Epidemiology and outcome of patients admitted to intensive care after anaphylaxis in France: a retrospective multicentre study

Guerci, Philippe; Tacquard, Charles; Chenard, Laura; Millard, David; Soufir, Lila; Malinovsky, Jean‐Marc; Garot, Matthias; Lalot, Jean-Marc; Besch, Guillaume; Louis, Guillaume; Thion, Laurie-Anne; Charpentier, Claire; Kimmoun, Antoine; Déserts, Marc Danguy des; Carreira, Serge; Plantefève, Gaëtan; Novy, Emmanuel; Abraham, Paul A.; Mertès, Paul-Michel

doi:10.1016/j.bja.2020.08.024

Cited by 23 publications

(31 citation statements)

References 32 publications

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“…11 In France, 339 cases of severe adult anaphylaxis leading to ICU admissions were recorded, including 51 grade 4 cases (15%) and 17 deaths (5%). 12 Among the 3734 patients presenting anaphylactic shock between 2005 and 2012 in Denmark, 14.5% were admitted to the ICU, 2.1% required mechanical ventilation and 2.7% received continuous treatment with inotropes or vasopressors. 13 However, few studies have provided a detailed description of these patients admitted to ICU.…”

Section: Discussionmentioning

confidence: 99%

“…In adults, drugs are the most common cause of grade 4 anaphylaxis as evidenced in our study. Furthermore, of the 339 cases of severe anaphylaxis warranting ICU admission, 300 (89%) were linked to a drug or an iodinated contrast product and only 23 (6.8%) to food 12 . There were no grade 4 food‐related cases.…”

Section: Discussionmentioning

confidence: 99%

“…Between 2005 and 2014, again in the United States, Motosue et al showed that among the 38,695 patients of all ages seen in the emergency department for food anaphylaxis, 5.3% required admission to the ICU, 1.5% had endotracheal intubation and 0.43% were diagnosed with near‐fatal anaphylaxis due to cardiac or respiratory arrest or tracheotomy 11 . In France, 339 cases of severe adult anaphylaxis leading to ICU admissions were recorded, including 51 grade 4 cases (15%) and 17 deaths (5%) 12 . Among the 3734 patients presenting anaphylactic shock between 2005 and 2012 in Denmark, 14.5% were admitted to the ICU, 2.1% required mechanical ventilation and 2.7% received continuous treatment with inotropes or vasopressors 13 .…”

Section: Discussionmentioning

confidence: 99%

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Fatal and near‐fatal anaphylaxis: The Allergy‐Vigilance® Network data (2002–2020)

Pouessel,

Alonzo,

Divaret‐Chauveau

et al. 2023

Allergy

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Background Having a better understanding of the risk factors of severe anaphylaxis is a crucial challenge for physicians. Methods To retrospectively analyse fatal/near‐fatal anaphylaxis cases recorded by the Allergy‐Vigilance® Network (2002–2020) and evaluate the characteristics associated with survival, age and allergens. Results Among the 3510 anaphylaxis cases documented in the network, 70 (2%) patients (males: 57%; mean age: 35.4 y) presented grade 4 (Ring‐Messmer) anaphylaxis and 25 died (19 food‐related); 33% had a history of asthma. The main allergens were food (60%; peanut, 20%; milks, 11%) involved in 25/26 cases in children and in 17/44 (39%) cases in adults. Non‐food anaphylaxis was related to drugs/latex (24%; neuromuscular blocking agents, 10%; betalactamins, 6%), Hymenoptera (16%). Three food‐related cases (one death) occurred during oral food challenge in children. Patients with a food allergy were younger (22.2 years vs. 55 years, p < .001), had more likely a history of asthma (50% vs. 7%; p < .001), a pre‐existing allergy (62% vs. 18%; p < .001) compared with other allergies. A cofactor was identified in 35 cases (50%) but predominantly in adults as opposed to children (64% vs. 27%; p = .01). The patients who died were younger (25.6 vs. 40.8 years; p = .01) than the survivors and mostly presented bronchospasm (56% vs. 29%; p = .05). Gaps in the prevention and management of anaphylaxis were noted in 15 cases (21%). Conclusions Severe food anaphylaxis has specific features compared with other causes such as young age, asthma history and exercise. Food is also involved in severe anaphylaxis in adults that should not be underestimated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fatal and near‐fatal anaphylaxis: The Allergy‐Vigilance® Network data (2002–2020)

Pouessel,

Alonzo,

Divaret‐Chauveau

et al. 2023

Allergy

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“…In 2020, Guerci et al reported that only lactate was a predictor of death in 339 patients with anaphylaxis who were admitted to the intensive care unit. 31 In a dog anaphylaxis model lactate concentration increased strongly, whereas gastrointestinal blood flow decreased severely and was still 60% reduced after 180 minutes even though the mean arterial pressure and liver blood flow had already returned to normal (see Fig E14 in this article's Online Repository at www.jacionline.org). 32 The rapid normalization of the ratio of Ace-C to carnitine within less than 3 hours after the symptom peak suggests that some reversible mitochondrial dysfunction was present, as has been described in patients with sepsis.…”

Section: Discussionmentioning

confidence: 99%

Metabolome and lipidome derangements during a severe mast cell activation event in a patient with indolent systemic mastocytosis

Boehm

Ristl

Joseph

et al. 2021

Journal of Allergy and Clinical Immunology

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Background: The number of mast cells in various organs is elevated manifold in individuals with systemic mastocytosis. Degranulation can lead to life-threatening symptomatology. No data about the alterations of the metabolome and lipidome during an attack have been published. Objective: Our aim was to analyze changes in metabolomics and lipidomics during the acute phase of a severe mast cell activation event. Methods: A total of 43 metabolites and 11 lipid classes comprising 200 subvariants from multiple plasma samples in duplicate, covering 72 hours of a severe mast cell activation attack with nausea and vomiting, were compared with 2 baseline samples by using quantitative liquid chromatographymass spectrometry. Results: A strong enterocyte dysfunction reflected in an almost 20-fold reduction in the functional small bowel length was extrapolated from strongly reduced ornithine and citrulline concentrations and was very likely secondary to severe endothelial cell dysfunction with hypoperfusion and extensive vascular leakage. Highly increased histamine and lactate concentrations accompanied the peak in clinical symptoms. Elevated asymmetric and symmetric dimethylarginine levels combined with reduced arginine levels compromised endothelial nitric oxide synthase activity and nitric oxide signaling. Specific and extensive depletion of many lysophosphatidylcholine variants indicates localized autotaxin activation and lysophosphatidic acid release. A strong correlation of clinical parameters with histamine concentrations and symptom reduction after 100-fold elevated plasma diamine oxidase concentrations implies that histamine is the key driver of the acute phase.Conclusions: Rapid elimination of elevated histamine concentrations through use of recombinant human diamine oxidase, supplementation of lysophosphatidylcholine for immunomodulation, inhibition of autotaxin activity, and/or blockade of lysophosphatidic acid receptors might represent new treatment options for life-threatening mast cell activation events. (J Allergy Clin Immunol 2021;nnn:nnn-nnn.)

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“…38 In France, the mortality rate was estimated at 4.1% after neuromuscular blocking agent-related reaction and 5% after intensive care unit admission for severe anaphylaxis. 42,43 agents Implicated in Perioperative anaphylaxis…”

Section: Mortality Of Anaphylaxismentioning

confidence: 99%

Perioperative Anaphylaxis

2022

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Epidemiology and outcome of patients admitted to intensive care after anaphylaxis in France: a retrospective multicentre study

Cited by 23 publications

References 32 publications

Fatal and near‐fatal anaphylaxis: The Allergy‐Vigilance® Network data (2002–2020)

Fatal and near‐fatal anaphylaxis: The Allergy‐Vigilance® Network data (2002–2020)

Metabolome and lipidome derangements during a severe mast cell activation event in a patient with indolent systemic mastocytosis

Perioperative Anaphylaxis

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