Anafilaksja – Rokowania, prognozy i postęp choroby

Anafilaksja
Rokowania, prognozy i postęp choroby

Anafilaksja stanowi nagłą, potencjalnie zagrażającą życiu reakcję alergiczną, której rokowanie zależy od szybkiego rozpoznania i natychmiastowego podania adrenaliny, jedynego skutecznego leku odwracającego objawy. Śmiertelność w przebiegu anafilaksji waha się od 0,65% do 20%, najczęściej z powodu niewydolności oddechowej (asfiksji) lub wstrząsu sercowo-naczyniowego. Analizy wykazały, że 50% zgonów spowodowanych anafilaksją wynika z asfiksji, w tym skurczu oskrzeli (49 przypadków), obrzęku górnych i dolnych dróg oddechowych (26 przypadków) oraz obrzęku górnych dróg oddechowych (23 przypadki). Czas od wystąpienia objawów do zatrzymania krążeniowo-oddechowego wynosi średnio 10-35 minut, co podkreśla konieczność natychmiastowego leczenia. Kluczowe czynniki ryzyka ciężkiego przebiegu to starszy wiek, astma, wcześniejsze choroby alergiczne, wielonarządowe zaangażowanie oraz anafilaksja wywołana lekami. Opóźnione podanie adrenaliny oraz nieodpowiednia pozycja ciała (siedząca lub stojąca) zwiększają ryzyko zgonu.

Rokowanie w anafilaksji (Anaphylaxis Prognosis)

Anafilaksja jest ciężką reakcją alergiczną, która może rozwinąć się w stan zagrażający życiu. Rokowanie w przypadku anafilaksji zależy od wielu czynników, w tym od szybkości rozpoznania objawów, wdrożenia odpowiedniego leczenia oraz identyfikacji i unikania czynników wyzwalających.¹² Wczesne rozpoznanie i szybkie wdrożenie leczenia mają kluczowe znaczenie dla pomyślnego rokowania.

Wskaźniki umieralności i przeżywalności

Anafilaksja może prowadzić do zgonu, choć śmiertelne przypadki są stosunkowo rzadkie. Szacuje się, że w Stanach Zjednoczonych występuje rocznie od 500 do 1000 przypadków śmiertelnych spowodowanych anafilaksją. Wskaźniki śmiertelności wahają się od 0,65% do 2% pacjentów z anafilaksją.³ Według innych źródeł, śmiertelność w przebiegu anafilaksji wynosi od 0,7% do 20% przypadków, najczęściej z powodu niewydolności oddechowej (zazwyczaj obejmującej asfiksję) lub powikłań sercowo-naczyniowych, takich jak wstrząs.⁴

W przypadkach gdy przyczyna jest znana i dostępne jest szybkie leczenie, rokowanie jest zazwyczaj dobre. Nawet jeśli przyczyna jest nieznana, ale dostępne są odpowiednie leki zapobiegawcze, rokowanie również jest generalnie korzystne.⁵

Przyczyny zgonów w przebiegu anafilaksji

Badania wykazały, że najczęstszymi przyczynami zgonów w przebiegu anafilaksji są:

Zapaść sercowo-naczyniowa⁶
Zaburzenia oddechowe:
- Ostry skurcz oskrzeli (głównie u osób z astmą)⁷
- Obrzęk górnych dróg oddechowych⁸
- Kombinacja obrzęku górnych i dolnych dróg oddechowych⁹

Analiza 214 przypadków śmiertelnych anafilaksji wykazała, że w 196 przypadkach, w których można było ustalić przyczynę zgonu, 98 (50%) było spowodowanych asfiksją: 49 z powodu dolnych dróg oddechowych (skurcz oskrzeli), 26 zarówno górnych, jak i dolnych dróg oddechowych, a 23 górnych dróg oddechowych (obrzęk naczynioruchowy). Zgony z powodu ostrego skurczu oskrzeli występowały prawie wyłącznie u osób z wcześniej istniejącą astmą.¹⁰

Inna analiza 23 nieselektywnych przypadków śmiertelnej anafilaksji wykazała, że 16 z 20 natychmiastowych zgonów (zgon w ciągu godziny od pojawienia się objawów) i 16 z 23 przypadków poddanych autopsji było spowodowanych obrzękiem górnych dróg oddechowych.¹¹

Czas progresji do stanu zagrożenia życia

Zgon może nastąpić szybko. Analiza przypadków śmiertelnych anafilaksji w Wielkiej Brytanii w latach 1992-2001 wykazała, że średni czas od początku objawów anafilaksji pokarmowej do zatrzymania krążeniowo-oddechowego wynosił 25-35 minut. Był on dłuższy niż w przypadku leków (średnio 10-20 minut przed przybyciem do szpitala; 5 minut w szpitalu) lub użądleń owadów (10-15 minut).¹²

Anafilaksja jest stanem nagłym, który może prowadzić do zgonu w czasie krótszym niż 15 minut. Adrenalina jest jedynym lekiem, który może odwrócić objawy. Kluczowe jest szybkie podanie adrenaliny jako pierwszego leku, a następnie niezwłoczne poszukanie pomocy na najbliższym oddziale ratunkowym.¹³

Czynniki ryzyka ciężkiego przebiegu i złego rokowania

Zidentyfikowano kilka kluczowych czynników ryzyka związanych z ciężkimi reakcjami anafilaktycznymi i gorszym rokowaniem:¹⁴

Czynniki demograficzne i kliniczne

Wiek – starszy wiek jest niezależnym predyktorem poważnych wyników. Jednakże w przypadkach śmiertelnych badania wykazują, że młodzież, nastolatki i młodzi dorośli z alergiami pokarmowymi są w grupie najwyższego ryzyka zgonu. Może to być częściowo spowodowane zachowaniami ryzykownymi typowymi dla tej grupy wiekowej, hormonami lub niechęcią do noszenia adrenaliny.¹⁵¹⁶
Astma – jest istotnym czynnikiem ryzyka śmiertelnej anafilaksji, szczególnie w przypadkach śmiertelnego skurczu oskrzeli.¹⁷
Historia chorób alergicznych – wcześniejsze choroby alergiczne są znaczącym predyktorem poważnych wyników wymagających hospitalizacji lub przedłużenia pobytu w szpitalu.¹⁸
Wielonarządowe zaangażowanie – jednoczesne wystąpienie objawów w wielu układach narządów jest istotnym czynnikiem prognostycznym poważniejszego przebiegu i wyniku klinicznego.¹⁹

Czynniki wyzwalające anafilaksję

Anafilaksja wywołana lekami – jest niezależnym predyktorem poważnych wyników i często wiąże się z cięższym przebiegiem klinicznym.²⁰
Reakcje na pokarmy – uważane są za najczęstszą przyczynę anafilaksji poza szpitalem i szacuje się, że powodują 125 zgonów rocznie w Stanach Zjednoczonych.²¹
Ciężkie reakcje na penicylinę – występują z częstością 15 przypadków na 10 000 kursów leczenia, ze zgonami w 1 przypadku na 50 000-100 000 kursów.²²
Reakcje na użądlenia owadów błonkoskrzydłych – rocznie w Stanach Zjednoczonych zgłasza się mniej niż 100 śmiertelnych reakcji, ale uważa się to za niedoszacowanie.²³

Czynniki związane z opóźnionym leczeniem

Opóźnione podanie adrenaliny jest istotnym czynnikiem ryzyka śmiertelnych wyników. Zgony z powodu anafilaksji są często związane z opóźnieniem w podaniu adrenaliny lub jej całkowitym brakiem.²⁴²⁵

Wpływ postawy ciała

Postawa ciała również wpływa na wyniki anafilaksji. W retrospektywnym przeglądzie przedszpitalnych zgonów z powodu anafilaksji w Wielkiej Brytanii, historia postawy była znana dla 10 osób. Cztery z 10 zgonów były związane z przyjęciem pozycji wyprostowanej lub siedzącej podczas anafilaksji.²⁶ Sugeruje to, że pozycja leżąca może być korzystniejsza podczas ciężkiej reakcji anafilaktycznej.

Nawracające epizody anafilaksji

Pacjenci mogą doświadczyć wielu epizodów anafilaktycznych w ciągu swojego życia. Badanie Rochester wykryło łącznie 154 epizody anafilaktyczne u 133 osób w okresie 5 lat. Większość pacjentów (116) miała tylko 1 epizod w ciągu tych 5 lat. Trzynaście osób miało 2 epizody, a 4 osoby miały 3 epizody.²⁷

Dla kontrastu, w badaniu Memphis, 48% pacjentów miało 3 lub więcej epizodów anafilaktycznych. Z 112 pacjentów, którzy odpowiedzieli na ankietę, 38 pacjentów (34%) zgłosiło nawrót objawów, a pozostałych 74 pacjentów (66%) zgłosiło remisję objawów. Ogólnie rzecz biorąc, 85% pacjentów było w remisji lub zgłaszało zmniejszoną nasilenie objawów w kolejnym epizodzie lub epizodach.²⁸

Reakcje dwufazowe

Objawy anafilaksji zwykle osiągają szczyt w ciągu pół godziny od ekspozycji, ale mogą utrzymywać się przez kilka godzin. Około 20% czasu możliwe jest opanowanie objawów za pomocą dawki adrenaliny, ale mogą one powrócić. Jest to tak zwana reakcja dwufazowa – druga reakcja. W przypadku wystąpienia reakcji dwufazowej należy szukać pomocy ratunkowej po podaniu drugiej dawki adrenaliny.²⁹

Rokowanie w szczególnych grupach pacjentów

Anafilaksja w ciąży

Reakcje anafilaktyczne podczas ciąży mogą wahać się od subiektywnych objawów skórnych do anafilaksji i śmiertelnego wstrząsu anafilaktycznego. Rokowanie dla matki i płodu jest nieprzewidywalne.³⁰

Przegląd dostępnej literatury pokazuje, że po reakcjach anafilaktycznych podczas ciąży, korzystne wyniki dla matki i płodu są osiągalne przy wysokim stopniu czujności, współpracy wielu specjalności i szybkim leczeniu.³¹

Wskaźnik śmiertelności związany z anafilaksją podczas ciąży szacuje się na 5%.³²

Anafilaksja wywołana wysiłkiem

Wyniki u osób z anafilaksją wywołaną wysiłkiem są zazwyczaj dobre, z mniejszą liczbą i mniej ciężkimi epizodami wraz z wiekiem pacjentów.³³

Anafilaksja idiopatyczna

Pacjenci z idiopatyczną anafilaksją (IA) mają znacznie wyższy poziom problemów ze zdrowiem psychicznym w porównaniu do norm populacyjnych. Badania wykazały, że większość pacjentów z idiopatyczną anafilaksją doświadcza również objawów zdrowia psychicznego, choć tylko niewielka mniejszość (8,8%) zgłosiła współistniejącą diagnozę zdrowia psychicznego.³⁴

Idiopatyczna anafilaksja jest poważnym zaburzeniem z chorobowością, która obejmuje zarówno fizjologiczne aspekty anafilaksji, jak i związane z nią problemy ze zdrowiem psychicznym. Uwaga zarówno na fizyczne, jak i psychologiczne potrzeby tych pacjentów prawdopodobnie prowadzi do poprawy wyników zdrowotnych.³⁵

Postępowanie poprawiające rokowanie

Opieka specjalistyczna

Jeśli u pacjenta wystąpiła potwierdzona reakcja anafilaktyczna, powinien on zostać skierowany do specjalisty alergologa. Zazwyczaj pacjent jest przyjmowany w przychodni szpitalnej przez konsultanta immunologa.³⁶

Najważniejszą rzeczą jest identyfikacja i unikanie czynników wyzwalających. Specjalista alergolog omówi to z pacjentem. Istnieje wiele przypadków, w których staranne unikanie alergenów zapobiegnie konieczności leczenia reakcji anafilaktycznej.³⁷

Autoinjektory adrenaliny

Autoinjektory adrenaliny powinny być przepisane każdej osobie, która miała anafilaksję lub jest uważana za zagrożoną anafilaksją, nawet jeśli nadal czeka na wizytę u specjalisty alergologa.³⁸

Każda osoba, której przepisano autoinjektor adrenaliny, powinna zostać zbadana przez specjalistę alergologa. Mogą oni zalecić dalsze noszenie autoinrektorów, ale czasami mogą stwierdzić, że nie jest to konieczne.³⁹

Standaryzacja opieki i podejmowanie decyzji klinicznych

Istnieją znaczące luki w wiedzy na temat postępowania i wyników u dzieci z anafilaksją. Niedawne badania wskazują na istotne luki w wiedzy dotyczące częstości występowania ciężkich, uporczywych i dwufazowych reakcji (1-15%) oraz potencjalnych czynników prognostycznych takich reakcji.⁴⁰

Ponadto, większość wcześniejszych badań jest jednoośrodkowa i ograniczona do dorosłych, co ogranicza możliwość uogólnienia i zastosowania do dzieci.⁴¹

Nie ma również powszechnie akceptowanych, opartych na dowodach wytycznych wspierających podejmowanie decyzji klinicznych po początkowym leczeniu adrenaliną. Prawdopodobnie przyczynia się to do dużej zmienności praktyk dotyczących okresów obserwacji na oddziale ratunkowym (zgłaszanych od 4 do 24 godzin) i wskaźników hospitalizacji (wahających się od 12% do 95% dzieci z anafilaksją).⁴²

Proponowane wieloośrodkowe badania mają na celu określenie częstości występowania i czynników ryzyka ciężkiej, uporczywej, opornej i dwufazowej anafilaksji, a także uporczywych i dwufazowych reakcji nieanafilaktycznych. Ponadto, badania te dążą do opracowania i walidacji modeli predykcyjnych dla dzieci, które mogą być kandydatami do wypisania z oddziału ratunkowego zamiast hospitalizacji, oraz określenia opartych na danych długości obserwacji na oddziale ratunkowym i podczas hospitalizacji przed wypisem do domu w oparciu o początkową ciężkość reakcji.⁴³

Dane te mogą potencjalnie informować i standaryzować praktykę kliniczną na oddziale ratunkowym, zmniejszyć wskaźniki hospitalizacji, optymalizować długość pobytu na oddziale ratunkowym i podczas hospitalizacji oraz złagodzić obciążenie dzieci, rodzin i systemów opieki zdrowotnej.⁴⁴

Ograniczenia w przewidywaniu ciężkości reakcji

Obecnie istnieje znaczna niepewność co do czynników prognostycznych ciężkości diagnostycznych lub przypadkowych reakcji alergicznych na pokarmy, a także co do tego, w jakim stopniu można przewidzieć ciężkość takich reakcji.⁴⁵

Ciężkość podwójnie ślepych, kontrolowanych placebo prób prowokacji pokarmowej (DBPCFC) i przypadkowych reakcji na żywność pozostaje w dużej mierze nieprzewidywalna. Klinicyści nie powinni używać dawki wywołującej uzyskanej z gradientowej próby prowokacji pokarmowej do podejmowania decyzji związanych z ryzykiem.⁴⁶

Przewidywanie ciężkości reakcji jest ważne, aby móc dokładnie ukierunkować postępowanie w przypadku reakcji alergicznych na pokarmy, na przykład poprzez przepisanie autoinrektorów adrenaliny. Jednak przy czynnikach ryzyka zidentyfikowanych w jednym z badań, możliwe było przewidzenie jedynie 23,5% ciężkości reakcji podczas DBPCFC i 7,3% ciężkości najcięższej przypadkowej reakcji w wywiadzie.⁴⁷

Dawka wywołująca (ED) nie przewidywała ciężkości przypadkowej reakcji. Sugeruje to, że ograniczenie dawki jako środek zdrowia publicznego prawdopodobnie nie zmniejszy ciężkich reakcji bardziej niż łagodniejszych. Ponadto, klinicyści nie powinni używać dawki wywołującej uzyskanej z gradientowej próby prowokacji pokarmowej do podejmowania decyzji związanych z ryzykiem, takich jak potrzeba rygorystycznego unikania pokarmów alergizujących lub przepisanie samopodawanej adrenaliny.⁴⁸

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Anaphylaxis – Wikipedia
https://en.wikipedia.org/wiki/Anaphylaxis
In those in whom the cause is known and prompt treatment is available, the prognosis is good. […] Even if the cause is unknown, if appropriate preventive medication is available, the prognosis is generally good. […] Usually death occurs due to either respiratory failure (typically involving asphyxia) or cardiovascular complications, such as cardiovascular shock, with 0.720% of cases causing death. […] There have been cases of death occurring within minutes. […] Outcomes in those with exercise-induced anaphylaxis are typically good, with fewer and less severe episodes as people get older.
#2 Anaphylaxis – Allergy & Asthma Network
https://allergyasthmanetwork.org/anaphylaxis/
Anaphylaxis is a severe allergic reaction. It can progress into a life-threatening condition. Anaphylaxis is caused by an exposure or ingestion of something to which you are allergic. The immune system then over-reacts. Symptoms involve multiple body systems including the skin, heart, stomach and airways. […] Anaphylaxis is an allergy emergency that can cause death in less than 15 minutes. Epinephrine is the only medication that can reverse symptoms. It is crucial to use epinephrine first and epinephrine fast. Then seek prompt treatment in your nearest emergency room. […] Anyone at risk for anaphylaxis can have a life-threatening allergic reaction even if previous reactions were mild. […] Left untreated, symptoms may cause you to lose consciousness and lead to a cardiac arrest, or even death.
#3 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
Fatal anaphylaxis is infrequent but not rare; milder forms occur much more frequently. Up to 500-1000 fatal cases of anaphylaxis per year are estimated to occur in the United States. Estimated mortality rates range from 0.65-2% of patients with anaphylaxis. […] Reactions to foods are thought to be the most common cause of anaphylaxis when it occurs outside of the hospital and are estimated to cause 125 deaths per year in the United States. Severe reactions to penicillin occur with a frequency of 15 cases per 10,000 patient courses, with fatalities in 1 case per 50,000-100,000 courses. Fewer than 100 fatal reactions to Hymenoptera stings are reported each year in the United States, but this is considered to be an underestimate. […] Anaphylaxis to conventional radiocontrast media (RCM) was estimated to have caused up to 900 fatalities in 1975, or 0.009% of patients receiving RCM. In one series, the reported risk of adverse reactions (mild or severe) in patients receiving lower osmolar RCM agents is 3.13% compared with 12.66% for patients receiving conventional RCM. The study also reported premedication did not lower the risk of nonionic reactions further. The rate of fatal anaphylaxis is also reduced significantly by lower-osmolar RCM, approximately 1 in 168,000 administrations.
#4 Anaphylaxis – Wikipedia
https://en.wikipedia.org/wiki/Anaphylaxis
In those in whom the cause is known and prompt treatment is available, the prognosis is good. […] Even if the cause is unknown, if appropriate preventive medication is available, the prognosis is generally good. […] Usually death occurs due to either respiratory failure (typically involving asphyxia) or cardiovascular complications, such as cardiovascular shock, with 0.720% of cases causing death. […] There have been cases of death occurring within minutes. […] Outcomes in those with exercise-induced anaphylaxis are typically good, with fewer and less severe episodes as people get older.
#5 Anaphylaxis – Wikipedia
https://en.wikipedia.org/wiki/Anaphylaxis
In those in whom the cause is known and prompt treatment is available, the prognosis is good. […] Even if the cause is unknown, if appropriate preventive medication is available, the prognosis is generally good. […] Usually death occurs due to either respiratory failure (typically involving asphyxia) or cardiovascular complications, such as cardiovascular shock, with 0.720% of cases causing death. […] There have been cases of death occurring within minutes. […] Outcomes in those with exercise-induced anaphylaxis are typically good, with fewer and less severe episodes as people get older.
#6 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
In the United Kingdom, half of fatal anaphylaxis episodes are of iatrogenic origin (eg, anesthesia, antibiotics, radiocontrast media), while foods and insect stings each account for a quarter of the fatal episodes. […] The most common causes of death are cardiovascular collapse and respiratory compromise. One report examined 214 anaphylactic fatalities for which the mode of death could be surmised in 196, 98 of which were due to asphyxia (49 lower airways [bronchospasm], 26 both upper and lower airways, and 23 upper airways [angioedema]). The fatalities from acute bronchospasm occurred almost exclusively in those with preexisting asthma. […] Another analysis of 23 unselected cases of fatal anaphylaxis determined that 16 of 20 immediate deaths (death occurring within one hour of symptom onset) and 16 of the 23 cases that underwent autopsy were due to upper airway edema.
#7 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
In the United Kingdom, half of fatal anaphylaxis episodes are of iatrogenic origin (eg, anesthesia, antibiotics, radiocontrast media), while foods and insect stings each account for a quarter of the fatal episodes. […] The most common causes of death are cardiovascular collapse and respiratory compromise. One report examined 214 anaphylactic fatalities for which the mode of death could be surmised in 196, 98 of which were due to asphyxia (49 lower airways [bronchospasm], 26 both upper and lower airways, and 23 upper airways [angioedema]). The fatalities from acute bronchospasm occurred almost exclusively in those with preexisting asthma. […] Another analysis of 23 unselected cases of fatal anaphylaxis determined that 16 of 20 immediate deaths (death occurring within one hour of symptom onset) and 16 of the 23 cases that underwent autopsy were due to upper airway edema.
#8 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
In the United Kingdom, half of fatal anaphylaxis episodes are of iatrogenic origin (eg, anesthesia, antibiotics, radiocontrast media), while foods and insect stings each account for a quarter of the fatal episodes. […] The most common causes of death are cardiovascular collapse and respiratory compromise. One report examined 214 anaphylactic fatalities for which the mode of death could be surmised in 196, 98 of which were due to asphyxia (49 lower airways [bronchospasm], 26 both upper and lower airways, and 23 upper airways [angioedema]). The fatalities from acute bronchospasm occurred almost exclusively in those with preexisting asthma. […] Another analysis of 23 unselected cases of fatal anaphylaxis determined that 16 of 20 immediate deaths (death occurring within one hour of symptom onset) and 16 of the 23 cases that underwent autopsy were due to upper airway edema.
#9 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
In the United Kingdom, half of fatal anaphylaxis episodes are of iatrogenic origin (eg, anesthesia, antibiotics, radiocontrast media), while foods and insect stings each account for a quarter of the fatal episodes. […] The most common causes of death are cardiovascular collapse and respiratory compromise. One report examined 214 anaphylactic fatalities for which the mode of death could be surmised in 196, 98 of which were due to asphyxia (49 lower airways [bronchospasm], 26 both upper and lower airways, and 23 upper airways [angioedema]). The fatalities from acute bronchospasm occurred almost exclusively in those with preexisting asthma. […] Another analysis of 23 unselected cases of fatal anaphylaxis determined that 16 of 20 immediate deaths (death occurring within one hour of symptom onset) and 16 of the 23 cases that underwent autopsy were due to upper airway edema.
#10 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
In the United Kingdom, half of fatal anaphylaxis episodes are of iatrogenic origin (eg, anesthesia, antibiotics, radiocontrast media), while foods and insect stings each account for a quarter of the fatal episodes. […] The most common causes of death are cardiovascular collapse and respiratory compromise. One report examined 214 anaphylactic fatalities for which the mode of death could be surmised in 196, 98 of which were due to asphyxia (49 lower airways [bronchospasm], 26 both upper and lower airways, and 23 upper airways [angioedema]). The fatalities from acute bronchospasm occurred almost exclusively in those with preexisting asthma. […] Another analysis of 23 unselected cases of fatal anaphylaxis determined that 16 of 20 immediate deaths (death occurring within one hour of symptom onset) and 16 of the 23 cases that underwent autopsy were due to upper airway edema.
#11 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
In the United Kingdom, half of fatal anaphylaxis episodes are of iatrogenic origin (eg, anesthesia, antibiotics, radiocontrast media), while foods and insect stings each account for a quarter of the fatal episodes. […] The most common causes of death are cardiovascular collapse and respiratory compromise. One report examined 214 anaphylactic fatalities for which the mode of death could be surmised in 196, 98 of which were due to asphyxia (49 lower airways [bronchospasm], 26 both upper and lower airways, and 23 upper airways [angioedema]). The fatalities from acute bronchospasm occurred almost exclusively in those with preexisting asthma. […] Another analysis of 23 unselected cases of fatal anaphylaxis determined that 16 of 20 immediate deaths (death occurring within one hour of symptom onset) and 16 of the 23 cases that underwent autopsy were due to upper airway edema.
#12 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
Death can occur rapidly. An analysis of anaphylaxis fatalities occurring in the United Kingdom from 1992 to 2001 revealed the interval between initial onset of food anaphylaxis symptoms and fatal cardiopulmonary arrest averaged 25-35 minutes, which was longer than for drugs (mean, 10-20 minutes pre-hospital; 5 minutes in-hospital) or for insect stings (10-15 minutes). […] Asthma is a risk factor for fatal anaphylaxis. Delayed administration of epinephrine is also a risk factor for fatal outcomes. […] Posture also influences anaphylaxis outcomes. In a retrospective review of prehospital anaphylactic fatalities in the United Kingdom, the postural history was known for 10 individuals. Four of the 10 fatalities were associated with the assumption of an upright or sitting posture during anaphylaxis.
#13 Anaphylaxis – Allergy & Asthma Network
https://allergyasthmanetwork.org/anaphylaxis/
Anaphylaxis is a severe allergic reaction. It can progress into a life-threatening condition. Anaphylaxis is caused by an exposure or ingestion of something to which you are allergic. The immune system then over-reacts. Symptoms involve multiple body systems including the skin, heart, stomach and airways. […] Anaphylaxis is an allergy emergency that can cause death in less than 15 minutes. Epinephrine is the only medication that can reverse symptoms. It is crucial to use epinephrine first and epinephrine fast. Then seek prompt treatment in your nearest emergency room. […] Anyone at risk for anaphylaxis can have a life-threatening allergic reaction even if previous reactions were mild. […] Left untreated, symptoms may cause you to lose consciousness and lead to a cardiac arrest, or even death.
#14 Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC4274465/
A total of 1,806 cases (52% male, age 16-86 years) were reported. […] All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. […] Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes. […] The severity of anaphylactic reaction is dependent on age, the presence of comorbidities, and specific causes. Drug-associated anaphylaxis, multi-organ involvement, and older age, are independent predictors of serious outcomes.
#15 Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC4274465/
A total of 1,806 cases (52% male, age 16-86 years) were reported. […] All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. […] Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes. […] The severity of anaphylactic reaction is dependent on age, the presence of comorbidities, and specific causes. Drug-associated anaphylaxis, multi-organ involvement, and older age, are independent predictors of serious outcomes.
#16 Anaphylaxis – Allergy & Asthma Network
https://allergyasthmanetwork.org/anaphylaxis/
Symptoms normally peak within a half-hour of exposure, but they can last for several hours. About 20% of the time, you can get your symptoms under control with a dose of epinephrine, but they may come back. This is what is known as a biphasic reaction a second reaction. If you experience a biphasic reaction, you should seek emergency care after giving a second dose of epinephrine. […] Anaphylaxis can be fatal. Deaths are often related to a delay in giving epinephrine or not giving epinephrine at all. […] People who have severe allergies are at higher risk. Most cases of anaphylaxis occur in people between the ages of 30 and 39. […] In fatal cases, studies show adolescents, teenagers and young adults with food allergies are at highest risk of death. This may be due in part to risk-taking behavior common in that age group, hormones, or a reluctance to carry epinephrine.
#17 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
Death can occur rapidly. An analysis of anaphylaxis fatalities occurring in the United Kingdom from 1992 to 2001 revealed the interval between initial onset of food anaphylaxis symptoms and fatal cardiopulmonary arrest averaged 25-35 minutes, which was longer than for drugs (mean, 10-20 minutes pre-hospital; 5 minutes in-hospital) or for insect stings (10-15 minutes). […] Asthma is a risk factor for fatal anaphylaxis. Delayed administration of epinephrine is also a risk factor for fatal outcomes. […] Posture also influences anaphylaxis outcomes. In a retrospective review of prehospital anaphylactic fatalities in the United Kingdom, the postural history was known for 10 individuals. Four of the 10 fatalities were associated with the assumption of an upright or sitting posture during anaphylaxis.
#18 Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC4274465/
A total of 1,806 cases (52% male, age 16-86 years) were reported. […] All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. […] Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes. […] The severity of anaphylactic reaction is dependent on age, the presence of comorbidities, and specific causes. Drug-associated anaphylaxis, multi-organ involvement, and older age, are independent predictors of serious outcomes.
#19 Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC4274465/
A total of 1,806 cases (52% male, age 16-86 years) were reported. […] All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. […] Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes. […] The severity of anaphylactic reaction is dependent on age, the presence of comorbidities, and specific causes. Drug-associated anaphylaxis, multi-organ involvement, and older age, are independent predictors of serious outcomes.
#20 Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC4274465/
A total of 1,806 cases (52% male, age 16-86 years) were reported. […] All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. […] Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes. […] The severity of anaphylactic reaction is dependent on age, the presence of comorbidities, and specific causes. Drug-associated anaphylaxis, multi-organ involvement, and older age, are independent predictors of serious outcomes.
#21 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
Fatal anaphylaxis is infrequent but not rare; milder forms occur much more frequently. Up to 500-1000 fatal cases of anaphylaxis per year are estimated to occur in the United States. Estimated mortality rates range from 0.65-2% of patients with anaphylaxis. […] Reactions to foods are thought to be the most common cause of anaphylaxis when it occurs outside of the hospital and are estimated to cause 125 deaths per year in the United States. Severe reactions to penicillin occur with a frequency of 15 cases per 10,000 patient courses, with fatalities in 1 case per 50,000-100,000 courses. Fewer than 100 fatal reactions to Hymenoptera stings are reported each year in the United States, but this is considered to be an underestimate. […] Anaphylaxis to conventional radiocontrast media (RCM) was estimated to have caused up to 900 fatalities in 1975, or 0.009% of patients receiving RCM. In one series, the reported risk of adverse reactions (mild or severe) in patients receiving lower osmolar RCM agents is 3.13% compared with 12.66% for patients receiving conventional RCM. The study also reported premedication did not lower the risk of nonionic reactions further. The rate of fatal anaphylaxis is also reduced significantly by lower-osmolar RCM, approximately 1 in 168,000 administrations.
#22 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
Fatal anaphylaxis is infrequent but not rare; milder forms occur much more frequently. Up to 500-1000 fatal cases of anaphylaxis per year are estimated to occur in the United States. Estimated mortality rates range from 0.65-2% of patients with anaphylaxis. […] Reactions to foods are thought to be the most common cause of anaphylaxis when it occurs outside of the hospital and are estimated to cause 125 deaths per year in the United States. Severe reactions to penicillin occur with a frequency of 15 cases per 10,000 patient courses, with fatalities in 1 case per 50,000-100,000 courses. Fewer than 100 fatal reactions to Hymenoptera stings are reported each year in the United States, but this is considered to be an underestimate. […] Anaphylaxis to conventional radiocontrast media (RCM) was estimated to have caused up to 900 fatalities in 1975, or 0.009% of patients receiving RCM. In one series, the reported risk of adverse reactions (mild or severe) in patients receiving lower osmolar RCM agents is 3.13% compared with 12.66% for patients receiving conventional RCM. The study also reported premedication did not lower the risk of nonionic reactions further. The rate of fatal anaphylaxis is also reduced significantly by lower-osmolar RCM, approximately 1 in 168,000 administrations.
#23 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
Fatal anaphylaxis is infrequent but not rare; milder forms occur much more frequently. Up to 500-1000 fatal cases of anaphylaxis per year are estimated to occur in the United States. Estimated mortality rates range from 0.65-2% of patients with anaphylaxis. […] Reactions to foods are thought to be the most common cause of anaphylaxis when it occurs outside of the hospital and are estimated to cause 125 deaths per year in the United States. Severe reactions to penicillin occur with a frequency of 15 cases per 10,000 patient courses, with fatalities in 1 case per 50,000-100,000 courses. Fewer than 100 fatal reactions to Hymenoptera stings are reported each year in the United States, but this is considered to be an underestimate. […] Anaphylaxis to conventional radiocontrast media (RCM) was estimated to have caused up to 900 fatalities in 1975, or 0.009% of patients receiving RCM. In one series, the reported risk of adverse reactions (mild or severe) in patients receiving lower osmolar RCM agents is 3.13% compared with 12.66% for patients receiving conventional RCM. The study also reported premedication did not lower the risk of nonionic reactions further. The rate of fatal anaphylaxis is also reduced significantly by lower-osmolar RCM, approximately 1 in 168,000 administrations.
#24 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
Death can occur rapidly. An analysis of anaphylaxis fatalities occurring in the United Kingdom from 1992 to 2001 revealed the interval between initial onset of food anaphylaxis symptoms and fatal cardiopulmonary arrest averaged 25-35 minutes, which was longer than for drugs (mean, 10-20 minutes pre-hospital; 5 minutes in-hospital) or for insect stings (10-15 minutes). […] Asthma is a risk factor for fatal anaphylaxis. Delayed administration of epinephrine is also a risk factor for fatal outcomes. […] Posture also influences anaphylaxis outcomes. In a retrospective review of prehospital anaphylactic fatalities in the United Kingdom, the postural history was known for 10 individuals. Four of the 10 fatalities were associated with the assumption of an upright or sitting posture during anaphylaxis.
#25 Anaphylaxis – Allergy & Asthma Network
https://allergyasthmanetwork.org/anaphylaxis/
Symptoms normally peak within a half-hour of exposure, but they can last for several hours. About 20% of the time, you can get your symptoms under control with a dose of epinephrine, but they may come back. This is what is known as a biphasic reaction a second reaction. If you experience a biphasic reaction, you should seek emergency care after giving a second dose of epinephrine. […] Anaphylaxis can be fatal. Deaths are often related to a delay in giving epinephrine or not giving epinephrine at all. […] People who have severe allergies are at higher risk. Most cases of anaphylaxis occur in people between the ages of 30 and 39. […] In fatal cases, studies show adolescents, teenagers and young adults with food allergies are at highest risk of death. This may be due in part to risk-taking behavior common in that age group, hormones, or a reluctance to carry epinephrine.
#26 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
Death can occur rapidly. An analysis of anaphylaxis fatalities occurring in the United Kingdom from 1992 to 2001 revealed the interval between initial onset of food anaphylaxis symptoms and fatal cardiopulmonary arrest averaged 25-35 minutes, which was longer than for drugs (mean, 10-20 minutes pre-hospital; 5 minutes in-hospital) or for insect stings (10-15 minutes). […] Asthma is a risk factor for fatal anaphylaxis. Delayed administration of epinephrine is also a risk factor for fatal outcomes. […] Posture also influences anaphylaxis outcomes. In a retrospective review of prehospital anaphylactic fatalities in the United Kingdom, the postural history was known for 10 individuals. Four of the 10 fatalities were associated with the assumption of an upright or sitting posture during anaphylaxis.
#27 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
Patients may experience multiple anaphylactic episodes. The Rochester study detected a total of 154 anaphylactic episodes involving 133 people in a 5-year period. Most patients (116) had only 1 episode in those 5 years. Thirteen people had 2 episodes, and 4 people had 3 episodes. […] In contrast, in the Memphis study, 48% of patients had 3 or more anaphylactic episodes. Of the 112 patients who responded to survey, however, 38 patients (34%) reported a recurrence of symptoms and the remaining 74 patients (66%) reported remission of symptoms. Overall, 85% of patients either were in remission or reported diminished symptom severity in a subsequent episode or episodes.
#28 Anaphylaxis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/135065-overview
Patients may experience multiple anaphylactic episodes. The Rochester study detected a total of 154 anaphylactic episodes involving 133 people in a 5-year period. Most patients (116) had only 1 episode in those 5 years. Thirteen people had 2 episodes, and 4 people had 3 episodes. […] In contrast, in the Memphis study, 48% of patients had 3 or more anaphylactic episodes. Of the 112 patients who responded to survey, however, 38 patients (34%) reported a recurrence of symptoms and the remaining 74 patients (66%) reported remission of symptoms. Overall, 85% of patients either were in remission or reported diminished symptom severity in a subsequent episode or episodes.
#29 Anaphylaxis – Allergy & Asthma Network
https://allergyasthmanetwork.org/anaphylaxis/
Symptoms normally peak within a half-hour of exposure, but they can last for several hours. About 20% of the time, you can get your symptoms under control with a dose of epinephrine, but they may come back. This is what is known as a biphasic reaction a second reaction. If you experience a biphasic reaction, you should seek emergency care after giving a second dose of epinephrine. […] Anaphylaxis can be fatal. Deaths are often related to a delay in giving epinephrine or not giving epinephrine at all. […] People who have severe allergies are at higher risk. Most cases of anaphylaxis occur in people between the ages of 30 and 39. […] In fatal cases, studies show adolescents, teenagers and young adults with food allergies are at highest risk of death. This may be due in part to risk-taking behavior common in that age group, hormones, or a reluctance to carry epinephrine.
#30 Severe Anaphylaxis in Pregnancy: A Systematic Review of Clinical Presentation to Determine Outcomes
https://www.mdpi.com/2075-4426/11/11/1060
Anaphylactic reactions during pregnancy can range from subjective cutaneous symptoms to anaphylaxis and lethal anaphylactic shock. The fetal and maternal outcomes are unpredictable. […] Accurate diagnosis with valid and reliable outcome measures was reported for 71.74% of cases. […] This review of the currently available literature shows that favorable outcomes are attainable with a high degree of observation, multidisciplinary cooperation, and rapid treatment. […] The mortality rate associated with anaphylaxis during pregnancy was estimated at 5%. […] Though the complication of anaphylaxis during pregnancy can be life-threatening, a high degree of vigilance combined with prompt multidisciplinary management may achieve favorable maternal and fetal outcomes. […] This review of the available literature shows that after anaphylactic reactions during pregnancy, favorable maternal and fetal outcomes are attainable with a high degree of vigilance, multispecialty cooperation, and rapid treatment.
#31 Severe Anaphylaxis in Pregnancy: A Systematic Review of Clinical Presentation to Determine Outcomes
https://www.mdpi.com/2075-4426/11/11/1060
Anaphylactic reactions during pregnancy can range from subjective cutaneous symptoms to anaphylaxis and lethal anaphylactic shock. The fetal and maternal outcomes are unpredictable. […] Accurate diagnosis with valid and reliable outcome measures was reported for 71.74% of cases. […] This review of the currently available literature shows that favorable outcomes are attainable with a high degree of observation, multidisciplinary cooperation, and rapid treatment. […] The mortality rate associated with anaphylaxis during pregnancy was estimated at 5%. […] Though the complication of anaphylaxis during pregnancy can be life-threatening, a high degree of vigilance combined with prompt multidisciplinary management may achieve favorable maternal and fetal outcomes. […] This review of the available literature shows that after anaphylactic reactions during pregnancy, favorable maternal and fetal outcomes are attainable with a high degree of vigilance, multispecialty cooperation, and rapid treatment.
#32 Severe Anaphylaxis in Pregnancy: A Systematic Review of Clinical Presentation to Determine Outcomes
https://www.mdpi.com/2075-4426/11/11/1060
Anaphylactic reactions during pregnancy can range from subjective cutaneous symptoms to anaphylaxis and lethal anaphylactic shock. The fetal and maternal outcomes are unpredictable. […] Accurate diagnosis with valid and reliable outcome measures was reported for 71.74% of cases. […] This review of the currently available literature shows that favorable outcomes are attainable with a high degree of observation, multidisciplinary cooperation, and rapid treatment. […] The mortality rate associated with anaphylaxis during pregnancy was estimated at 5%. […] Though the complication of anaphylaxis during pregnancy can be life-threatening, a high degree of vigilance combined with prompt multidisciplinary management may achieve favorable maternal and fetal outcomes. […] This review of the available literature shows that after anaphylactic reactions during pregnancy, favorable maternal and fetal outcomes are attainable with a high degree of vigilance, multispecialty cooperation, and rapid treatment.
#33 Anaphylaxis – Wikipedia
https://en.wikipedia.org/wiki/Anaphylaxis
In those in whom the cause is known and prompt treatment is available, the prognosis is good. […] Even if the cause is unknown, if appropriate preventive medication is available, the prognosis is generally good. […] Usually death occurs due to either respiratory failure (typically involving asphyxia) or cardiovascular complications, such as cardiovascular shock, with 0.720% of cases causing death. […] There have been cases of death occurring within minutes. […] Outcomes in those with exercise-induced anaphylaxis are typically good, with fewer and less severe episodes as people get older.
#34 Mental health problems associated with idiopathic anaphylaxis | Allergy, Asthma & Clinical Immunology | Full Text
https://aacijournal.biomedcentral.com/articles/10.1186/s13223-023-00824-0
Compared to population norms, those with IA had significantly higher levels of mental health problems. […] This is the first paper to demonstrate that patients living with idiopathic anaphylaxis are more symptomatic for mental illness than those in the community. […] This study provides clear evidence of the increased risk of unrecognised mental health problems in this clinical population. It demonstrated that the majority of patients with idiopathic anaphylaxis also experience mental health symptoms, although only a small minority (8.8%) reported having a coexisting mental health diagnosis. […] In summary idiopathic anaphylaxis is a serious disorder with morbidity that encompasses both the physiological aspects of anaphylaxis and associated mental health problems. Attention to both the physical and psychological needs of these patients is likely to lead to improved health outcomes.
#35 Mental health problems associated with idiopathic anaphylaxis | Allergy, Asthma & Clinical Immunology | Full Text
https://aacijournal.biomedcentral.com/articles/10.1186/s13223-023-00824-0
Compared to population norms, those with IA had significantly higher levels of mental health problems. […] This is the first paper to demonstrate that patients living with idiopathic anaphylaxis are more symptomatic for mental illness than those in the community. […] This study provides clear evidence of the increased risk of unrecognised mental health problems in this clinical population. It demonstrated that the majority of patients with idiopathic anaphylaxis also experience mental health symptoms, although only a small minority (8.8%) reported having a coexisting mental health diagnosis. […] In summary idiopathic anaphylaxis is a serious disorder with morbidity that encompasses both the physiological aspects of anaphylaxis and associated mental health problems. Attention to both the physical and psychological needs of these patients is likely to lead to improved health outcomes.
#36 Anaphylaxis: Symptoms, Causes, and Treatment
https://patient.info/allergies-blood-immune/allergies/anaphylaxis
What is the outlook (prognosis) for anaphylaxis? […] If you have had a confirmed anaphylactic reaction, you should be referred to an allergy specialist. Generally you would be seen in a hospital outpatient clinic by a consultant immunologist. […] The most important thing is to identify and avoid trigger factors. The allergy specialist will go through this with you. There are many cases where careful allergen avoidance will prevent the need to have treatment for an anaphylactic reaction in the first place. […] Adrenaline auto-injectors should be prescribed to anyone who has had anaphylaxis or is thought to be at risk of anaphylaxis, even if they are still waiting to see an allergy specialist. […] Everyone who has been prescribed an adrenaline auto-injector should be seen by an allergy specialist. They might recommend continuing to carry auto-injectors, but sometimes may say that it isn’t necessary.
#37 Anaphylaxis: Symptoms, Causes, and Treatment
https://patient.info/allergies-blood-immune/allergies/anaphylaxis
What is the outlook (prognosis) for anaphylaxis? […] If you have had a confirmed anaphylactic reaction, you should be referred to an allergy specialist. Generally you would be seen in a hospital outpatient clinic by a consultant immunologist. […] The most important thing is to identify and avoid trigger factors. The allergy specialist will go through this with you. There are many cases where careful allergen avoidance will prevent the need to have treatment for an anaphylactic reaction in the first place. […] Adrenaline auto-injectors should be prescribed to anyone who has had anaphylaxis or is thought to be at risk of anaphylaxis, even if they are still waiting to see an allergy specialist. […] Everyone who has been prescribed an adrenaline auto-injector should be seen by an allergy specialist. They might recommend continuing to carry auto-injectors, but sometimes may say that it isn’t necessary.
#38 Anaphylaxis: Symptoms, Causes, and Treatment
https://patient.info/allergies-blood-immune/allergies/anaphylaxis
What is the outlook (prognosis) for anaphylaxis? […] If you have had a confirmed anaphylactic reaction, you should be referred to an allergy specialist. Generally you would be seen in a hospital outpatient clinic by a consultant immunologist. […] The most important thing is to identify and avoid trigger factors. The allergy specialist will go through this with you. There are many cases where careful allergen avoidance will prevent the need to have treatment for an anaphylactic reaction in the first place. […] Adrenaline auto-injectors should be prescribed to anyone who has had anaphylaxis or is thought to be at risk of anaphylaxis, even if they are still waiting to see an allergy specialist. […] Everyone who has been prescribed an adrenaline auto-injector should be seen by an allergy specialist. They might recommend continuing to carry auto-injectors, but sometimes may say that it isn’t necessary.
#39 Anaphylaxis: Symptoms, Causes, and Treatment
https://patient.info/allergies-blood-immune/allergies/anaphylaxis
What is the outlook (prognosis) for anaphylaxis? […] If you have had a confirmed anaphylactic reaction, you should be referred to an allergy specialist. Generally you would be seen in a hospital outpatient clinic by a consultant immunologist. […] The most important thing is to identify and avoid trigger factors. The allergy specialist will go through this with you. There are many cases where careful allergen avoidance will prevent the need to have treatment for an anaphylactic reaction in the first place. […] Adrenaline auto-injectors should be prescribed to anyone who has had anaphylaxis or is thought to be at risk of anaphylaxis, even if they are still waiting to see an allergy specialist. […] Everyone who has been prescribed an adrenaline auto-injector should be seen by an allergy specialist. They might recommend continuing to carry auto-injectors, but sometimes may say that it isn’t necessary.
#40 PEMCRC anaphylaxis study protocol: a multicentre cohort study to derive and validate clinical decision models for the emergency department management of children with anaphylaxis | BMJ Open
https://bmjopen.bmj.com/content/11/1/e037341
There remain significant knowledge gaps about the management and outcomes of children with anaphylaxis. […] The objectives of this multicentre study are to (1) determine the prevalence of and risk factors for severe, persistent, refractory and biphasic anaphylaxis, as well as persistent and biphasic non-anaphylactic reactions; (2) derive and validate prediction models for emergency department (ED) discharge; and (3) determine data-driven lengths of ED and inpatient observation prior to discharge to home based on initial reaction severity. […] Recent studies report significant knowledge gaps regarding the incidence of severe, persistent and biphasic reactions (1%15%)58 and potential predictors of such reactions. […] Furthermore, most prior studies are single centre and restricted to adults, which limit generalisability and applicability to children.
#41 PEMCRC anaphylaxis study protocol: a multicentre cohort study to derive and validate clinical decision models for the emergency department management of children with anaphylaxis | BMJ Open
https://bmjopen.bmj.com/content/11/1/e037341
There remain significant knowledge gaps about the management and outcomes of children with anaphylaxis. […] The objectives of this multicentre study are to (1) determine the prevalence of and risk factors for severe, persistent, refractory and biphasic anaphylaxis, as well as persistent and biphasic non-anaphylactic reactions; (2) derive and validate prediction models for emergency department (ED) discharge; and (3) determine data-driven lengths of ED and inpatient observation prior to discharge to home based on initial reaction severity. […] Recent studies report significant knowledge gaps regarding the incidence of severe, persistent and biphasic reactions (1%15%)58 and potential predictors of such reactions. […] Furthermore, most prior studies are single centre and restricted to adults, which limit generalisability and applicability to children.
#42 PEMCRC anaphylaxis study protocol: a multicentre cohort study to derive and validate clinical decision models for the emergency department management of children with anaphylaxis | BMJ Open
https://bmjopen.bmj.com/content/11/1/e037341
Finally, there are no widely accepted evidence-based guidelines to support clinical decision-making following initial treatment with epinephrine. […] This likely contributes to wide practice variation regarding ED observation periods (reported from 4 to 24 hours) and hospitalisation rates (varying from 12% to 95% of children with anaphylaxis). […] We propose a large, multicentre study conducted in a network of North American EDs to achieve the following objectives: (1) determine the prevalence of and risk factors for severe, persistent, refractory and biphasic anaphylaxis, as well as persistent and biphasic non-anaphylactic reactions; (2) derive and validate prediction models of children who may be candidates for ED discharge rather than hospitalisation; and (3) determine data-driven lengths of ED and inpatient observation prior to discharge to home based on initial reaction severity.
#43 PEMCRC anaphylaxis study protocol: a multicentre cohort study to derive and validate clinical decision models for the emergency department management of children with anaphylaxis | BMJ Open
https://bmjopen.bmj.com/content/11/1/e037341
Finally, there are no widely accepted evidence-based guidelines to support clinical decision-making following initial treatment with epinephrine. […] This likely contributes to wide practice variation regarding ED observation periods (reported from 4 to 24 hours) and hospitalisation rates (varying from 12% to 95% of children with anaphylaxis). […] We propose a large, multicentre study conducted in a network of North American EDs to achieve the following objectives: (1) determine the prevalence of and risk factors for severe, persistent, refractory and biphasic anaphylaxis, as well as persistent and biphasic non-anaphylactic reactions; (2) derive and validate prediction models of children who may be candidates for ED discharge rather than hospitalisation; and (3) determine data-driven lengths of ED and inpatient observation prior to discharge to home based on initial reaction severity.
#44 PEMCRC anaphylaxis study protocol: a multicentre cohort study to derive and validate clinical decision models for the emergency department management of children with anaphylaxis | BMJ Open
https://bmjopen.bmj.com/content/11/1/e037341
These data have the potential to inform and standardise ED clinical practice, reduce hospitalisation rates, optimise ED and inpatient lengths of stay and mitigate the burden on children, families and healthcare systems. […] Safe ED discharge is defined as no receipt of acute anaphylaxis medications and no hypotension beyond 4hours from first administered dose of epinephrine (intravenous, intramuscular and subQ). […] Patients may have the outcome for safe ED discharge despite fulfilling criteria for severe, persistent or biphasic anaphylaxis. […] These data will inform clinicians on data-driven observation periods in the ED and inpatient setting within predefined clinical subgroups.
#45 Prediction of the severity of allergic reactions to foods
https://pmc.ncbi.nlm.nih.gov/articles/PMC6033096/
There is currently considerable uncertainty regarding what the predictors of the severity of diagnostic or accidental food allergic reactions are, and to what extent the severity of such reactions can be predicted. […] The severity of DBPCFCs and accidental reactions to food remains largely unpredictable. Clinicians should not use the eliciting dose obtained from a graded food challenge for the purposes of making risk-related management decisions. […] Prediction of the severity of reactions is important to be able to accurately target the management of food allergic reactions, for example, with the prescription of epinephrine autoinjectors. However, with the risk factors identified in our study, we were only able to predict 23.5% of the severity of reactions during DBPCFC and 7.3% of the severity of the most severe accidental reaction by history.
#46 Prediction of the severity of allergic reactions to foods
https://pmc.ncbi.nlm.nih.gov/articles/PMC6033096/
There is currently considerable uncertainty regarding what the predictors of the severity of diagnostic or accidental food allergic reactions are, and to what extent the severity of such reactions can be predicted. […] The severity of DBPCFCs and accidental reactions to food remains largely unpredictable. Clinicians should not use the eliciting dose obtained from a graded food challenge for the purposes of making risk-related management decisions. […] Prediction of the severity of reactions is important to be able to accurately target the management of food allergic reactions, for example, with the prescription of epinephrine autoinjectors. However, with the risk factors identified in our study, we were only able to predict 23.5% of the severity of reactions during DBPCFC and 7.3% of the severity of the most severe accidental reaction by history.
#47 Prediction of the severity of allergic reactions to foods
https://pmc.ncbi.nlm.nih.gov/articles/PMC6033096/
There is currently considerable uncertainty regarding what the predictors of the severity of diagnostic or accidental food allergic reactions are, and to what extent the severity of such reactions can be predicted. […] The severity of DBPCFCs and accidental reactions to food remains largely unpredictable. Clinicians should not use the eliciting dose obtained from a graded food challenge for the purposes of making risk-related management decisions. […] Prediction of the severity of reactions is important to be able to accurately target the management of food allergic reactions, for example, with the prescription of epinephrine autoinjectors. However, with the risk factors identified in our study, we were only able to predict 23.5% of the severity of reactions during DBPCFC and 7.3% of the severity of the most severe accidental reaction by history.
#48 Prediction of the severity of allergic reactions to foods
https://pmc.ncbi.nlm.nih.gov/articles/PMC6033096/
The ED did not predict the severity of the accidental reaction. This suggests that dose limitation as a public health measure is unlikely to reduce severe reactions more than milder ones. Finally, clinicians should not use the eliciting dose obtained from a graded food challenge for the purposes of making risk-related management decisions such as the need for stringent avoidance of allergenic foods or the prescription of self-injectable epinephrine.