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

Abstract

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.

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

“…In the retrospective analysis, we used a questionnaire-based survey completed by doctors specialized in allergology. Details on the study design are presented in another publication [ 42 ]. Of all 10,738 new patients examined at the Allergology Department in 2006–2015, with suspicion of any allergy or non-allergic hypersensitivity, we found above 490 patients with suspicion of moderate and severe anaphylaxis.…”

“…The basic questionnaire was a simplified version of the Network for Online-Registration of Anaphylaxis survey (NORA) from Berlin [ 42 ]; more information in the Appendix A .…”

“…The most common cause of anaphylaxis mentioned in Polish and German registries are Hymenoptera stings [ 41 , 42 ]. Current German and European guidelines recommend Venom Immunotherapy (VIT) for all patients with grade II or higher reactions and for patients with a grade 1 reaction if they have any other risk factors or if their quality of life has been negatively impacted [ 43 , 44 , 45 , 46 ].…”

Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan

“…Comprehensive management and monitoring of patients who have had anaphylaxis are very important. Partnership between allergy specialists, emergency medicine, and primary care providers is necessary [ 3 ]. A previous sting reaction may be associated with a large local or systemic allergic reaction, but it is a poor predictor of the severity of sting anaphylaxis [ 33 ].…”

“…Hymenoptera stings are the common animal assault injury caused by arthropods that are encountered in the emergency department (ED). Hymenopteran venom allergy is one of the most common causes of anaphylaxis in adults, and it is frequently associated with severe anaphylaxis [ 1 , 2 , 3 ]. In Italy, hymenopteran stings have been reported to be the cause of anaphylaxis in 1.5% to 34.1% of the population.…”