Which of the following agents are responsible for causing the most serious anaphylactic reactions?

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Abstract

Background

Anaphylaxis is a life-threatening allergic reaction. Several studies reported different anaphylactic reactions according to the causative substances. However, a comparison of anaphylaxis for each cause has not been done. This study was conducted to identify common causes of anaphylaxis, characteristics of anaphylactic reaction for each cause and to analyze the factors related to the severity of the reaction.

Methods

Medical records of patients who visited the emergency room of Ewha Womans University Mokdong Hospital from March 2003 to April 2016 and diagnosed with anaphylactic shock were retrospectively reviewed. We compared the clinical features of anaphylaxis according to the cause. In addition, the severity of anaphylaxis was analyzed and contributing factors for severe anaphylaxis were reviewed.

Results

A total of 199 patients with anaphylaxis were analyzed. Food was the most common cause (49.7%), followed by drug reaction (36.2%), bee venom (10.1%), and unknown cause (4.0%). Cardiovascular symptoms of syncope and hypotension were more common in drug-induced anaphylaxis. The incidence of severe anaphylaxis was the highest in anaphylaxis due to drugs (54.2%). Urticaria and other skin symptoms were significantly more common in food-induced anaphylaxis. Risk factors for severe anaphylaxis included older age, male, and drug-induced one. Epinephrine treatment of anaphylaxis was done for 69.7% and 56.9% of patients with food-induced and drug-induced anaphylaxis, respectively.

Conclusions

More severe anaphylaxis developed with drug treatment and in males. Low rate of epinephrine prescription was also observed. Male patients with drug induced anaphylaxis should be paid more attention.

Keywords

Anaphylactic shock

Anaphylaxis

Drug hypersensitivity

Food hypersensitivity

Risk factors

Abbreviations

NOS

Not otherwise specified

KCD

Korean standard classification of disease

MAST

multiple allergosorbent test

ECP

eosinophil cationic protein

AST

aspartate transaminase

NSAIDs

nonsteroidal anti-inflammatory drugs

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Anaphylaxis is a severe and potentially life-threatening reaction to a trigger such as an allergy.

Symptoms of anaphylaxis

Anaphylaxis usually develops suddenly and gets worse very quickly.

The symptoms include:

feeling lightheaded or faint
breathing difficulties – such as fast, shallow breathing
wheezing
a fast heartbeat
clammy skin
confusion and anxiety
collapsing or losing consciousness

There may also be other allergy symptoms, including an itchy, raised rash (hives); feeling or being sick; swelling (angioedema) or stomach pain.

What to do if someone has anaphylaxis

Anaphylaxis is a medical emergency. It can be very serious if not treated quickly.

If someone has symptoms of anaphylaxis:

Use an adrenaline auto-injector if the person has one – but make sure you know how to use it correctly first.
Call 999 for an ambulance immediately (even if they start to feel better) – mention that you think the person has anaphylaxis.
Remove any trigger if possible – for example, carefully remove any stinger stuck in the skin.
Lie the person down and raise their legs – unless they're having breathing difficulties and need to sit up to help them breathe. If they're pregnant, lie them down on their left side.
Give another injection after 5 minutes if the symptoms do not improve and a second auto-injector is available.

If you're having an anaphylactic reaction, you can follow these steps yourself if you feel able to.

Read about how to treat anaphylaxis for more advice about using auto-injectors and correct positioning.

Triggers of anaphylaxis

Anaphylaxis is the result of the immune system, the body's natural defence system, overreacting to a trigger.

This is often something you're allergic to, but not always.

Common anaphylaxis triggers include:

foods – including nuts, milk, fish, shellfish, eggs and some fruits
medicines – including some antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin
insect stings – particularly wasp and bee stings
general anaesthetic
contrast agents – dyes used in some medical tests to help certain areas of your body show up better on scans
latex – a type of rubber found in some rubber gloves and condoms

In some cases, there's no obvious trigger. This is known as idiopathic anaphylaxis.

Preventing anaphylaxis

If you have a serious allergy or have experienced anaphylaxis before, it's important to try to prevent future episodes.

The following can help reduce your risk:

identify any triggers – you may be referred to an allergy clinic for allergy tests to check for anything that could trigger anaphylaxis
avoid triggers whenever possible – for example, be careful when food shopping or eating out if you have a food allergy
carry 2 in-date adrenaline auto-injectors at all times – give yourself an injection whenever you think you may be experiencing anaphylaxis, even if you're not completely sure

What causes the most serious anaphylactic reactions?

The result is symptoms such as vomiting or swelling. The most common triggers of anaphylaxis are allergens. Medicines, foods, insect stings and bites, and latex most often cause severe allergic reactions. Common culprits are penicillin and other antibiotics, aspirin and aspirin-related products and insulin.