Prevalence of anaphylaxis and prescription rates of epinephrine auto-injectors in urban and rural areas of Korea

Evidence-based use of epinephrine in anaphylaxis

PURPOSE OF REVIEW

Epinephrine is the first line treatment for anaphylaxis, however, there are limited data to support this. This review examines data surrounding evidence for the use of epinephrine in anaphylaxis, data on prescription for and use of epinephrine autoinjectors, and data examining newer routes of delivery of epinephrine; with a focus on recent publications over the past few years.

RECENT FINDINGS

With recent epidemiologic studies of anaphylaxis and new forms of epinephrine being studied, new data on the effects of epinephrine are aiding in the understanding of epinephrine's effects and the shortcomings of epinephrine both in its effect and utility in the real world.

SUMMARY

Epinephrine is still considered the first line therapy for anaphylaxis, and we are starting to have a better understanding of its effects in both healthy patients and those with anaphylaxis.

Epidemiologic and Clinical Features of Campylobacter Enteritis Before and During COVID-19 in Korea

BACKGROUND

With the increase in meals at home due to coronavirus disease 2019 (COVID-19), the pattern and incidence of enteritis seemed to change. Some types of enteritis, such as Campylobacter enteritis, appear to have increased. Our study aimed to evaluate the change in the trend of enteritis, especially Campylobacter enteritis, before COVID-19 (2016-2019) and at the present time during COVID-19 in South Korea.

METHODS

We analyzed data from the Health Insurance Review and Assessment Service. From 2016 to 2020, the International Classification of Diseases codes related to enteritis were examined to distinguish bacterial and viral enteritis and the trends of each were analyzed. The aspects of enteritis, before and after the COVID-19 outbreak, were compared.

RESULTS

Both bacterial and viral enteritis declined in all age groups from 2016 to 2020 (P < 0.001). In 2020, the reduction rate of viral enteritis was higher than that of bacterial enteritis. However, unlike other causes of enteritis, even after COVID-19, Campylobacter enteritis increased in all age groups. An increase of Campylobacter enteritis in 2020 was particularly noticeable in children and adolescents. The prevalence of viral and bacterial enteritis was higher in urban areas than in rural areas (P < 0.001). Campylobacter enteritis was more common in the rural areas (P < 0.001).

CONCLUSION

Although the prevalence of bacterial and viral enteritis have decreased in COVID-19, Campylobacter enteritis has increased in all age groups and in rural areas compared to urban areas. Recognizing that the trend of Campylobacter enteritis before and during COVID-19 is helpful for future public health measures and interventions.

Trends and determinants of epinephrine prescriptions: a proxy of anaphylaxis epidemiology?

PURPOSE OF REVIEW

Epinephrine autoinjectors (EAIs) are recommended to all patients previously experiencing anaphylaxis reaction in order to prevent further reactions and fatalities. Under that perspective, EAI prescription could be considered as a proxy of anaphylaxis epidemiology. Nevertheless EAI prescription rates are still unacceptably low.

RECENT FINDINGS

The review focuses on potential determinants, in addition to clinical indications, which might impact EAI prescription rates by exploring the scientific literature published within the past 18 months, wherever available. Although some controversial results, age, sex, ethnicity, geographical setting and socioeconomic conditions might influence both physician prescription behaviour and EAIs' accessibility from the patient's side, which hampers the accuracy of EAI prescription as a proxy of anaphylaxis. Low EAI prescription and refill rates have been recorded even in the absence of significant socioeconomic barriers, suggesting that economical limitations only partially account for the issue, and cultural restrictions have also to be considered and addressed.

SUMMARY

In addition to providing the same opportunities in terms of EAI availability in all countries worldwide, implementing the resources for anaphylaxis management in terms of practical knowledge, education, and allergy specialist networks is an urgent need, even in the absence of socioeconomic barriers.

Risk factors of anaphylaxis in Korea: Identifying drug-induced anaphylaxis culprits using big data

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.

Anaphylaxis: Epidemiology and Differential Diagnosis

Anaphylaxis-related emergency department (ED) visits and hospitalizations are increasing. Triggers for anaphylaxis include food, medications, and stinging insects. Idiopathic anaphylaxis accounts for 30% to 60% of cases of anaphylaxis in adults and up to 10% of cases in children with novel allergens such as galactose-α-1,3 galactose reclassifying these cases. Recent practice guidelines have recommended against the routine use of systemic corticosteroids and antihistamines for the prevention of biphasic reactions and recommend an extended observation, up to 6 hours, for those with risk factors for biphasic anaphylaxis and those with lack of access to epinephrine and to emergency medical services.

Management of Anaphylaxis in Infants and Toddlers

Anaphylaxis is a systemic allergic reaction that can be caused by food, drugs, insect bites, or unknown triggers in infants and toddlers. Anaphylaxis rates are increasing. Infants and toddlers may have increased exposure to known and unknown allergens, decreased ability to describe their symptoms, and an expanded differential diagnosis for consideration on presentation. The most common symptoms in these age groups are cutaneous and gastrointestinal. Age-specific language may be helpful for caregivers to identify and describe the symptoms of anaphylaxis in infants and toddlers. Long-term management of anaphylaxis includes allergy evaluation to guide avoidance and assess prognosis and education on allergic reaction management; this incorporates the prescription of epinephrine autoinjector and provision of an allergy emergency plan.

World allergy organization anaphylaxis guidance 2020

Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions. The occurrence of anaphylaxis has increased in recent years, and subsequently, there is a need to continue disseminating knowledge on the diagnosis and management, so every healthcare professional is prepared to deal with such emergencies. The rationale of this updated position document is the need to keep guidance aligned with the current state of the art of knowledge in anaphylaxis management. The World Allergy Organization (WAO) anaphylaxis guidelines were published in 2011, and the current guidance adopts their major indications, incorporating some novel changes. Intramuscular epinephrine (adrenaline) continues to be the first-line treatment for anaphylaxis. Nevertheless, its use remains suboptimal. After an anaphylaxis occurrence, patients should be referred to a specialist to assess the potential cause and to be educated on prevention of recurrences and self-management. The limited availability of epinephrine auto-injectors remains a major problem in many countries, as well as their affordability for some patients.

Underuse of Epinephrine for Pediatric Anaphylaxis Victims in the Emergency Department: A Population-based Study

Purpose

Epinephrine is a key drug for treating anaphylaxis; however, its underuse is still a significant issue worldwide. The objective of this study was to compare epinephrine use between pediatric and adult patients who were treated with anaphylaxis in the emergency department (ED).

Methods

The data were retrieved from the National Sample Cohort of South Korea, which contains claim data from the National Health Insurance Service. We included patients who visited the ED with a discharge code of anaphylaxis between 2004 and 2013. We assessed prescription information of epinephrine, antihistamine and systemic steroid, previous medical history and discharge disposition from the ED. The study population was categorized based on age at the visit.

Results

A total of 175 pediatric and 1,605 adult patients with anaphylaxis were identified. Only 42 (24%) of the pediatric patients were treated with epinephrine, while 592 (36.9%) of the adult patients were treated with epinephrine (P = 0.001). Furthermore, the pediatric patients were less likely to be treated with systemic steroid than the adult patients (6.9% vs. 12.3%, P = 0.047). The odds ratios for the administration of epinephrine relative to the baseline in the 19-65 age group were 0.34 (95% confidence interval [CI], 0.15–0.67), 0.56 (95% CI, 0.28–1.03) and 0.79 (95% CI, 0.45–1.33) in the < 7, 7–12 and 13–18 age groups, respectively.

Conclusions

The pediatric patients with anaphylaxis experienced a lower rate of epinephrine injection use than the adult patients and the injection use decreased as age decreased.