Patterns of anaphylaxis after diagnostic work-up: a follow-up study of 226 patients with suspected anaphylaxis

Abstract

Background

Most published studies on anaphylaxis are retrospective or register based. Data on subsequent diagnostic work-up are sparse. We aimed to characterize patients seen with suspected anaphylaxis at the emergency care setting (ECS), after subsequent diagnostic work-up at our Allergy Center (AC).

Methods

Prospective study including patients from the ECS, Odense University Hospital, during May 2013–April 2014. Possible anaphylaxis cases were daily identified based on a broad search profile including history and symptoms in patient records, diagnostic codes and pharmacological treatments. At the AC, all patients were evaluated according to international guidelines.

Results

Among 226 patients with suspected anaphylaxis, the diagnosis was confirmed in 124 (54.9%) after diagnostic work-up; 118 of the 124 fulfilled WAO/EAACI criteria of anaphylaxis at the ECS, while 6 were found among 46 patient with clinical suspicion but not fulfilling the WAO/EAACI criteria at the ECS. The estimated incidence rate of anaphylaxis was 26 cases per 100,000 person years and the one year period prevalence was 0.04%. The most common elicitor was drugs (41.1%) followed by venom (27.4%) and food (20.6%). In 13 patients (10.5%) no elicitor could be identified. Mastocytosis was diagnosed in 7.7% of adult patients and was significantly associated with severe anaphylaxis. Atopic diseases were significantly associated only with food-induced anaphylaxis. Co-factors were present in 58.1% and were significantly associated with severe anaphylaxis.

Conclusion

A broad search profile in the ECS and subsequent diagnostic work-up is important for identification and classification of patients with anaphylaxis. Evaluation of co-morbidities and co-factors are important.

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