Anaphylaxis: incidence, presentation, causes and outcome in patients in a tertiary-care hospital in Karachi, Pakistan

Khan, Nadeem Ullah; Shakeel, Nishi; Makda, Aamir; Mallick, Ajay; Memon, Mazhar Ali; Hashmi, Shiraz; Khan, Uzma Rahim; Razzak, Junaid Abdul

doi:10.1093/qjmed/hct179

Cited by 24 publications

(26 citation statements)

References 23 publications

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“…In line with most recently published studies of anaphylaxis in adults, food was the suspected trigger for the majority of anaphylaxis cases [6,8,14] and shellfish was the major food allergen triggering anaphylaxis [26]. In contrast, in a study conducted by our research team in a tertiary care pediatric ED, we found that peanut is the major food trigger in children [21].…”

Section: Discussionsupporting

confidence: 86%

“…Epinephrine underuse has been reported in EDs from a variety of countries, including Pakistan [14], Puerto Rico [8], Italy [6], the United States [19] and Germany [15]. In the Italian study, only 2 patients among 18 with anaphylaxis received intramuscular epinephrine from an ambulance physician [6].…”

Section: Discussionmentioning

confidence: 99%

“…Although guidelines on the management of anaphylaxis in the emergency department (ED) stipulate the use of epinephrine [11], several studies have suggested that physicians are uncertain regarding the diagnosis and management of anaphylaxis [12,13] and that epinephrine is underused [8,14,15]. …”

Section: Introductionmentioning

confidence: 99%

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Rate, Triggers, Severity and Management of Anaphylaxis in Adults Treated in a Canadian Emergency Department

Asai

Yanishevsky²,

Clarke³

et al. 2014

Int Arch Allergy Immunol

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Background: The Cross-Canada Anaphylaxis Registry (C-CARE) assesses the triggers and management of anaphylaxis and identifies predictors of the development of severe allergic reactions and of epinephrine use. Here, we present data from an urban adult tertiary care emergency department (ED) in Montreal, Canada. Methods: Potential anaphylaxis cases were identified using ICD-10 codes related to anaphylaxis or allergic reactions. Putative cases underwent chart review to ensure they met anaphylaxis diagnostic criteria. Demographic, clinical and management data were collected. Multivariate logistic regressions were conducted to assess the effect of demographic characteristics, triggers, and comorbidities on severity and management of reactions. Results: Among 37,730 ED visits, 0.26% (95% CI 0.21, 0.32) fulfilled the definition of anaphylaxis. Food was the suspected trigger in almost 60% of cases. Epinephrine was not administered in almost half of moderate-to-severe cases, and similar numbers of individuals with moderate-to-severe reactions were not prescribed an epinephrine autoinjector. Reaction to shellfish was associated with more severe reactions (OR 13.9; 95% CI 2.2, 89.4). Older individuals and those not receiving steroids were more likely managed without epinephrine (OR 1.04; 95% CI 1.01, 1.07 and OR 2.97; 95% CI 1.05, 8.39, respectively). Conclusions: Anaphylaxis accounted for a substantial number of ED visits in adults, and the most common trigger was food. There is non-adherence to guidelines recommending epinephrine use for all cases of anaphylaxis. We postulate that this may be related to concerns regarding the side effects of epinephrine in adults.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Rate, Triggers, Severity and Management of Anaphylaxis in Adults Treated in a Canadian Emergency Department

Asai

Yanishevsky²,

Clarke³

et al. 2014

Int Arch Allergy Immunol

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“…Similarly, studies conducted in a variety of countries also found poor adherence to guidelines [14,15]. Specifically, the underuse of epinephrine by paramedics was noted in a recent retrospective study concerning the EMS in Edmonton, Alberta, Canada [5].…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis Cases Presenting To Primary Care Paramedics In Quebec

Kimchi

Clarke

Moisan

et al. 2014

Journal of Allergy and Clinical Immunology

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Data on anaphylaxis cases in pre-hospital settings is limited. As part of the Cross Canada Anaphylaxis Registry (C-CARE), we assessed anaphylaxis cases managed by paramedics in Outaouais, Quebec. A software program was developed to prospectively record demographic and clinical characteristics as well as management of cases meeting the definition of the anaphylaxis. Univariate and multivariate logistic regressions were compared to assess factors associated with severity of reactions and epinephrine use. 1.5, 12.0], respectively). This is the first prospective study evaluating anaphylaxis managed by paramedics. Anaphylaxis accounts for a substantial proportion of the cases managed by paramedics in Outaouais, Quebec and exceeds prior reports of the proportion of Quebec emergency room visits attributed to anaphylaxis. Although guidelines recommend prompt use of epinephrine for all cases of anaphylaxis, more than a third of cases did not receive epinephrine. It is crucial to develop educational programs targeting paramedics to promote the use of epinephrine in all cases of anaphylaxis regardless of the specific trigger.

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“…Anafilaksi çeşitli tetikleyici ajanlarla temas sonrası ortaya çıkan, ciddi, fatal olabilen sistemik allerjik reaksiyondur (1)(2)(3)(4)(5). Tanısı öykü ve klinik şüphe ile konulmaktadır.…”

Section: Introductionunclassified

Risk Grup in Anaphylaxis: Infant Anaphylaxis

Erdem¹,

Karaman²,

Nacaroğlu³

et al. 2016

Asthma Allergy Immunol

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ÖZGiriş: Anafilaksi açısından riskli kabul edilen infantil grup, hem yakınmalarını ifade edemediği için, hem de anafilaksi semptom ve bulguları infanttaki salya akması, kusma, ishal, kaşınma gibi sık görülen bulgularla karışabildiği için özel bir öneme sahiptir. Oysa ki anafilakside semptom ve bulguların erken saptanması efektif tanı ve tedavi için çok kritiktir. Çalışmada amacımız infant anafilaksilerine dikkat çekmektir. Bulgular: Çalışmaya alınan 15 hastanın 9'u (%60) erkek, 6'sı (%40) kız olup ortalama anafilaksi görülme yaşı 8,13±6,83 (min 1-max 24) aydır. Olguların %93'ünde (n=14) tetikleyicinin besin olduğu, %7 olguda (n=1) tetikleyicinin saptanamadığı belirlenmiştir. En sık sorumlu besin sırasıyla inek sütü (%67) ve yumurta (%20) dır. Olguların 7'sinde (%47) solunum sistemi ve deri bulgusu, 7'sinde (%47) 3 sistem tutulumu, 1 hastada ise solunum ve GIS tutulumu gözlenmiştir. Olguların sadece 3'ünün (%20) kan basıncı ölçülmüş, 3'üne (%20) hastanede epinefrin uygulanmıştır. Hastalardan sadece 3'üne (%20) anafilaksi sonrası epinefrin hazır enjektör reçete edilmiştir. Anafilaksi bir hastada 2 kez, bir diğer hastada da 4 kez tekrarlamıştır. Gereç veSonuç: En sık tetikleyicinin inek sütü ve yumurta olduğu, subjektif semptomların genellikle gözden kaçtığı, atopik yapının risk faktörü olduğu ve kan basıncı ölçme, epinefrin uygulama, epipen otoenjektörü reçeteleme oranlarımızın düşük olduğu saptanmıştır. ABSTRACTObjective: The infantile group that is accepted to be at risk of anaphylaxis has a special importance since they are unable to express their complaints and also the signs and symptoms of anaphylaxis can be confused with common symptoms of infants such as drooling, vomiting, diarrhea and itching. However, early detection of the signs and symptoms of anaphylaxis is crucial for effective diagnosis and treatment. The aim of study was to draw attention to infants anaphylaxis. Materials and Methods:All of the patients in the infant group (n=15) among a total of 35 anaphylaxis cases that we followed in the Pediatric Allergy Clinic of Dr. Behçet Uz Children's Hospital between the years 2011-2015 were included in the study. Demographic and clinical features of the patients were evaluated.Results: 9 of 15 (60%) patients involved in the study were male and 6 (40%) were female, and the average age of anaphylaxis was 8.13±6.83 (min 1-max 24) months. In 93% of cases (n=14) the trigger was food and in 7% of cases (n=1) the trigger was not determined. The most frequently responsible foods were respectively cow's milk (67%) and egg (20%). In 7 patients (47%), there were respiratory system and skin manifestations, in 7 patients (47%) 3 system involvement and in 1 patient respiratory and gastrointestinal system involvement has been observed. In only 3 cases (20%) the blood pressure was measured and also epinephrine was administered to only 3 cases (20%) in the hospital. In only 3 of the patients (20%), an epinephrine injector was prescribed after anaphylaxis. Conclusion:It was detected that the most common triggers are cow's...

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Anaphylaxis: incidence, presentation, causes and outcome in patients in a tertiary-care hospital in Karachi, Pakistan

Abstract: Anaphylaxis is a rare but life-threatening condition. Though cutaneous features are most common, their absence does not exclude the diagnosis. Drugs were the most common cause and epinephrine was not commonly used as first-line agent for its management.

Cited by 24 publications

References 23 publications

Rate, Triggers, Severity and Management of Anaphylaxis in Adults Treated in a Canadian Emergency Department

Rate, Triggers, Severity and Management of Anaphylaxis in Adults Treated in a Canadian Emergency Department

Anaphylaxis Cases Presenting To Primary Care Paramedics In Quebec

Risk Grup in Anaphylaxis: Infant Anaphylaxis

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