To evaluate incidence and causes of anaphylactic reactions in the emergency room (E.R.) of a general hospital in Milan during a 2-year period.
We retrospectively studied the computerized records of patients discharged from an E.R. with a diagnosis of anaphylactic reaction. Anaphylaxis was established on the presence of at least two cutaneous, respiratory, gastrointestinal or cardiovascular system symptoms.
During 1997 and 1998, out of 38 685 patients referred to the E.R., 13 had severe anaphylaxis with loss of consciousness (LOC) and 127 had anaphylactic symptoms, without LOC. Of the 13 patients with LOC, a possible cause was identified in 12 (five foods, six drugs, one hair dye). In the other 127 patients anaphylaxis was related to foods in 49 cases (38.5%), drugs in 44 (34.6%), unknown causes in 29 (22.8%), hymenoptera stings in two (1.5%), and other causes in three (2.3%).
The incidence of anaphylactic reactions was 0.4% and mainly affected females and atopic subjects. Foods, particularly fruits and vegetables, appeared to be the most important cause; other important causes were non steroidal antiinflammatory drugs and beta-lactam antibiotics.
"Two of our patients experienced anaphylaxis from sesame sauce tahini. Fish and shellfish were rather seldom reported (8%) but are common causes of anaphylaxis in Italy, Asia, and the United States [13,14,24,27]. No deaths from food are known in Finland. "
[Show abstract][Hide abstract] ABSTRACT: Background: No data have been available on severe allergic reactions in Finland.
Materials and Methods: We summarize the data accumulated from 2000 to 2007 in the national register established at the Skin and Allergy Hospital of the Helsinki University Central Hospital, where physicians voluntarily report on patients with severe allergic reactions.
Results: During the period, the 530 reported cases of severe allergic reactions represented an annual frequency of 0.001%. Of the patients, 66% were adults and 56% were female, with a median age of 27 years. Food was the causative agent in 53% of the cases, drugs in 26%, allergen preparations in 12%, and insects in 8%. Dermatologic symptoms were reported in 85%, respiratory in 76%, cardiovascular in 50%, gastrointestinal in 33%, and eye/nose symptoms in 18%. The reaction was a life-threatening anaphylactic shock in 26% of the cases, with no deaths reported. Patients were treated with intramuscular adrenaline in 75% of the cases. Not only nuts and seeds, but also fruit and vegetables were the most important allergens for the adults. Nuts were also important allergens for children, along with milk, egg, and wheat. In addition, many "exotic" allergens were identified: patent blue, carmine dye, yeast, buckwheat, and macrogol.
Conclusions: Severe allergic reactions are underreported, but a register reflects the real-life situation and helps to identify new causative agents. It also contributes to improvements in first aid treatment practice.
World Allergy Organization Journal 10/2008; 1(11):184-189. DOI:10.1097/WOX.0b013e3181898224
"The contribution of food allergy to anaphylaxis varies across series, ranging from 15% to 57% of cases of anaphylaxis      . Nuts, fish, and shellfish are consistently the most common food allergens triggering anaphylaxis , with dairy, eggs, fruits, and vegetables also common causes. "
[Show abstract][Hide abstract] ABSTRACT: Food allergy is a common cause of anaphylaxis, and its incidence is rising. The development of allergy is multifactorial, and the mechanisms of tolerance are complex. The natural history of food allergy varies by causative food; some allergies are mostly outgrown, while others are usually life-long. Anaphylaxis caused by food allergy may differ clinically from other causes of anaphylaxis. Death is usually caused by respiratory failure, and patients who have asthma are at greatest risk for severe reactions. At this time, avoiding allergenic triggers, and when that fails, timely administration of epinephrine, are the main approaches to food allergy. Although several experimental medications promise to dramatically change the field of food allergy, none of these treatments are currently available outside of research settings.
Immunology and Allergy Clinics of North America 06/2007; 27(2):193-212, vi. DOI:10.1016/j.iac.2007.03.005 · 1.82 Impact Factor
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