Symptom profile and risk factors of anaphylaxis in Central Europe

Abstract

Background: Anaphylaxis is the most severe manifestation of an IgE-dependent allergy. Standardized acquired clinical data from large cohorts of well-defined cases are not available. The aim of this study was to analyse the symptom profile and risk factors of anaphylaxis in a large Central European cohort. Methods: We acquired data from patients in Germany, Austria and Switzerland who experienced a severe allergic reaction defined by the onset of severe pulmonary and/or severe cardiovascular symptoms. The data were gained via an online questionnaire from 83 medical centres specialized in allergy. Data were collected from 2006 to 2010 and analysed by using a multinomial regression model. Results: A total of 2012 paediatric and adult patients were included into the present analysis. The skin (84%) was the most frequently affected organ followed by the cardiovascular (72%) and the respiratory (68%) system. The regression model analysing the onset of cardiovascular versus respiratory symptoms revealed a strong impact of age (adjusted OR = 6.08; 95% CI, 3.35-11.01; P < 0.001). Furthermore, the elicitor food (adjusted OR = 0.29; 95% CI, 0.21-0.41, P < 0.001) and the presence of atopic diseases (adjusted OR = 0.54; 95% CI, 0.40-0.73, P < 0.001) were significantly associated with the onset of respiratory symptoms. Conclusion: Data from individuals who experienced anaphylaxis can support the identification of risk factors. The present study indicates that age, the elicitor itself and the presence of atopic diseases have an impact on the symptom profile of anaphylaxis. Identifying further risk factors of anaphylaxis is of significant importance for clinical practice in the future.Anaphylaxis is defined as a serious hypersensitivity reaction that is rapid in onset and may cause death (1, 2). The incidence rate of anaphylaxis varies from 7.9 to 49.8 per 10 000 personyears depending on the region, but more importantly on the definition and inclusion criteria applied (3-5). The literature citing the causes of anaphylaxis indicates that drugs, insect venom and food are the most frequent triggers (6, 7). Anaphylaxis can present with various clinical symptoms involving different organ systems including the skin, gastrointestinal and respiratory tract and the cardiovascular system. The involvement of the skin is most frequent and has been documented in 80-90% of reported episodes (8,9). The respiratory tract is affected in up to 70% of patients, and the cardiovascular system and the gastrointestinal tract have been reported to be less Abbreviations aOR(s) adjusted odds ratio(s); CI confidence interval; CVD cardiovascular diseases; ENT ear, nose and throat; IgE immunoglobulin E; SD standard deviation. Allergy 67 (2012) 691-698 © 2012 John Wiley & Sons A/S 691 Allergy Allergy 67 (2012) 691-698

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“…Fatal anaphylaxis has been considered to represent grade 5 (7). Common causes of anaphylaxis are food, insect stings and medicines (8,9). Anaphylaxis is due to the sudden systemic release of inflammatory mediators from mast cells and basophils.…”

Modern Recommendations for Treating Anaphylactic Shock in Children

“…Также характерны кардиоваскулярные проявления (72%) -головокружение, слабость, синко-пальные состояния, сердцебиение, загрудинные боли. Респираторные симптомы -заложенность носа, ринит, першение в горле, кашель, осиплость голоса, свистящие хрипы, одышка, затруднение дыхания -встречаются у 68% пациентов [20]. Поражение дыхательных путей чаще встречается у детей, тогда как у взрослых преоб-ладает симптоматика поражения сердечно-сосудистой системы [21].…”

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“…Wegweisend ist das plötzliche Auftreten von Beschwerden an mehr als zwei Organsystemen [4]; wobei als betroffene Organsysteme das Herz-Kreislauf-System, der Gastrointestinaltrakt, die Haut und Schleimhäute sowie die Atemwege definiert werden. Die am häufigsten betroffenen Organsysteme sind Haut und Schleimhaut, bei über 80 % der allergischen Notfallpatienten finden sich kutane Reaktionen [9]. Hier sind als häufigste Symptome Urtikaria, Angioödeme und Juckreiz zu nennen [9].…”

“…Die am häufigsten betroffenen Organsysteme sind Haut und Schleimhaut, bei über 80 % der allergischen Notfallpatienten finden sich kutane Reaktionen [9]. Hier sind als häufigste Symptome Urtikaria, Angioödeme und Juckreiz zu nennen [9]. Patienten mit kardiovaskulären Symptomen können Benommenheit, Blutdruckabfall, Ohnmacht oder eine Tachykardie aufweisen.…”

“…Betrachtet man die Atemwege, zeigen die betroffenen Patienten bevorzugt Symptome wie Dyspnoe, Stridor und Husten. Weniger häufig ist der Gastrointestinaltrakt betroffen, hier dominieren Beschwerden wie Übelkeit, Erbrechen und Schluckbeschwerden [9].…”