Incidence of Anaphylaxis in Hospitalized Patients

Tejedor-Alonso, Miguel A; Moro, M.; Hernández, Juan Martínez; García, M V Múgica; Albelda, C. Vila; Rosado, Ana; Encinas, Montserrat Pérez; Lorena, Wendy; Abreu, Almanzar

doi:10.1159/000322997

Cited by 15 publications

(17 citation statements)

References 55 publications

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“…Our findings reveal a higher percentage of visits to the ED due to anaphylaxis than previously reported in other adult ED studies [6,8,19,20], although they are comparable to our pediatric ED estimate [21] (table 4). Differences in populations and ED referral patterns may contribute to the higher rate of anaphylaxis in our adult ED center.…”

Section: Discussionsupporting

confidence: 89%

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: 89%

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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“…However, the incidence of anaphylaxis in our emergency department was 57.84 episodes per 100 000 person‐years, almost 15 times than that reported by Harduar–Morano et al. Likewise, the use of codes proposed by these authors did not reveal any additional patients in a cohort of 114 749 discharges of our hospital, which was the source for retrieval in a series of hospitalized patients with anaphylaxis recently published by our group . Consequently, this comparison confirms the effectiveness of our retrieval method.…”

Section: Discussionmentioning

confidence: 78%

Incidence of anaphylaxis in the city of Alcorcon (Spain): a population‐based study

Alonso

Moro

García

et al. 2012

Clin Experimental Allergy

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Summary Background Relatively few studies have examined the incidence of anaphylaxis in the general population. Objective To report the incidence of anaphylaxis among the general population of the city of Alcorcon, Spain, using various public health care databases. Methods Episodes of anaphylaxis were recovered using validated alphanumeric strings in different fields of electronic clinical records used in the different public health settings in the city of Alcorcon (primary care, Emergency Department, hospitalized patients and Allergy Outpatient Clinic). Patients with anaphylaxis were tracked across the different clinical settings in Alcorcon. Results The incidence of anaphylaxis in Alcorcon was 103.37 episodes per 100 000 person‐years (total standardized incidence rate of 112.2). There was a peak of 313.58 episodes in the 0–4 years age group and a different distribution of incidence rates (although non‐significant) among different age groups between male patients and female patients. In most age groups, incidence tended to be higher for female patients aged over 10 years. Patients were attended at two or more levels in 76.78% of episodes, and a new evaluation was often made at a primary care centre (71.43%), Allergy Outpatient Clinic (75.6%), or both after the episode (58.93%). Conclusion and Clinical Relevance This study revealed a higher rate of anaphylaxis than that in previous studies, although this incidence rate is probably lower than the real incidence rate. Studies exploring potential methodological, genetic and environmental factors accounting for these higher rates of anaphylaxis are required.

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“…The risk of anaphylaxis in hospital was analysed by Tejedor‐Alonso et al. and in the International Collaborative Study of Severe Anaphylaxis . The results showed that many standard NSAIDs and ß‐lactam antibiotics carried a lower risk of triggering anaphylaxis than other drugs (number of episodes of anaphylaxis divided by the number of persons taking the drug or by the number of doses received) (Table ).…”

Section: How Frequent Is Anaphylaxis?mentioning

confidence: 99%

Epidemiology of anaphylaxis

Tejedor-Alonso

Moro

García

2015

Clin Experimental Allergy

146

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Knowledge about the epidemiology of anaphylaxis is based on data from various sources: clinical practice, large secondary clinical and administrative databases of primary care or hospitalized patients, and recent surveys with representative samples of the general population. As several similar results are often reported in several publications and populations, such findings are highly like to be robust. One such finding is that the incidence and prevalence of anaphylaxis are higher than previously thought. Publications from the last 5 years reveal an incidence of between 50 and 112 episodes per 100 000 person-years; estimated prevalence is 0.3-5.1% depending on the rigour of the definitions used. Figures are higher in children, especially those aged 0-4 years. Publications from various geographical areas based on clinical and administrative data on hospitalized patients suggest that the frequency of admissions due to anaphylaxis has increased (5-7-fold in the last 10-15 years). Other publications point to a geographic gradient in the incidence of anaphylaxis, with higher frequencies recorded in areas with few hours of sunlight. However, these trends could be the result of factors other than a real change in the incidence of anaphylaxis, such as changes in disease coding and in the care provided. Based on data from the records of voluntary declarations of death by physicians and from large national databases, death from anaphylaxis remains very infrequent and stands at 0.35-1.06 deaths per million people per year, with no increases observed in the last 10-15 years. Although anaphylaxis can be fatal, recurrence of anaphylaxis--especially that associated with atopic diseases and hymenoptera stings--affects 26.5-54% of patients.

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Incidence of Anaphylaxis in Hospitalized Patients

Cited by 15 publications

References 55 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

Incidence of anaphylaxis in the city of Alcorcon (Spain): a population‐based study

Epidemiology of anaphylaxis

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