Decker WW, Campbell RL, Manivannan V, et al. The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project

Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
The Journal of allergy and clinical immunology (Impact Factor: 11.48). 12/2008; 122(6):1161-5. DOI: 10.1016/j.jaci.2008.09.043
Source: PubMed

ABSTRACT Reported incidences of anaphylaxis range from 3.2 to 20 per 100,000 population. The incidence and trend over time has meaningful public health implications but has not been well characterized because of a lack of a standard definition and deficiencies in reporting of events.
We sought to determine the incidence and cause of anaphylaxis over a 10-year period.
We performed a population-based incidence study that was conducted in Rochester, Minnesota, from 1990 through 2000. Anaphylaxis episodes were identified on the basis of symptoms and signs of mast cell and basophil mediator release plus mucocutaneous, gastrointestinal tract, respiratory tract, or cardiovascular system involvement.
Two hundred eleven cases of anaphylaxis were identified (55.9% in female subjects). The mean age was 29.3 years (SD, 18.2 years; range, 0.8-78.2 years). The overall age- and sex-adjusted incidence rate was 49.8 (95% CI, 45.0-54.5) per 100,000 person-years. Age-specific rates were highest for ages 0 to 19 years (70 per 100,000 person-years). Ingested foods accounted for 33.2% (70 cases), insect stings accounted for 18.5% (39 cases), medication accounted for 13.7% (29 cases), radiologic contrast agent accounted for 0.5% (1 case), "other" causes accounted for 9% (19 cases), and "unknown" causes accounted for 25.1% (53 cases). The "other" group included cats, latex, cleaning agents, environmental allergens, and exercise. There was an increase in the annual incidence rate during the study period from 46.9 per 100,000 persons in 1990 to 58.9 per 100,000 persons in 2000 (P = .03).
The overall incidence rate is 49.8 per 100,000 person-years, which is higher than previously reported. The annual incidence rate is also increasing. Food and insect stings continue to be major inciting agents for anaphylaxis.

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Available from: Eric Bergstralh, Sep 28, 2015
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    • "La symptomatologie des manifestations cliniques de l'anaphylaxie concerne différents organes : l'appareil respiratoire , l'appareil cardiovasculaire, l'appareil digestif, l'appareil neurologique et le système cutanéo-muqueux [3] [10] [21] [22]. L'évaluation clinique est l'étalon-or du diagnostic [2] [3] [23] [24]. "
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    ABSTRACT: L’anaphylaxie est une réaction d’hypersensibilité sévère, potentiellement fatale, de mécanisme IgE-dépendant ou non. Sa prévalence est estimée à 0,3 % en Europe. Les auteurs exposent les bases physiopathogéniques de la réaction anaphylactique, ses aspects cliniques et les facteurs de risque, rappelant que le pronostic dépend de la rapidité du diagnostic et du traitement. Comme le soulignent les recommandations internationales, l’administration rapide d’adrénaline est essentielle. La littérature fait état d’une sous-utilisation de ce médicament. Les auteurs proposent un algorithme de prise en charge de l’anaphylaxie en fonction du grade de sévérité basée sur la classification de Ring et Messmer. À la sortie de l’hôpital, la prescription d’une trousse d’urgence contenant 2 stylos auto-injecteurs d’adrénaline avec éducation à leur utilisation est essentielle. Un document exposant la réaction clinique, ses circonstances de survenue et son traitement doit être remis au patient. Au décours d’une réaction anaphylactique, une consultation allergologique est indispensable dans l’objectif d’identifier l’allergène responsable et mettre en œuvre une stratégie préventive secondaire pour prévenir la récidive. Il convient de recommander au patient et à son entourage de conserver les aliments et médicaments pour faciliter l’enquête étiologique réalisée par l’allergologue.
    Journal Europeen des Urgences et de Reanimation 05/2015; 27(2). DOI:10.1016/j.jeurea.2015.03.009
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    • "Studies also indicate discordance with guideline recommendations for discharge in the US: approximately 45% of patients treated for anaphylaxis in the ED received a discharge prescription for epinephrine (range 16%–63%);[8–10,27,29,31,33,34] and even fewer were given a referral to an allergist (21.6%, range 11%–33%)[8–10,27,29,33,34] and/or information about avoiding causative agents (23.5%, range 3%–40%).[9,10,33,34] Treatment with epinephrine in the ED may predict the likelihood of a prescription for epinephrine at discharge and referral to an allergist.[9,27,29] "
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    ABSTRACT: BACKGROUND: Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting. Current guidelines recommend: 1) quick diagnosis using standard criteria; 2) first-line treatment with epinephrine; and 3) discharge with a prescription for an epinephrine auto-injector, written instructions regarding long-term management, and a referral (preferably, allergy) for follow-up. However, studies suggest low concordance with guideline recommendations by emergency medicine (EM) providers. The study aimed to evaluate how emergency departments (EDs) in the United States (US) manage anaphylaxis in relation to guideline recommendations. METHODS: This was an online anonymous survey of a random sample of EM health providers in US EDs. RESULTS: Data analysis included 207 EM providers. For respondent EDs, approximately 9% reported using agreed-upon clinical criteria to diagnose anaphylaxis; 42% reported administering epinephrine in the ED for most anaphylaxis episodes; and <50% provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge. Most provided some written materials, and follow-up with a primary care clinician was recommended. CONCLUSIONS: This is the first cross-sectional survey to provide “real-world” data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis, treatment, and follow-up of patients with anaphylaxis. The primary gaps are low (or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine. Prospective research is recommended.
    03/2013; 4(2):98-106. DOI:10.5847/wjem.j.1920-8642.2013.02.003
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    • "The numbers of pediatric emergency department (ED) visits and deaths related to food induced anaphylaxis have also increased in western countries [21-23]. In children, one of the most common causes of anaphylaxis treated in emergency rooms is FA, and peanut and tree nuts are the main causes of plant food allergies resulting in fatal or near fatal forms of allergies in western countries [24-30]. "
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    ABSTRACT: Food allergy (FA) is a worldwide problem, with increasing prevalence in many countries, and it poses a clearly increasing health problem in Korea. In Korea, as a part of International Study of Asthma and Allergy in Childhood (ISAAC), a series of nation-wide population studies for prevalence of allergic disease in children were carried out, with the Korean version of ISAAC in 1995, 2000, and 2010. From the survey, the twelve-month prevalence of FA showed no significant differences from 1995 to 2000 in both age groups (6-12 years-old, 6.5% in 1995 and 5.7% in 2000; 12-15 year-olds, 7.4% in 1995 and 8.6% in 2000). The mean lifetime prevalence of FA which had ever been diagnosed by medical doctor was 4.7% in 6-12 year-olds and 5.1% in 12-15 year-olds respectively in 2000. In Korean children, the major causes of FA are almost same as in other countries, although the order prevalence may vary, a prime example of which being that peanut and tree nut allergies are not prevalent, as in western countries. Both pediatric emergency department (ED) visits and deaths relating to food induced anaphylaxis have also increased in western countries. From a study which based on data from the Korean Health Insurance Review and Assessment Service (KHIRA) from 2001 to 2007, the incidence of anaphylaxis under the age of 19 was 0.7-1 per 100,000 person-year, and foods (24.9%) were the most commonly identified cause of childhood anaphylaxis. In another epidemiologic study, involving 78889 patients aged 0-18 years who visited the EDs of 9 hospitals during June 2008 to Mar 2009, the incidence of food related anaphylaxis was 4.56 per 10,000 pediatric ED visits. From these studies, common causes of food related anaphylaxis were seafood, buckwheat, cow's milk, fruits, peanut and tree nuts. Although systematic epidemiologic studies have not reported on the matter, recently, plant foods related allergy has increased in Korean children. Among 804 children with moderate to severe atopic dermatitis, we reveals that the peanut sensitization rate in Korea reaches 18%, and that, when sensitized to peanut, patients showed a significant tendency to have co-sensitization with house dust mites, egg white, wheat, and soybean. The higher specific IgE to peanut was related to the likelihood of the patient developing severe systemic reactions. In another study, based on the data analysis of 69 patients under 4 years of age who had suspected peanut and tree nut allergy, 22 (31.9%) were sensitized to walnut (>0.35 kU/L, 0.45-27.4 kU/L) and 6 (8.7%) experienced anaphylaxis due to a small amount of walnut exposure. Furthermore, in this review, clinical and immunological studies on plant food allergies, such as buckwheat allergy, rice allergy, barley allergy, and kiwi fruit allergy, in Korean children are discussed.
    01/2013; 3(1):15-22. DOI:10.5415/apallergy.2013.3.1.15
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