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Goh SH, Yap GC, Cheng HY, Chiang WC, Soh JY, Chong KW, Goh A, Tham EH, Tyebally A, Ganapathy S, Ibrahim I, Lee BW. Trends in Childhood Anaphylaxis in Singapore: 2015-2022. Clin Exp Allergy 2024. [PMID: 38923779 DOI: 10.1111/cea.14528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND There has been limited data regarding the incidence of anaphylaxis in Asia. We aim to describe patterns in patient characteristics, triggers and clinical presentation of childhood anaphylaxis in Singapore. METHODS This was a retrospective review of emergency electronic medical records of children with anaphylaxis. Patients with the allergy-related diagnoses of anaphylaxis, angioedema, allergy and urticaria based on ICD-9 codes were screened. Cases fulfilling the World Allergy Organization criteria for anaphylaxis were included. RESULTS A total of 1188 cases of anaphylaxis were identified with a median age of 6.3 years. Extrapolating data from the study sites, from 2015 to 2022, the incidence rate of childhood anaphylaxis emergency visits in Singapore doubled from 18.9 to 38.8 per 100,000 person-years, with an incidence rate ratio (IRR) of 2.06 (95% confidence interval [CI] 1.70-2.49). In 2022, the incidence rate of food anaphylaxis was 30.1 per 100,000 person-years, IRR 2.39 (95% CI 1.90-3.01) and drug anaphylaxis was 4.6 per 100,000 person-years, IRR 1.89 (95% CI 1.11-3.25). The incidence rate in children aged 0-4 years quadrupled during the study period. Common triggers were egg (10.4%), peanut (9.3%), tree nut (8.8%), milk (8%), shellfish (7.8%) and non-steroidal anti-inflammatory drug (4.4%). The majority (88.6%) of patients were treated with intramuscular adrenaline. Total number of allergy-related visits did not increase over time between 2015 and 2019. Rates of severe anaphylaxis, namely anaphylactic shock and admission to high-dependency and intensive care, did not increase over time, with a mean incidence of 1.6, IRR 0.85 (95% CI 0.40-1.83) and 0.7, IRR 1.77 (95% CI 0.54-5.76) per 100,000 person-years, respectively. CONCLUSION While the number of emergency visits due to childhood anaphylaxis has increased, the number of cases of allergy-related visits, anaphylactic shock and anaphylaxis requiring high-dependency and intensive care did not rise.
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Affiliation(s)
- Si Hui Goh
- Allergy Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Gaik Chin Yap
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hsin Yue Cheng
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Chin Chiang
- Allergy Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jian Yi Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Kok Wee Chong
- Allergy Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Anne Goh
- Allergy Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Arif Tyebally
- Department of Emergency Medicine, KK Woman's and Children's Hospital, Singapore, Singapore
| | - Sashikumar Ganapathy
- Department of Emergency Medicine, KK Woman's and Children's Hospital, Singapore, Singapore
| | - Irwani Ibrahim
- Emergency Medicine Department, National University Hospital and Department of Surgery, National University Health Systems, Singapore, Singapore
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Han N, Oh OH, Oh J, Kim Y, Lee Y, Cha WC, Yu YM. The Application of Knowledge-Based Clinical Decision Support Systems to Detect Antibiotic Allergy. Antibiotics (Basel) 2024; 13:244. [PMID: 38534679 DOI: 10.3390/antibiotics13030244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
Prevention of drug allergies is important for patient safety. The objective of this study was to evaluate the outcomes of antibiotic allergy-checking clinical decision support system (CDSS), K-CDSTM. A retrospective chart review study was performed in 29 hospitals and antibiotic allergy alerts data were collected from May to August 2022. A total of 15,535 allergy alert cases from 1586 patients were reviewed. The most frequently prescribed antibiotics were cephalosporins (48.5%), and there were more alerts of potential cross-reactivity between beta-lactam antibiotics than between antibiotics with the same ingredients or of the same class. Regarding allergy symptoms, dermatological disorders were the most common (38.8%), followed by gastrointestinal disorders (28.4%). The 714 cases (4.5%) of immune system disorders included 222 cases of anaphylaxis and 61 cases of severe cutaneous adverse reactions. Alerts for severe symptoms were reported in 6.4% of all cases. This study confirmed that K-CDS can effectively detect antibiotic allergies and prevent the prescription of potentially allergy-causing antibiotics among patients with a history of antibiotic allergies. If K-CDS is expanded to medical institutions nationwide in the future, it can prevent an increase in allergy recurrence related to drug prescriptions through cloud-based allergy detection CDSSs.
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Affiliation(s)
- Nayoung Han
- Jeju Research Institute of Pharmaceutical Sciences, College of Pharmacy, Jeju National University, Jeju 63243, Republic of Korea
| | - Ock Hee Oh
- FirstDIS Ltd., Seoul 07343, Republic of Korea
| | - John Oh
- Kakao Healthcare Corp., Seongnam 13529, Republic of Korea
| | - Yoomi Kim
- Korea Health Information Service, Seoul 04512, Republic of Korea
| | - Younghee Lee
- Department of Pharmacy, Ajou University Hospital, Suwon 16499, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Yun Mi Yu
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon 21983, Republic of Korea
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Jeong HS, Chun BC. COVID-19 vaccine safety: Background incidence rates of anaphylaxis, myocarditis, pericarditis, Guillain-Barré Syndrome, and mortality in South Korea using a nationwide population-based cohort study. PLoS One 2024; 19:e0297902. [PMID: 38381729 PMCID: PMC10881009 DOI: 10.1371/journal.pone.0297902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND To properly assess an association between vaccines and specific adverse events requires a comparison between the observed and background rates; however, studies in South Korea are currently limited. Therefore, in this study, we estimated the background incidence of anaphylaxis, myocarditis, pericarditis, Guillain-Barré syndrome (GBS), and mortality in South Korea. METHODS A retrospective cohort study was conducted using the National Sample Cohort (NSC) data. Using NSC, the background incidence rate was estimated by dividing the number of episodes during 2009-2019 by the total population by year and then multiplying by 100,000. Using Statistics Korea data, the background mortality rate was estimated by dividing the number of deaths, during 2009-2019 by the standard population for that year and then multiplying by 100,000. Using background mortality rates, we predicted mortality rates for 2021 using autoregressive integrated moving average models. Further, the expected mortality rates were compared with observed mortality rates. RESULTS The age-adjusted incidence rate (AIR) of anaphylaxis increased from 4.28 to 22.90 cases per 100,000 population (p = 0.003); myocarditis showed no significant increase, changing from 0.56 to 1.26 cases per 100,000 population (p = 0.276); pericarditis increased from 0.94 to 1.88 cases per 100,000 population (p = 0.005); and GBS increased from 0.78 to 1.21 cases per 100,000 population (p = 0.013). The age-adjusted mortality rate decreased from 645.24 to 475.70 deaths per 100,000 population (p <0.001). The 2021 observed/expected mortality rates for overall (ratio: 1.08, 95% confidence interval [CI]: 1.07-1.08), men (ratio: 1.07, 95% CI: 1.07-1.08), and women (ratio: 1.08, 95% CI: 1.07-1.09), were all significantly higher. When stratified by age group, those aged ≥80 (ratio: 1.16, 95% CI: 1.15-1.17), 60-69 (ratio: 1.11, 95% CI: 1.10-1.13), and 20-29 years old (ratio: 1.07, 95% CI: 1.02-1.13) were also significantly higher. CONCLUSION Through the estimation of background rates related to anaphylaxis, myocarditis, pericarditis, GBS, and mortality, we established a reference point for evaluating the potential excess occurrence of adverse events following COVID-19 vaccination. This reference point serves as substantive evidence supporting the safety profile of COVID-19 vaccines.
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Affiliation(s)
- Hye Su Jeong
- Drug Safety Monitoring Center, National Medical Center, Seoul, South Korea
- Department of Public Health, Korea University Graduate School, Seoul, South Korea
| | - Byung Chul Chun
- Department of Public Health, Korea University Graduate School, Seoul, South Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
- Department of Epidemiology and Health Informatics Graduate School of Public Health, Korea University, Seoul, South Korea
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Pühringer V, Jilma B, Herkner H. Population-based incidence of all-cause anaphylaxis and its development over time: a systematic review and meta-analysis. FRONTIERS IN ALLERGY 2023; 4:1249280. [PMID: 38148907 PMCID: PMC10749935 DOI: 10.3389/falgy.2023.1249280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction It is extremely difficult to compare studies investigating the frequency of anaphylaxis making it challenging to satisfactorily assess the worldwide incidence rate. Using a systematic review and meta-analysis, this publication aims to determine the current incidence of all-cause anaphylaxis worldwide. Additionally, we investigated whether the incidence of anaphylaxis has changed over time and which factors influence the rates determined by individual studies. Methods A literature search was performed in four databases. All articles that reported relevant information on population-based incidence rates of all-cause anaphylaxis were included. The protocol was published on INPLASY, the International Platform of Registered Systematic Review and Meta-analysis Protocols. Results The database query and screening process resulted in 46 eligible articles on anaphylaxis. The current incidence worldwide was found to be approximately 46 cases per 100,000 population per year (95% CI 21-103). Evaluating confounding factors showed that studies using allergy clinics and hospitalizations as data source result in comparably low rates. Moreover, children are less prone to develop anaphylaxis compared to the general population. Using a random effects Poisson model we calculated a yearly increase of anaphylaxis incidence by 7.4% (95% CI 7.3-7.6, p < 0.05). Discussion This seems to be the first approach to analyze every reported all-cause anaphylaxis incidence rate until 2017 for an at most accurate determination of its epidemiology. Based on these results, future research could investigate the underlying causes for the rising incidence in order find ways to decrease the condition's frequency. Systematic Review Registration inplasy.com, identifier [INPLASY202330047].
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Affiliation(s)
- Vanessa Pühringer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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Chang C, Liao SC, Shao SC. Positive Predictive Values of Anaphylaxis Diagnosis in Claims Data: A Multi-Institutional Study in Taiwan. J Med Syst 2023; 47:97. [PMID: 37695529 DOI: 10.1007/s10916-023-01989-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023]
Abstract
Real-world data sources can facilitate essential understanding of the epidemiological features of anaphylaxis. However, the accuracy of case-identifying definitions based on diagnosis codes for anaphylaxis in healthcare databases remains understudied. We conducted a cross-sectional study analyzing claims data from the largest multi-institutional healthcare system in Taiwan during 2017-2021. We included patients with incident anaphylaxis identified by either ICD-10-CM codes for anaphylaxis (Group 1) or ICD-10-CM codes for severe allergic or drug adverse events and additional modifier codes for acute allergy events (Group 2). We randomly selected 20% of the cases to determine the positive predictive value (PPV) of anaphylaxis case-identifying definitions in Groups 1 and 2 after review of electronic medical records by two physicians. From the original cohort (n = 2,176), we randomly selected 433 patients with either a diagnosis of anaphylaxis (Group 1), or a diagnosis of severe allergic and drug adverse events with additional modifier codes for acute allergy events (Group 2). In Group 1, we judged 135 / 170 patients as true anaphylaxis cases, giving a PPV of 79.4% (95% CI: 73.3-85.5). In Group 2, we judged 47 / 263 patients as true anaphylaxis cases, giving a PPV of 17.9% (95% CI: 13.3-22.5). In conclusion, acceptable PPVs were observed when anaphylaxis cases were identified by ICD-10-CM codes for anaphylaxis, but not by ICD-10-CM codes for severe allergic or drug adverse event with additional modifier codes for acute allergy events. Our multi-institutional findings could serve as a fundamental reference for further studies of anaphylaxis based on real-world healthcare databases.
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Affiliation(s)
- Chun Chang
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, 222 Maijin Rd, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Chen Liao
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, 222 Maijin Rd, Keelung, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, 222 Maijin Rd, Keelung, Taiwan.
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Stiles SL, Sanfilippo FM, Loh R, Said M, Clifford RM, Salter SM. Contemporary trends in anaphylaxis burden and healthcare utilisation in Western Australia: A linked data study. World Allergy Organ J 2023; 16:100818. [PMID: 37780579 PMCID: PMC10534263 DOI: 10.1016/j.waojou.2023.100818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
Background Anaphylaxis is a growing public health problem in Australia. To determine the extent of the problem, we linked multiple health datasets to examine temporal trends in anaphylaxis events across the health system in Western Australia (WA). Methods We identified an anaphylaxis cohort from 1980 to 2020 using linked datasets from ambulance, emergency departments, hospital inpatients and deaths. Age-standardised anaphylaxis event rates were calculated from 2010 to 2020. Dataset-specific rates for anaphylaxis were also examined, to show differences in health care utilisation. Annual percent change in rates (2010-2019) were estimated using age-adjusted Poisson regression models. Results A total of 19 140 individuals (mean age 31 years; 51% female) experienced 24 239 anaphylaxis events between 2010 and 2020. From 2010 to 2019, the average annual percent increase (95% CI) in rates was 5.3% (4.8-5.8%), from 70.3 to 113.9, with rates reducing to 76.5/100 000 population in 2020. Adolescents and young adults aged 5-14 years and 15-24 years had the greatest increase of 6.9% (5.6-8.1%) and 6.8% (5.6-8.0) respectively, with those over 25 years increasing by approximately 5% per year and children 1-4 years showing the lowest annual increase of 2.6% (1.1-4.2%). The highest absolute rates were seen in under 1 year (269.7/100 000; 2019). There has been an acceleration of trends from 2015 to 2019, underpinned by large increases in 15-24 and 25-34 years. All databases, show similar increasing trends, with ambulance attendance (33.7 per 100 000), emergency presentation (89.8 per 100 000) and hospital admissions (46.2 per 100 000), for anaphylaxis highest in 2019. However, whilst ambulance and emergency presentations have grown by 8.9% (95%CI 7.9-9.8%) and 6.6% per year (95%CI 6.0-7.2%), respectively, hospitalisations appear to be steadying with only a 0.9% (95%CI 0.2-1.6%) yearly rise. Conclusion Rates of anaphylaxis continue to increase, with WA having higher rates than previous estimates for Australia. Whilst rates are still high in infants, lower trends in children compared to older ages may indicate better prevention of allergy. Results show more people experiencing anaphylaxis now receive care in emergency and ambulance, rather than hospital. Further exploration of the patient care journey through prehospital and inpatient care is required, to understand the changing health demands of people who experience anaphylaxis.
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Affiliation(s)
- Samantha L. Stiles
- School of Allied Health, The University of Western Australia, Perth, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Frank M. Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Richard Loh
- Medical School, The University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
- Australasian Society of Clinical Immunology and Allergy (ASCIA), Sydney, Australia
| | - Maria Said
- School of Allied Health, The University of Western Australia, Perth, Australia
- Allergy & Anaphylaxis Australia, Sydney, Australia
- National Allergy Strategy, Sydney, Australia
- Australasian Society of Clinical Immunology and Allergy (ASCIA), Sydney, Australia
| | - Rhonda M. Clifford
- School of Allied Health, The University of Western Australia, Perth, Australia
| | - Sandra M. Salter
- School of Allied Health, The University of Western Australia, Perth, Australia
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Al Ali A, Gabrielli S, Delli Colli L, Delli Colli M, McCusker C, Clarke AE, Morris J, Gravel J, Lim R, Chan ES, Goldman RD, O'Keefe A, Gerdts J, Chu DK, Upton J, Hochstadter E, Moisan J, Bretholz A, Zhang X, Protudjer JL, Abrams EM, Simons E, Ben-Shoshan M. Temporal trends in anaphylaxis ED visits over the last decade and the effect of COVID-19 pandemic on these trends. Expert Rev Clin Immunol 2023; 19:341-348. [PMID: 36620923 DOI: 10.1080/1744666x.2023.2166934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Anaphylaxis is an acute systemic and potentially fatal allergic reaction. We evaluated trends in yearly rates of anaphylaxis in a pediatric Emergency Department (ED) in Montreal, Canada. METHODS A prospective and retrospective recruitment process was used to find families of children who had presented with anaphylaxis at the Montreal Children's Hospital between April 2011 and April 2021. Using a uniform recruitment form, data were collected. Anaphylaxis patterns were compared to clinical triggers using descriptive analysis. RESULTS Among 830,382 ED visits during the study period, 2726 (26% recruited prospectively) presented with anaphylaxis. The median age was 6 years (IQR: 0.2, 12.00), and 58.7% were males. The relative frequency of anaphylaxis cases doubled between 2011-2015, from 0.22% (95% CI, 0.19, 0.26) to 0.42 March 2020, the total absolute number of anaphylaxis cases and relative frequency declined by 24 cases per month (p < 0.05) and by 0.5% of ED visits (p < 0.05). CONCLUSIONS The rate of anaphylaxis has changed over the years, representing modifications in food introduction strategies or lifestyle changes. The decrease in the frequency of anaphylaxis presenting to the ED during the COVID pandemic may reflect decreased accidental exposures with reduced social gatherings, closed school, and reluctance to present to ED.
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Affiliation(s)
- Adnan Al Ali
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Luca Delli Colli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Marina Delli Colli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Rodrick Lim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, Ontario, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ran D Goldman
- Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Jennifer Gerdts
- Executive Director, Food Allergy Canada, Toronto, Ontario, Canada
| | - Derek K Chu
- Division of Clinical Immunology & Allergy, Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jocelyn Moisan
- Department of Emergency Medicine, Regional Medical Director of Emergency Medical Services of Outaouais, Outaouais, Quebec, Canada
| | - Adam Bretholz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Jennifer Lp Protudjer
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
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Ahn KM, Kim BK, Yang MS. Risk factors of anaphylaxis in Korea: Identifying drug-induced anaphylaxis culprits using big data. Medicine (Baltimore) 2022; 101:e30224. [PMID: 36107532 PMCID: PMC9439811 DOI: 10.1097/md.0000000000030224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Drug-induced anaphylaxis is a fatal medical condition whose incidence has been increasing continuously. Due to differences between genetic backgrounds and health care systems, different populations may be prone to various causative drugs. Using the Health Insurance Service and Assessment Service database, we investigated culprit drugs for drug-induced anaphylaxis and common medication risk factors in the Korean general population. We collected medical prescription histories within 3 days prior to anaphylaxis between January 2011 and December 2019 from the HIRA database. Designed as a case-crossover study, the attributable visits (case visits) were matched to medical visits (control visits) with the drug sets for each visit. We collected a list of medication risk factors for anaphylaxis and calculated the risk ratio of each agent using the chi-square test and conditional logistic regression analysis. A total of 159,473 individuals were listed in the database with a diagnosis of anaphylaxis in the HIRA from 2011 to 2019. After evaluating the suitability of control visits for matching with a case visit, 8168 subjects and 767 drugs were analyzed. The chi-square analysis identified 31 drugs as potential risk factors for drug-induced anaphylaxis in Korea. After applying a conditional logistic regression analysis for each agent, 5 drugs were found to be the common medication risk factors for drug-induced anaphylaxis: cefaclor, iopromide, iohexol, iomeprol, and tolperisone. We found 5 medication risk factors that showed the highest risk of drug-induced anaphylaxis and their degree of risk using an objective methodology in the Korean general population.
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Affiliation(s)
- Kyung-Min Ahn
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Byung-Keun Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Min-Suk Yang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
- *Correspondence: Min-Suk Yang, Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (e-mail: )
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Drewett GP, Encena J, Gregory J, Franklin L, Trubiano JA. Anaphylaxis in Victoria: presentations to emergency departments, with a focus on drug‐ and antimicrobial‐related cases. Med J Aust 2022; 216:520-524. [DOI: 10.5694/mja2.51459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022]
Affiliation(s)
- George P Drewett
- Austin Health Melbourne VIC
- Victorian Department of Health Melbourne VIC
| | - Jess Encena
- Victorian Department of Health Melbourne VIC
| | - Joy Gregory
- Victorian Department of Health Melbourne VIC
| | | | - Jason A Trubiano
- Austin Health Melbourne VIC
- Peter MacCallum Cancer Institute Melbourne VIC
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10
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Lee MH, Roh EJ, Jung YM, Ahn Y, Chung EH. Characteristics of anaphylaxis patients who visited emergency departments in Korea: Results from a national emergency department information system. PLoS One 2022; 17:e0266712. [PMID: 35486614 PMCID: PMC9053810 DOI: 10.1371/journal.pone.0266712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Anaphylaxis is an allergic disease with fatal respiratory or cardiovascular symptoms that require immediate emergency treatment. We aimed to understand the characteristics and frequency of emergency department (ED) visits of patients with anaphylaxis in Korea. Methods Between 2007 and 2013, using data from 147 ED from the National Emergency Department Information System in Korea, we retrospectively evaluated patients with a primary diagnosis of anaphylaxis. Results During the study, a total 23,313 patients visited the ED due to anaphylaxis. The number of patients with anaphylaxis who visited the ED increased from 3.0 per 100,000 population in 2007 to 11.6 per 100,000 population in 2013 (P<0.001). Overall, the frequency of anaphylaxis emergency department visits increased by 1.24 times each year (95% CI 1.23–1.25). The risk of visiting ED due to anaphylaxis by population-based age-specific group was highest in the 60–69 years old (OR 2.30, 95% CI 1.96–2.70). Deaths from anaphylaxis increased by 1.35 times per year (95% CI 1.13–1.62). The causes of anaphylaxis were unknown (80.8%; 95% CI 80.35–81.38), drugs (8.9%; 95% CI 8.47–9.24), food (4.1%; 95% CI 3.87–4.39), bees (3.2%; 95% CI 3.02–3.48) and arthropods (2.3%; 95% CI 2.11–2.48). In 2009, drugs were the most common cause of anaphylaxis in November (35.5%), followed by food in May (15.5%) (P<0.001). Between July and September, stings from insects were the most common causes (P<0.001). By age, food was the most common cause in children aged <6 years (7.6%, <12 months; 9.0%, 1–6 years) and drugs in those aged ≥7 years. The 7-year overall mortality rate was 0.104 case per 1,000,000 population; men accounted for 77.8% of the deaths. By region, the number of cases was the highest in metropolitan areas, Gyeonggi and Seoul; however, the number of anaphylaxis cases per 100,000 population was the highest in Jeju and Gangwon. Conclusion Based on ICD-10 codes, the number of ED visits due to anaphylaxis is increasing in Korea, and the incidence of anaphylaxis varies by region, season, and age.
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Affiliation(s)
- Mi-Hee Lee
- Department of Pediatrics, Incheon Medical Center, Incheon, Republic of Korea
| | - Eui-Jeong Roh
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Yu-Mi Jung
- Medical Record Team, National Medical Center, Seoul, Republic of Korea
| | - Youngmin Ahn
- Department of Pediatrics, Eulji General Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- * E-mail:
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11
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Epidemiology of Anaphylaxis Induced by Food: Incidence, Trends, Natural History, and Bias. CURRENT TREATMENT OPTIONS IN ALLERGY 2022. [DOI: 10.1007/s40521-022-00305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Park JS, Kim JK, Kwon JW. Anaphylaxis-related interventional demand and the response status of pediatric and youth educational institutions in Gangwon-do Province, South Korea: A school nurse and childcare teacher survey. ALLERGY ASTHMA & RESPIRATORY DISEASE 2022. [DOI: 10.4168/aard.2022.10.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jin-Sung Park
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ja Kyoung Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jae-Woo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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13
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Xing Y, Wong GWK. Environmental Influences and Allergic Diseases in the Asia-Pacific Region: What Will Happen in Next 30 Years? ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:21-39. [PMID: 34983105 PMCID: PMC8724831 DOI: 10.4168/aair.2022.14.1.21] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/14/2021] [Indexed: 12/22/2022]
Abstract
Asia-Pacific is a populous region with remarkable variations in socioeconomic development and environmental exposure among countries. The prevalence rates of asthma and allergic rhinitis appear to have recently reached a plateau in Western countries, whereas they are still increasing in many Asian countries. Given the large population in Asia, even a slight increase in the prevalence rate will translate into an overwhelming number of patients. To reduce the magnitude of the increase in allergic diseases in next few decades in Asia, we must understand the potential factors leading to the occurrence of these disorders and the development of potential preventive strategies. The etiology of allergic disorders is likely due to complex interactions among genetic, epigenetic, and environmental factors for the manifestations of inappropriate immune responses. As urbanization and industrialization inevitably progress in Asia, there is an urgent need to curtail the upcoming waves of the allergy epidemic. Potentially modifiable risk exposure, such as air pollution, should be minimized through timely implementation of effective legislations. Meanwhile, re-introduction of protective factors that were once part of the traditional farming lifestyle might give new insight into primary prevention of allergy.
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Affiliation(s)
- Yuhan Xing
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Gary Wing-Kin Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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14
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Lee H, Kwon JW, Jeong YW, Lee C, Lee J. Pilot Project of Special Emergency Medical Service Team for Anaphylaxis in Gangwon-do, Korea: Results from an Online Questionnaire Survey. J Korean Med Sci 2021; 36:e258. [PMID: 34725975 PMCID: PMC8560315 DOI: 10.3346/jkms.2021.36.e258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/30/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Early recognition and prompt intramuscular epinephrine administration are critical for the treatment of anaphylaxis. The special emergency medical service team (SEMST) is a reorganization plan that incorporates first-level emergency medical technicians (EMTs) and nurses from Korea to give the authority to administer epinephrine. This study evaluates the experience of SEMST and aims to investigate further needs in the pre-hospital management of anaphylaxis. METHODS An online survey of 29 questions on the Gangwon-do 119 EMST was conducted. IBM SPSS Statistics ver. 20.0 (IBM Co., Armonk, NY, USA) and R ver.4.0.3. were used for statistical analysis. RESULTS A total of 428 (44.6%) participants responded to the questionnaire, and 55.6% (238/428) experienced anaphylaxis. The common presumed cause was insect sting/animal bites at 84.5% (201/238), followed by food (7.6%, 18/238), and drugs (6.3%, 15/238). The frequency of occurrence was highest for tourist attractions (58.6%, 167/285), followed by homes (31.9%, 91/285) and workplace (3.5%, 10/285). Among 136 medical personnel (31.8%) who were currently active or had been active as the SEMST, 95 (70.0%) experienced anaphylaxis, and 58 (61.1%) used epinephrine, which was significantly lower in the non-SEMST group (n = 36, 25.2%). The biggest difficulty in pre-hospital treatment was the limitation of drug administration authority (23.4%, 22/95). The lack of experience and tricky treatment are the chief difficulties in pediatric anaphylaxis. The percentage of correct answers regarding anaphylaxis awareness was significantly higher in the educated (n = 374) than in the non-educated group (n = 54), both for diagnosis (24.9% vs. 11.1%) and treatment (73.5% vs. 37.0%). CONCLUSION Proper administration of epinephrine is particularly important for pre-hospital anaphylaxis management in rural areas. Expanding SEMST and conducting periodic education using virtual experiences is necessary.
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Affiliation(s)
- Hyeonseung Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae-Woo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yong Whi Jeong
- Department of Information and Statistics, Yonsei University, Wonju, Korea
| | - Changhoon Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jeongmin Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea.
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15
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Quoc QL, Bich TCT, Jang JH, Park HS. Recent update on the management of anaphylaxis. Clin Exp Emerg Med 2021; 8:160-172. [PMID: 34649404 PMCID: PMC8517462 DOI: 10.15441/ceem.21.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
Anaphylaxis is a life-threatening systemic allergic reaction presenting various clinical manifestations. Its prevalence has increased in almost all age groups and both sexes. Food, venom, and drugs are major causes in both children and adults; a higher prevalence of food-induced anaphylaxis is noted in children, while a higher prevalence of drug-induced anaphylaxis is noted in adults. The pathogenic mechanism is mediated by immunologic and nonimmunologic mechanisms, where mast cells and basophils are key cells that release mediators. A diagnosis of anaphylaxis is mainly based on clinical symptoms and physical findings; however, an increased serum tryptase level is a useful biomarker. Epinephrine is the first-line drug to treat acute symptoms, and an epinephrine auto-injector should be prescribed for each patient. Antihistamines and systemic corticosteroids are used to relieve symptoms. This review updates current issues in the management of anaphylaxis as well as the new guidelines for proper diagnosis and treatment.
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Affiliation(s)
- Quang Luu Quoc
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Tra Cao Thi Bich
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hyuk Jang
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
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16
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Risk factors of beta-lactam anaphylaxis in Korea: A 6-year multicenter retrospective adult case-control study. World Allergy Organ J 2021; 14:100580. [PMID: 34567348 PMCID: PMC8433252 DOI: 10.1016/j.waojou.2021.100580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/06/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background Beta-lactams (BLs) are commonly used antibiotics and leading causative agents of drug-induced anaphylaxis. Few studies on the culprit drugs and risk factors of BL-induced anaphylaxis are available. Our goal was to evaluate the culprit drugs and compare the risk factors in patients with BL-induced anaphylaxis to matched tolerant controls in a hospital setting. Methods We retrospectively enrolled all patients who developed anaphylaxis from intravenous BL during hospitalization from 9 Korean hospitals. We compared clinical parameters between patients with BL-induced anaphylaxis and 4-fold BL-tolerant controls matched by age, sex, BL use, and the purpose of BL administration. Results Seventy-four cases of BL-induced anaphylaxis and 296 BL-tolerant controls were enrolled. Cephalosporin accounted for 77% of total BL-induced anaphylaxis, and the top derivatives were ceftriaxone (23.0%), cefazedone (10.8%), and cefbuperazone (9.5%). Among penicillin derivatives, piperacillin (16.2%) was the most common, followed by ampicillin (2.7%). History of drug allergy (odds ratio [OR], 19.91; 95% confidence interval [CI] 5.33–74.44), previous exposure to the causative BL (OR, 7.71; 95% CI, 1.62–36.76), and concurrent administration of angiotensin-converting enzyme inhibitors (ACEIs) (OR, 5.97; 95% CI, 1.28–27.91) were independent risk factors associated with BL-induced anaphylaxis. Food allergy (OR, 13.93; 95% CI 1.31–148.9) and previous exposure to BL (OR, 6.59; 95% CI, 1.30–33.31) were identified as risk factors for cephalosporin-induced anaphylaxis. Conclusions To prevent BL-induced anaphylaxis, attention should be paid to histories of drug or food allergy, previous exposure to BLs, and ACEI use. The risk factors and clinical outcomes might vary according to the BL classes.
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17
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Huh K, Kim YE, Radnaabaatar M, Lee DH, Kim DW, Shin SA, Jung J. Estimating Baseline Incidence of Conditions Potentially Associated with Vaccine Adverse Events: a Call for Surveillance System Using the Korean National Health Insurance Claims Data. J Korean Med Sci 2021; 36:e67. [PMID: 33686812 PMCID: PMC7940120 DOI: 10.3346/jkms.2021.36.e67] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Vaccines against coronavirus disease 2019 (COVID-19) are raising concerns about vaccine safety, particularly in the context of large-scale immunization. To address public concerns, we measured the baseline incidence rates of major conditions potentially related to vaccine-related adverse events (VAEs). We aimed to provide a basis for evaluating VAEs and verifying causality. METHODS Conditions of interest were selected from the US Vaccine Adverse Event Reporting System Table of Reportable Events and a recent report from a European consortium on vaccine surveillance. We used the National Health Insurance Service database in Korea to identify the monthly numbers of cases with these conditions. Data from January 2006 to June 2020 were included. Prediction models were constructed from the observed incidences using an autoregressive integrated moving average. We predicted the incidences of the conditions and their respective 95% confidence intervals (CIs) for January through December 2021. In addition, subgroup analysis for the expected vaccination population was conducted. RESULTS Mean values (95% CIs) of the predicted monthly incidence of vasovagal syncope, anaphylaxis, brachial neuritis, acute disseminated encephalomyelitis, Bell's palsy, Guillain-Barré syndrome, encephalopathy, optic neuritis, transverse myelitis, immune thrombocytopenic purpura, and systemic lupus erythematosus in 2021 were 23.89 (19.81-27.98), 4.72 (3.83-5.61), 57.62 (51.37-63.88), 0.03 (0.01-0.04), 8.58 (7.90-9.26), 0.26 (0.18-0.34), 2.13 (1.42-2.83), 1.65 (1.17-2.13), 0.19 (0.14-0.25), 0.75 (0.61-0.90), and 3.40 (2.79-4.01) cases per 100,000 respectively. The majority of the conditions showed an increasing trend with seasonal variations in their incidences. CONCLUSION We measured the incidence of a total of 11 conditions that could potentially be associated with VAEs to predict the monthly incidence in 2021. In Korea, conditions that could potentially be related to VAEs occur on a regular basis, and an increasing trend is observed with seasonality.
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Affiliation(s)
- Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Eun Kim
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea
| | - Munkhzul Radnaabaatar
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Dae Ho Lee
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Dong Wook Kim
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea
| | - Soon Ae Shin
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea.
| | - Jaehun Jung
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea.
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18
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Black SB, Law B, Chen RT, Dekker CL, Sturkenboom M, Huang WT, Gurwith M, Poland G. The critical role of background rates of possible adverse events in the assessment of COVID-19 vaccine safety. Vaccine 2021; 39:2712-2718. [PMID: 33846042 PMCID: PMC7936550 DOI: 10.1016/j.vaccine.2021.03.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
Beginning in December of 2019, a novel coronavirus, SARS-CoV-2, emerged in China and is now a global pandemic with extensive morbidity and mortality. With the emergence of this threat, an unprecedented effort to develop vaccines against this virus began. As vaccines are now being introduced globally, we face the prospect of millions of people being vaccinated with multiple types of vaccines many of which use new vaccine platforms. Since medical events happen without vaccines, it will be important to know at what rate events occur in the background so that when adverse events are identified one has a frame of reference with which to compare the rates of these events so as to make an initial assessment as to whether there is a potential safety concern or not. Background rates vary over time, by geography, by sex, socioeconomic status and by age group. Here we describe two key steps for post-introduction safety evaluation of COVID-19 vaccines: Defining a dynamic list of Adverse Events of Special Interest (AESI) and establishing background rates for these AESI. We use multiple examples to illustrate use of rates and caveats for their use. In addition we discuss tools available from the Brighton Collaboration that facilitate case evaluation and understanding of AESI.
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Affiliation(s)
- Steven B Black
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA.
| | - Barbara Law
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | - Robert T Chen
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | - Cornelia L Dekker
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | | | - Wan-Ting Huang
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | - Marc Gurwith
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
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19
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Anaphylaxis: Five Years' Experience in the Emergency Rooms of Five University Hospitals in Korea. ACTA ACUST UNITED AC 2020; 56:medicina56120695. [PMID: 33327374 PMCID: PMC7764798 DOI: 10.3390/medicina56120695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 11/17/2022]
Abstract
Background: Anaphylaxis is an allergic disease that requires special handling due to its potential fatality. Recent epidemiological data indicate that the incidence of anaphylaxis is rising. However, actual data on the prevalence or causes of anaphylaxis in Korea are limited. Methods: The emergency room attendees diagnosed with anaphylaxis between 2011 and 2015 in five university hospitals were included. Medical records were reviewed retrospectively. Results: During the 5 years, a total of 505 subjects were diagnosed with anaphylaxis. Respiratory presentations were more common in children than in adults, while adults presented more frequently with cardiovascular symptoms. Intraoral angioedema was more often observed in the countryside than in the city. Insect stings/bites were more common in the countryside than in the city. Drugs were much more common in adults than in children. In the countryside, the frequency of anaphylaxis was higher in summer and autumn than in spring and winter. The use of corticosteroids was less common in children than in adults, while children more frequently got treatment with inhaled beta 2 agonist. Conclusions: The principal causes of anaphylaxis in Korean patients were food, drugs, and stings/bites. The cause, clinical features and management of anaphylaxis were significantly different depending on age and region. These real-world data on anaphylaxis could be helpful to deepen that understanding of this condition for physicians and patients.
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20
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The Challenge of Establishing the Burden of Anaphylaxis: Some Recent Trends. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00257-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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A multicenter anaphylaxis registry in Korea: Clinical characteristics and acute treatment details from infants to older adults. World Allergy Organ J 2020; 13:100449. [PMID: 32817782 PMCID: PMC7426446 DOI: 10.1016/j.waojou.2020.100449] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/11/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background Although the prevalence of anaphylaxis is increasing worldwide, the large-scale studies in Asia evaluating anaphylaxis in all age groups are limited. We aimed to collect more precise and standardized data on anaphylaxis in Korea using the first multicenter web-based registry. Methods Twenty-two departments from 16 hospitals participated from November 2016 to December 2018. A web-based case report form, designed by allergy specialists, was used to collect anaphylaxis data. Results Within the 2-year period, 558 anaphylaxis cases were registered. The age of registered patients ranged from 2 months to 84 years, and 60% were aged <18 years. In children and adolescents, foods (84.8%) were the most common cause of anaphylaxis, followed by drugs (7.2%); in adults, drugs (58.3%) were the most common cause, followed by foods (28.3%) and insect venom (8.1%). The onset time was ≤10 min in 37.6% of patients. Among the 351 cases registered via the emergency department (ED) of participating hospitals, epinephrine was administered to 63.8% of patients. Among those receiving epinephrine in the ED, 13.8% required 2 or more epinephrine shots. Severe anaphylaxis accounted for 23.5% cases (38.1% in adults; 13.7% in children); patients with drug and insect venom-induced anaphylaxis had higher rates of severe anaphylaxis. Conclusion This multicenter registry provides data on anaphylaxis for all age groups for the first time in Asia. The major causes and severity of anaphylaxis were remarkably different according to age group, and the acute treatment features of anaphylaxis in the EDs were examined in detail.
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22
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Tuttle R, Popescu L, Hill S, Slanczka A, Jankowski J, Barre K, Krueger E, Slade D, Croutch C, Robben M, Mesa Z, Mesa M, Dretchen KL. Intranasal epinephrine effects on epinephrine pharmacokinetics and heart rate in a nasal congestion canine model. Respir Res 2020; 21:78. [PMID: 32245384 PMCID: PMC7119008 DOI: 10.1186/s12931-020-01343-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Histamine release and vasodilation during an allergic reaction can alter the pharmacokinetics of drugs administered via the intranasal (IN) route. The current study evaluated the effects of histamine-induced nasal congestion on epinephrine pharmacokinetics and heart rate changes after IN epinephrine. METHODS Dogs received 5% histamine or saline IN followed by 4 mg epinephrine IN. Nasal restriction pressure, epinephrine concentration, and heart rate were assessed. Maximum concentration (Cmax), area under plasma concentration-time curve from 1 to 90 min (AUC1-90), and time to reach Cmax (Tmax) were measured. Clinical observations were documented. RESULTS In the 12 dogs in this study, nasal congestion occurred at 5-10 min after IN histamine administration versus no nasal congestion after IN saline. After administration of IN epinephrine, IN histamine-mediated nasal congestion was significantly reduced to baseline levels at 60, 80, and 100 min. There were no significant differences in Cmax and AUC1-90 between histamine and saline groups after IN epinephrine delivery (3.5 vs 1.7 ng/mL, p = 0.06, and 117 vs 59 ng/mL*minutes, p = 0.09, respectively). After receiving IN epinephrine, the histamine group had a significantly lower Tmax versus the saline group (6 vs 70 min, respectively; p = 0.02). Following IN epinephrine administration, the histamine group showed rapidly increased heart rate at 5 min, while there was a delayed increase in heart rate (occurring 30-60 min after administration) in the saline group. Clinical observations included salivation and emesis. CONCLUSION IN histamine led to more rapid epinephrine absorption and immediately increased heart rate compared with IN saline. IN epinephrine decreased histamine-induced nasal congestion.
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Affiliation(s)
- Richard Tuttle
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA.
| | - Luca Popescu
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA
| | - Scott Hill
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA
| | | | | | - Katherine Barre
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA
| | - Erika Krueger
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA
| | - Desmond Slade
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA
| | - Claire Croutch
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA
| | | | - Zack Mesa
- Mesa Science Associates, Inc, Frederick, MD, USA
| | - Michael Mesa
- Mesa Science Associates, Inc, Frederick, MD, USA
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23
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Tham EH, Leung ASY, Pacharn P, Lee S, Ebisawa M, Lee BW, Wong GWK. Anaphylaxis - Lessons learnt when East meets West. Pediatr Allergy Immunol 2019; 30:681-688. [PMID: 31220363 DOI: 10.1111/pai.13098] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/28/2019] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
The rapidly increasing prevalence of allergic disorders over the past 2 decades highlights the need to understand the epidemiology of anaphylaxis. In Europe, the United States, and Australia, the incidence of anaphylaxis is estimated to be between 60 and 950 cases per 100 000 population, with a lifetime prevalence of anaphylaxis of 0.05%-2%. The incidence appears to be increasing over time. Although the existing Asian literature is heterogeneous and limited by under-reporting, it also suggests a similar increasing trend in anaphylaxis incidence in Asia. Anaphylaxis triggers in Asia, such as the predominance of shellfish and wheat in older children and adolescents, differ from those seen in Western populations. Triggers unique to Asia such as traditional Chinese medications, galacto-oligosaccharides, and food delicacies have also been reported. Low usage of adrenaline as first-line treatment of anaphylaxis is evident across all countries and is particularly concerning. There is a need to establish prospective, standardized protocols for anaphylaxis data collection and reporting, to enhance the collective understanding of anaphylaxis and its burden, gaps in management and to identify areas for future research and intervention in each region. Understanding of the underlying reasons explaining the difference between East and West will facilitate future primary preventive strategies.
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Affiliation(s)
- Elizabeth H Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Agnes S Y Leung
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - Punchama Pacharn
- Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gary W K Wong
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Sha Tin, Hong Kong, China
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Wang Y, Allen KJ, Suaini NHA, McWilliam V, Peters RL, Koplin JJ. The global incidence and prevalence of anaphylaxis in children in the general population: A systematic review. Allergy 2019; 74:1063-1080. [PMID: 30688375 DOI: 10.1111/all.13732] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/15/2018] [Accepted: 01/20/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite an increasing number of publications from individual countries and regions, there is still no systematic review of the global epidemiology of anaphylaxis in the general paediatric population. METHODS We conducted a systematic review, using a protocol registered and published with the international prospective register of systematic reviews (PROSPERO). Results were reported following PRISMA guidelines. The search strategy was designed in Medline (ovid) and modified for Embase (ovid) and PubMed. Papers were screened by two independent reviewers following selection and exclusion criteria. Data extraction and risk of bias assessment were completed by the same two reviewers. Studies in adults only or those that did not report data in children separately were excluded. RESULTS A final total of 59 articles were included. Of these, 5 reported cumulative incidence, 39 reported incidence rate and 17 reported prevalence data. The incidence of anaphylaxis in children worldwide varied widely, ranging from 1 to 761 per 100 000 person-years for total anaphylaxis and 1 to 77 per 100 000 person-years for food-induced anaphylaxis. The definition of anaphylaxis from NIAID/FAAN was the most commonly used. Gender and ethnicity were demographic risk factors associated with anaphylaxis in children. Increasing total or food-induced anaphylaxis incidence over time was reported by 19 studies. CONCLUSION The reported incidence of anaphylaxis in children varied widely. Studies in developing countries are underrepresented. To accurately compare anaphylaxis incidence between countries and investigate the time trends, further studies using a standardized definition across different countries are required.
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Affiliation(s)
- Yichao Wang
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Katrina J. Allen
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
- The Department of Allergy and Immunology; Royal Children's Hospital; Melbourne Victoria Australia
| | - Noor H. A. Suaini
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Vicki McWilliam
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
- The Department of Allergy and Immunology; Royal Children's Hospital; Melbourne Victoria Australia
| | - Rachel L. Peters
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Jennifer J. Koplin
- Murdoch Children's Research Institute; Parkville Victoria Australia
- The School of Population and Global Health; University of Melbourne; Melbourne Victoria Australia
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25
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Cho H, Kwon JW. Prevalence of anaphylaxis and prescription rates of epinephrine auto-injectors in urban and rural areas of Korea. Korean J Intern Med 2019; 34:643-650. [PMID: 30360025 PMCID: PMC6506728 DOI: 10.3904/kjim.2018.094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/19/2018] [Accepted: 06/06/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/AIMS Despite the clinical importance anaphylaxis and the recent increase in its occurrence, studies regarding the epidemiology of anaphylaxis, risk factors for anaphylaxis, and epinephrine auto-injector (EAI) prescription status for patients with anaphylaxis remain poorly described. Thus, we investigated the prevalence of anaphylaxis and prescription rates of EAI in urban and rural areas in Korea. METHODS We used data from the 2010 to 2014 Health Insurance Review and Assessment database. Anaphylaxis was identified through physician-certified diagnoses using the International Classification of Diseases 10th (ICD-10) codes (T780, T782, T805, T886). Data on prescription rates of EAI were collected from the Korea Orphan & Essential Drug Center, the only pharmacy exclusively dealing with EAI in Korea. The prescription rates of EAI were defined as the number of EAI prescribed against the number of patients with anaphylaxis. RESULTS The prevalence of anaphylaxis over the 5-year period was 0.023%. The annual prevalence of anaphylaxis increased over the 5-year period. Anaphylaxis was more common in males than in females (54% vs. 46%) and in the population aged 50 to 59 years old. For regional analysis, urban areas showed a relatively lower prevalence of anaphylaxis (17.3 per 100,000 individuals) along with higher prescription rates (12.0%) of EAI for patients with anaphylaxis. In contrast, rural areas showed a relatively higher prevalence of anaphylaxis (28.8 per 100,000 individuals) along with lower prescription rates (3.1%) of EAI. CONCLUSION The prevalence of anaphylaxis has increased annually in Korea. There were regional differences in the prevalence of anaphylaxis and prescription rates of EAI between urban and rural areas in Korea.
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Affiliation(s)
- Hyunseok Cho
- Department of Pediatrics, Hwacheon Health Center and County Hospital, Hwacheon, Korea
| | - Jae-Woo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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Hung L, Obernolte H, Sewald K, Eiwegger T. Human ex vivo and in vitro disease models to study food allergy. Asia Pac Allergy 2019; 9:e4. [PMID: 30740352 PMCID: PMC6365658 DOI: 10.5415/apallergy.2019.9.e4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/11/2019] [Indexed: 12/25/2022] Open
Abstract
Food allergy is a growing global public health concern. As treatment strategies are currently limited to allergen avoidance and emergency interventions, there is an increasing demand for appropriate models of food allergy for the development of new therapeutics. Many models of food allergy rely heavily on the use of animals, and while useful, many are unable to accurately reflect the human system. In order to bridge the gap between in vivo animal models and clinical trials with human patients, human models of food allergy are of great importance. This review will summarize the commonly used human ex vivo and in vitro models of food allergy and highlight their advantages and limitations regarding how accurately they represent the human in vivo system. We will cover biopsy-based systems, precision cut organ slices, and coculture systems as well as organoids and organ-on-a-chip. The availability of appropriate experimental models will allow us to move forward in the field of food allergy research, to search for effective treatment options and to further explore the cause and progression of this disorder.
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Affiliation(s)
- Lisa Hung
- Department of Immunology, University of Toronto, Toronto, ON, Canada.,Translational Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Helena Obernolte
- Department of Preclinical Pharmacology and In-Vitro Toxicology, Fraunhofer ITEM, Hannover, Germany
| | - Katherina Sewald
- Department of Preclinical Pharmacology and In-Vitro Toxicology, Fraunhofer ITEM, Hannover, Germany
| | - Thomas Eiwegger
- Department of Immunology, University of Toronto, Toronto, ON, Canada.,Translational Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Clinical Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Hospital for Sick Children, Toronto, ON, Canada
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Seo B, Lee SH, Yang MS, Lee SH, Kim SH, Cho SH, Chang YS. 119 Rescue team's awareness of anaphylaxis and asthma exacerbation in Gyeonggi-do province of Korea: Before and after education. ALLERGY ASTHMA & RESPIRATORY DISEASE 2019. [DOI: 10.4168/aard.2019.7.4.199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Bomi Seo
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Gyeonggi-do Atopy·Asthma Education Information Center, Seongnam, Korea
| | - So-Hee Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seon Hwa Lee
- Gyeonggi-do Atopy·Asthma Education Information Center, Seongnam, Korea
| | - Sae-Hoon Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Gyeonggi-do Atopy·Asthma Education Information Center, Seongnam, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Gyeonggi-do Atopy·Asthma Education Information Center, Seongnam, Korea
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Yao TC, Wu AC, Huang YW, Wang JY, Tsai HJ. Increasing trends of anaphylaxis-related events: an analysis of anaphylaxis using nationwide data in Taiwan, 2001-2013. World Allergy Organ J 2018; 11:23. [PMID: 30349617 PMCID: PMC6178262 DOI: 10.1186/s40413-018-0202-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/07/2018] [Indexed: 11/21/2022] Open
Abstract
Background Anaphylaxis is a severe, potentially fatal, and systemic allergic reaction. Previous studies document increasing trends in incidence rates of anaphylaxis-related events in Western countries, yet little is known about the incidence and trend of anaphylaxis in Asia. In this study, we aimed to determine time trends in incidence rates of anaphylaxis-related events in Taiwan from 2001 through 2013. Methods We utilized medical claims data from the National Health Insurance Research Databases in Taiwan. We identified anaphylaxis-related events (ICD-9-CM-codes: 995.0, 995.60–995.69, 999.41–999.42, and 999.49) and calculated incidence rates. Poisson regression models were applied to examine trends and incidence rates. Results A total of 2496 patients (mean age, 45.11 years; 56% male) with first-time anaphylaxis were identified during 34,430,000 person-years of observation time. The overall incidence of anaphylaxis was 7.25 (95% confidence interval (CI) = 6.97–7.53) per 100,000 person-years, increasing from 4.79 in 2001 to 8.20 in 2013, with an incidence rate ratio (IRR) of 1.05 (95%CI = 1.04–1.06). Over the 13-year period, the increasing trends were found in incident diagnosis of anaphylaxis-related outpatient or emergency department visits (IRR = 1.06, 95%CI = 1.05–1.08) and admissions to intensive care units (IRR = 1.06, 95%CI = 1.03–1.10), whereas the trends in incidence of anaphylaxis-related hospitalizations remained steady. The proportion of patients requiring hospitalizations among all patients with anaphylaxis (p_trend = 0.01), as well as the proportion requiring intensive care treatment among patients who were hospitalized (p_trend = 0.01), both increased with age. Conclusion The incidence rate of anaphylaxis in Taiwan has increased at an average rate of 5% annually since 2001, paralleling the rising trends in several Western countries. Electronic supplementary material The online version of this article (10.1186/s40413-018-0202-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tsung-Chieh Yao
- 1Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,2Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,3Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ann Chen Wu
- 4PrecisiOn Medicine and Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA USA.,5Department of Pediatrics, Children's Hospital, Boston, MA USA
| | - Ya-Wen Huang
- 6Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli 350 Taiwan
| | - Jiu-Yao Wang
- 7Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,8Allergy and Clinical Immunology Research (ACIR) Centre, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Ju Tsai
- 6Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli 350 Taiwan
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Ring J, Klimek L, Worm M. Adrenaline in the Acute Treatment of Anaphylaxis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:528-534. [PMID: 30149833 PMCID: PMC6131363 DOI: 10.3238/arztebl.2018.0528] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anaphylaxis is the most serious manifestation of an immediate allergic reaction and the most common emergency event in allergology. Adrenaline (epi- nephrine) is the mainstay of acute pharmacotherapy for this complication. Although epinephrine has been in use for more than a century, physicians and patients are often unsure and inadequately informed about its proper administration and dosing in everyday situations. METHODS This review is based on pertinent publications from the period 1 January 2012 to 30 September 2017 that were retrieved, on the basis of the existing guide- lines of 2007 and 2014, by a PubMed search employing the keywords "anaphylaxis treatment," "allergic shock," "adrenaline," and "epinephrine," as well as on further ar- ticles from the literature. RESULTS Adrenaline/epinephrine administration often eliminates all manifestations of anaphylaxis. The method of choice for administering it (except in intensive-care medicine) is by intramuscular injection with an autoinjector; this is mainly done to treat reactions of intermediate severity. The injection is given in the lateral portion of the thigh and can be repeated every 10-15 minutes until there is a response. The dose to be administered is 300-600 µg for an adult or 10 µg/kg for a child. The risk of a serious cardiac adverse effect is lower than with intravenous administration. There have not been any randomized controlled trials on the clinical efficacy of ephi- nephrine in emergency situations. The use of an autoinjector should be specially practiced in advance. CONCLUSION The immediate treatment of patients with anaphylaxis is held to be ad- equate, yet major deficiencies remain in their further diagnostic evaluation, in the prescribing of emergency medications, and in patient education. Further research is needed on cardiovascular involvement in anaphylaxis and on potential new thera- peutic approaches.
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Affiliation(s)
- Johannes Ring
- Department of Dermatology and Allergology, Technical University Munich
| | | | - Margitta Worm
- Department of Dermatology, Venerology and Allergology, Charité—Universitätsmedizin Berlin
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Jeong K, Lee JD, Kang DR, Lee S. A population-based epidemiological study of anaphylaxis using national big data in Korea: trends in age-specific prevalence and epinephrine use in 2010-2014. Allergy Asthma Clin Immunol 2018; 14:31. [PMID: 29988631 PMCID: PMC6027562 DOI: 10.1186/s13223-018-0251-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/05/2018] [Indexed: 12/22/2022] Open
Abstract
Background Previous reports on anaphylaxis in Asia are limited to relatively small-scale studies. We performed this study to identify the nationwide prevalence of anaphylaxis and epinephrine prescription rates by age groups. Methods The total number of patients, yearly and overall prevalence, percentage of emergency department visits, and epinephrine prescription rates were calculated for patients diagnosed with anaphylaxis based on the Korean National Health Insurance database from 2010 to 2014. Results The mean prevalence of anaphylaxis in Korea was 26.23 (95% confidence interval, CI 25.78-26.68) per 100,000 person-years during the 5 years. It increased from 20.55 (95% CI 20.15-20.10) in 2010 to 35.33 (95% CI 34.81-35.85) per 100,000 person-years in 2014. The average prevalence was > 35 per 100,000 person-years among 50-69 year-olds, and the mean crude prevalence in children was 22.3 (0-2 years), 17.3 (3-6 years), 12.1 (7-12 years), and 14.9 (13-17 years) per 100,000 person-years, respectively. The overall prevalence increased 1.7-fold, with the highest rate of increase in 0-2 years of age. The overall percentage of emergent anaphylaxis patients was 88.4%, and the prevalence of emergent anaphylaxis increased from 18.63 (95% CI 18.25-19.01) to 31.28 (95% CI 30.79-31.77) per 100,000 person-years. In-hospital epinephrine prescription rate increased from 31.5 to 39.7%. Conclusions The mean prevalence of anaphylaxis in Korea was 26.2 per 100,000 person-years during the study period. The total number of anaphylaxis patients increased 1.7-fold from 2010 to 2014, with the most noticeable increment being in young children.
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Affiliation(s)
- Kyunguk Jeong
- 1Department of Pediatrics, Ajou University School of Medicine, Worldcup-ro 164, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Jung-Dong Lee
- 2Office of Biostatistics, Ajou University School of Medicine, Worldcup-ro 164, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Dae Ryong Kang
- 2Office of Biostatistics, Ajou University School of Medicine, Worldcup-ro 164, Yeongtong-gu, Suwon, 16499 Republic of Korea
| | - Sooyoung Lee
- 1Department of Pediatrics, Ajou University School of Medicine, Worldcup-ro 164, Yeongtong-gu, Suwon, 16499 Republic of Korea
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Wang Y, Koplin JJ, Ho MHK, Wong WHS, Allen KJ. Increasing hospital presentations for anaphylaxis in the pediatric population in Hong Kong. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1050-1052.e2. [DOI: 10.1016/j.jaip.2017.09.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 11/17/2022]
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Lee SY, Lee SC, Shin SD, Song KJ, Ro YS, Park JH, Kong SY. Epidemiology and outcomes of anaphylaxis-associated out-of-hospital cardiac arrest. PLoS One 2018; 13:e0194921. [PMID: 29579130 PMCID: PMC5868822 DOI: 10.1371/journal.pone.0194921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background Understanding the epidemiological characteristics of anaphylaxis-associated out-of-hospital cardiac arrest (OHCA) is the first step toward developing preventative strategies and optimizing care systems. We aimed to describe and compare epidemiological features and clinical outcomes among patients with anaphylaxis-associated OHCAs according to causative agent groups. Methods We identified emergency medical service (EMS)-treated anaphylaxis-associated OHCA patients from a nationwide OHCA registry between 2008 and 2015. We compared epidemiological characteristics and outcomes according to causal agents (a natural agents group and an iatrogenic agents group) and evaluated temporal variability in incidence. Multivariate logistic regression analysis was performed to compare survival to discharge between causative agent groups. Results During the study period (8 years), the total number of anaphylaxis-associated OHCAs was 233. A total of 224 eligible cases were included in the analysis. There were 192 patients (85.6%) in the natural agents group and 32 patients (14.3%) in the iatrogenic agents group. There was significant diurnal and seasonal variability in the frequency of anaphylaxis-associated OHCAs (p values<0.01 for both), with the highest incidences occurring during the day (7:01 am to 3 pm; 64.6%) and in summer (June to August, 48.7%). Compared with the natural agents group, the adjusted odds ratio (AOR) for survival to discharge in the iatrogenic agents group was statistically insignificant (AOR 3.61, 95% CI 0.86 to 15.06). Conclusion The incidence of anaphylaxis-associated OHCA is considerably low, and significant temporal variability, with a peak during the day and in summer, is evident. Anaphylaxis-associated OHCA is more common by natural agents than by iatrogenic agents, but no difference in the survival-to-discharge rate is evident.
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Affiliation(s)
- Sun Young Lee
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Seung Chul Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea
- * E-mail:
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - So Yeon Kong
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
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Kang SY, Song WJ, Cho SH, Chang YS. Time trends of the prevalence of allergic diseases in Korea: A systematic literature review. Asia Pac Allergy 2018; 8:e8. [PMID: 29423375 PMCID: PMC5796968 DOI: 10.5415/apallergy.2018.8.e8] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/27/2018] [Indexed: 11/30/2022] Open
Abstract
The prevalence of allergic diseases has increased dramatically in recent decades, and are now considered major chronic diseases at the global level. The increasing burden of allergic diseases has led to numerous worldwide and local researchers to investigate the time trends in its prevalence and identify its driving factors. Environmental changes such as urbanization and industrialization have been suggested to explain the increasing prevalence, but recent reports from Western countries suggest that this prevalence has reached a plateau or even possibly, started to decrease. However, such environmental changes are still occurring in many Asia-Pacific countries, including Korea, and it is speculated that the peak in allergy epidemics has yet to come. The present systematic literature review aimed to explore the time trends in the prevalence of allergic diseases in Korea and to identify the unmet needs for facilitating further studies.
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Affiliation(s)
- Sung-Yoon Kang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Woo-Jung Song
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Sang-Heon Cho
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea.,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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34
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Lee S. The past, present, and future of research on anaphylaxis in Korean children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.s1.s21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sooyoung Lee
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
- Suwon Center for Environmental Disease and Atopy, Suwon, Korea
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35
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Motosue MS, Bellolio MF, Van Houten HK, Shah ND, Campbell RL. Risk factors for severe anaphylaxis in the United States. Ann Allergy Asthma Immunol 2017; 119:356-361.e2. [DOI: 10.1016/j.anai.2017.07.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 01/17/2023]
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Abstract
Drugs are among the main triggers of anaphylaxis, but identification of the culprit drug is frequently difficult. To confirm diagnosis of the causative agent, medical records and clinical history are fundamental. There are a few in vitro tests available in clinical practice, such as serum-specific IgE and basophil activation test. Skin tests are often useful for the diagnosis, although drug challenge is indicated in patients with inconclusive clinical history or to provide safe alternatives. Treatment of anaphylaxis is standard and intramuscular epinephrine is the main agent to prevent morbidity and mortality. Rapid desensitization may be indicated in selected cases.
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Affiliation(s)
- Marcelo Vivolo Aun
- Avenida Eneas de Carvalho Aguiar 155, 8th Floor, Prédio dos Ambulatórios, Bloco 03, 05403-900, Sao Paulo, Brasil.
| | - Jorge Kalil
- Avenida Eneas de Carvalho Aguiar 155, 8th Floor, Prédio dos Ambulatórios, Bloco 03, 05403-900, Sao Paulo, Brasil
| | - Pedro Giavina-Bianchi
- Avenida Eneas de Carvalho Aguiar 155, 8th Floor, Prédio dos Ambulatórios, Bloco 03, 05403-900, Sao Paulo, Brasil
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37
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Abstract
Anaphylaxis is a systemic, life-threatening disorder triggered by mediators released by mast cells and basophils activated via allergic (IgE-mediated) or nonallergic (non-IgE-mediated) mechanisms. It is a rapidly evolving, multisystem process involving the integumentary, pulmonary, gastrointestinal, and cardiovascular systems. Anaphylaxis and angioedema are serious disorders that can lead to fatal airway obstruction and culminate in cardiorespiratory arrest, resulting in hypoxemia and/or shock. Often, these disorders can be appropriately managed in an outpatient setting; however, these conditions can be severe enough to warrant evaluation of the patient in the ED and in some cases, hospitalization, and management in an ICU. Reports suggest that underdiagnosis and undertreatment of anaphylaxis are common. Several new syndromes have been described recently including bird-egg, pork-cat, delayed allergy to mammalian meat and a diverse group of mast cell activation disorders. Conditions such as postural orthostatic tachycardia syndrome, carcinoid syndrome, Munchausen stridor, and factitious anaphylaxis can present similarly and need to be included in the differential diagnosis. Anaphylaxis is a clinical diagnosis, but plasma tryptase and urinary histamine levels are often elevated, allowing diagnostic confirmation; however, diagnostic testing should not delay treatment as results may not be immediately available. The sine qua non of treatment is avoidance of any known triggers and epinephrine, which should never be delayed if this disorder is suspected. Secondary treatments include fluids, bronchodilators, antihistamines, and glucocorticoids. Patients with cardiopulmonary arrest or airway or vascular compromise require mechanical ventilation, vasopressors, and other advanced life support in the ICU.
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