Drug-induced anaphylaxis in China: a 10 year retrospective analysis of the Beijing Pharmacovigilance Database

Zhao, Ying; Sun, Shusen; Li, Xiaotong; Ma, Xiang; Tang, Huilin; Sun, Lulu; Zhai, Suodi; Wang, Tiansheng

doi:10.1007/s11096-017-0535-2

Cited by 29 publications

(32 citation statements)

References 23 publications

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“…Age as a risk factor for more severe reactions is discussed below. Females seem to be more prone to developing DIA [5,6,16,18], and some studies report that females are twice as likely to have DIA than males (e.g., female/male odds ratio [OR] 2.20 [6]). The reasons for this sex discrepancy are still incompletely understood [19].…”

Section: Incidence and Prevalencementioning

confidence: 99%

Drug-Induced Anaphylaxis: An Update on Epidemiology and Risk Factors

Regateiro

Marques

Gomes

2020

Int Arch Allergy Immunol

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Drug hypersensitivity is one of the most frequent causes of anaphylaxis, particularly in adults and in hospitalized patients. Drug-induced anaphylaxis (DIA) is also associated with more severe outcomes than other anaphylaxis triggers, and drugs are responsible for the majority of deaths due to anaphylaxis. We here review the current knowledge on the incidence, prevalence, drugs involved, mortality, and mortality risk factors for DIA. The incidence of both anaphylaxis and DIA seems to be increasing worldwide. Antibiotics and analgesics are the most frequently reported triggers of DIA. However, the importance of other drug groups should be taken into account, especially in particular settings (e.g., peri-operative and oncology). The identification of risk factors, geographical variables, and drugs associated with higher risk for DIA may improve the outcomes of this entity.

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Section: Incidence and Prevalencementioning

confidence: 99%

Drug-Induced Anaphylaxis: An Update on Epidemiology and Risk Factors

Regateiro

Marques

Gomes

2020

Int Arch Allergy Immunol

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“…Additives and impurities such as pigment, tannin, starch, and proteins found in TCMs may also be triggers of adverse drug reactions (ADRs). For example, the ingredient Ciwujia was found to be the leading cause of ADRs in one study, followed by Qingkailing, Houttuynia cordata , and Shuxuening . Prescription and dispensing practices are not regulated in many Asian countries.…”

Section: Anaphylaxis Triggers—east Vs Westmentioning

confidence: 99%

“…Studies with data on anaphylaxis treatment modalities and the prevalence of biphasic anaphylaxis among the studies with available data are summarized in Table and Table , respectively. Few studies were able to identify predictors of biphasic anaphylaxis.…”

Section: Anaphylaxis Management and Outcomesmentioning

confidence: 99%

“…Traditional Chinese medications formed a significant proportion of drug-induced anaphylaxis in China, Hong Kong, and Singapore. 8,31,33,[38][39][40] Nutritional support, a mainstay of Chinese medical therapy, was also a leading cause of anaphylaxis in China. 41 The high incidence of TCM-related anaphylaxis has also been associated with high fatality rates.…”

Section: Traditional Chinese Medication (Tcm) Allergymentioning

confidence: 99%

“…For example, the ingredient Ciwujia was found to be the leading cause of ADRs in one study, followed by Qingkailing, Houttuynia cordata, and Shuxuening. 31,39 Prescription and dispensing practices are not regulated in many Asian countries. TCM has also been traditionally delivered in the form of decoctions (tea-like solutions produced by boiling of herbs) for oral consumption rather than injections.…”

Section: Traditional Chinese Medication (Tcm) Allergymentioning

confidence: 99%

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Anaphylaxis – Lessons learnt when East meets West

Tham

Leung

Lee

et al. 2019

Pediatric Allergy Immunology

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The rapidly increasing prevalence of allergic disorders over the past 2 decades highlights the need to understand the epidemiology of anaphylaxis. In Europe, the United States, and Australia, the incidence of anaphylaxis is estimated to be between 60 and 950 cases per 100 000 population, with a lifetime prevalence of anaphylaxis of 0.05%‐2%. The incidence appears to be increasing over time. Although the existing Asian literature is heterogeneous and limited by under‐reporting, it also suggests a similar increasing trend in anaphylaxis incidence in Asia. Anaphylaxis triggers in Asia, such as the predominance of shellfish and wheat in older children and adolescents, differ from those seen in Western populations. Triggers unique to Asia such as traditional Chinese medications, galacto‐oligosaccharides, and food delicacies have also been reported. Low usage of adrenaline as first‐line treatment of anaphylaxis is evident across all countries and is particularly concerning. There is a need to establish prospective, standardized protocols for anaphylaxis data collection and reporting, to enhance the collective understanding of anaphylaxis and its burden, gaps in management and to identify areas for future research and intervention in each region. Understanding of the underlying reasons explaining the difference between East and West will facilitate future primary preventive strategies.

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Clinical features and treatment of pediatric patients with drug-induced anaphylaxis: a study based on pharmacovigilance data

et al. 2017

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We assessed the clinical features and treatment of pediatric patients with drug-induced anaphylaxis in clinical settings. Pediatric drug-induced anaphylaxis cases collected by the Beijing Pharmacovigilance Database from 2004 to 2014 were analyzed. A total of 91 cases were identified. Drug-induced anaphylaxis was primarily caused by antibiotics (53%). Children of 0–5 years were more likely to develop cyanosis symptoms than children of 13–17 years (OR = 5.14, 95%CI [1.74, 15.20], P = 0.002). Children of 13–17 years were more likely to develop hypotension than children of 6–12 years (OR = 11.79, 95%CI [2.28, 60.87], P = 0.002), and to manifest both neurological symptoms (OR = 3.56, 95%CI [1.26, 10.08], P = 0.015) and severe anaphylaxis than children of 0–5 years (OR = 15.46, 95%CI [1.85, 129.33], P = 0.002). Supratherapeutic doses of epinephrine were more likely with intravenous (IV) bolus (92%) in contrast to either intramuscular (IM) (36%, OR = 19.25, 95%CI [1.77, 209.55], P = 0.009) or subcutaneous (SC) injections (36%, OR = 19.80, 95% CI [1.94, 201.63], P = 0.005). Only 62 (68%) patients received epinephrine treatment as the first-line therapy. Conclusion: This study demonstrates that antibiotics were the most common cause of pediatric drug-induced anaphylaxis. Children may present with different anaphylactic signs/symptoms based on age groups. Epinephrine is under-utilized and provider education on the proper management of drug-induced anaphylaxis is warranted. What is Known: • The most common causes of anaphylaxis in children are allergies to foods. Drugs are the second most common cause of pediatric anaphylaxis. • IM epinephrine is the recommended initial treatment of anaphylaxis. What is New: • Drug-induced anaphylaxis in pediatric patients has age-related clinical features. • IV bolus epinephrine was overused and associated with supratherapeutic dosing. Electronic supplementary materialThe online version of this article (10.1007/s00431-017-3048-z) contains supplementary material, which is available to authorized users.

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Drug-induced anaphylaxis in China: a 10 year retrospective analysis of the Beijing Pharmacovigilance Database

Cited by 29 publications

References 23 publications

Drug-Induced Anaphylaxis: An Update on Epidemiology and Risk Factors

Drug-Induced Anaphylaxis: An Update on Epidemiology and Risk Factors

Anaphylaxis – Lessons learnt when East meets West

Clinical features and treatment of pediatric patients with drug-induced anaphylaxis: a study based on pharmacovigilance data

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