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Multicenter Study
. 2014 May 23;111(21):367-75.
doi: 10.3238/arztebl.2014.0367.

Triggers and treatment of anaphylaxis: an analysis of 4,000 cases from Germany, Austria and Switzerland

Margitta Worm  1 , Oliver Eckermann, Sabine Dölle, Werner Aberer, Kirsten Beyer, Thomas Hawranek, Stephanie Hompes, Alice Koehli, Vera Mahler, Katja Nemat, Bodo Niggemann, Claudia Pföhler, Uta Rabe, Angelika Reissig, Ernst Rietschel, Kathrin Scherer, Regina Treudler, Franziska Ruëff
Affiliations
Multicenter Study

Triggers and treatment of anaphylaxis: an analysis of 4,000 cases from Germany, Austria and Switzerland

Margitta Worm et al. Dtsch Arztebl Int. .

Abstract

Background: Anaphylaxis is the most severe manifestation of a mast cell-dependent immediate reaction and may be fatal. According to data from the Berlin region, its incidence is 2-3 cases per 100 000 persons per year.

Method: We evaluated data from the anaphylaxis registry of the German-speaking countries for 2006-2013 and data from the protocols of the ADAC air rescue service for 2010-2011 to study the triggers, clinical manifestations, and treatment of anaphylaxis.

Results: The registry contained data on 4141 patients, and the ADAC air rescue protocols concerned 1123 patients. In the registry, the most common triggers for anaphylaxis were insect venom (n = 2074; 50.1%), foods (n = 1039; 25.1%), and drugs (n = 627; 15.1%). Within these groups, the most common triggers were wasp (n = 1460) and bee stings (n = 412), legumes (n = 241), animal proteins (n = 225), and analgesic drugs (n = 277). Food anaphylaxis was most frequently induced by peanuts, cow milk, and hen's egg in children and by wheat and shellfish in adults. An analysis of the medical emergency cases revealed that epinephrine was given for grade 3 or 4 anaphylaxis to 14.5% and 43.9% (respectively) of the patients in the anaphylaxis registry and to 19% and 78% of the patients in the air rescue protocols.

Conclusion: Wasp and bee venom, legumes, animal proteins, and analgesic drugs were the commonest triggers of anaphylaxis. Their relative frequency was age-dependent. Epinephrine was given too rarely, as it is recommended in the guidelines for all cases of grade 2 and above.

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Figures

Figure 1
Figure 1
Distribution of severity grades (Ring and Messmer [4]) of cases reported to the anaphylaxis registry (n = 4141) (1 January 2006 to 31 March 2013); 95% CI, 95% confidence interval. Respiratory and/or cardiovascular symptoms are inclusion criteria for the registry, and therefore grade I is under-represented in this population
Figure 2
Figure 2
Relative percentages of the most frequent trigger groups related to the age of the patients reported in the anaphylaxis registry (n = 4141) (1 January 2006 to 31 March 2013); 95% CI, 95% confidence interval
Figure 3
Figure 3
The ten most common food allergens as triggers in various age groups (n = 665, children and adolescents 0–17 years, adults >18 years) among cases reported in the anaphylaxis registry (1 January 2006 to 31 March 2013); 95% CI, 95% confidence interval
Figure 4
Figure 4
Comparison of emergency treatments: Berlin emergency physicians (ground-based) (n = 120), ADAC air rescue service (n = 994), anaphylaxis registry (n = 1123) (1 January 2010 to 31 December 2011)
See this image and copyright information in PMC

Comment in

  • Adrenaline as the medication of choice.
    Seifert R. Seifert R. Dtsch Arztebl Int. 2015 Jan 23;112(4):59. doi: 10.3238/arztebl.2015.0059a. Dtsch Arztebl Int. 2015. PMID: 25797424 Free PMC article. No abstract available.
  • Not all legumes are triggers.
    Ting N. Ting N. Dtsch Arztebl Int. 2015 Jan 23;112(4):59. doi: 10.3238/arztebl.2015.0059b. Dtsch Arztebl Int. 2015. PMID: 25797425 Free PMC article. No abstract available.
  • In reply.
    Worm M. Worm M. Dtsch Arztebl Int. 2015 Jan 23;112(4):59. doi: 10.3238/arztebl.2015.0059c. Dtsch Arztebl Int. 2015. PMID: 25797426 Free PMC article. No abstract available.

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