

Cited by 15 publications

References 38 publications

Severe Anaphylaxis in Pregnancy: A Systematic Review of Clinical Presentation to Determine Outcomes

Severe Anaphylaxis in Pregnancy: A Systematic Review of Clinical Presentation to Determine Outcomes

Epidemiology of anaphylaxis: is the trend still going up?

Serum tryptase and drug hypersensitivity: why, how and what? A systematic review

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