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. 2015 Sep-Oct;3(5):780-8.
doi: 10.1016/j.jaip.2015.05.012. Epub 2015 Jul 2.

Drug-Induced Anaphylaxis in Latin American Countries

Edgardo José Jares  1 , Carlos E Baena-Cagnani  2 , Mario Sánchez-Borges  3 , Luis Felipe C Ensina  4 , Alfredo Arias-Cruz  5 , Maximiliano Gómez  6 , Mabel Noemi Cuello  7 , Blanca María Morfin-Maciel  8 , Alicia De Falco  9 , Susana Barayazarra  10 , Jonathan A Bernstein  11 , Carlos Serrano  12 , Silvana Monsell  13 , Juan Schuhl  14 , Ricardo Cardona-Villa  15 ; Latin America Drug Allergy Interest Group
Collaborators, Affiliations

Drug-Induced Anaphylaxis in Latin American Countries

Edgardo José Jares et al. J Allergy Clin Immunol Pract. 2015 Sep-Oct.

Abstract

Background: Information regarding the clinical features and management of drug-induced anaphylaxis (DIA) in Latin America is lacking.

Objective: The objective of this study was to assess implicated medications, demographics, and treatments received for DIA in Latin American patients referred to national specialty centers for evaluation.

Method: A database previously used to compile information on drug-induced allergic reactions in 11 Latin American countries was used to identify and characterize patients presenting specifically with a clinical diagnosis of DIA. Information regarding clinical presentation, causative agent(s), diagnostic studies performed, treatment, and contributing factors associated with increased reaction severity was analyzed.

Results: There were 1005 patients evaluated for possible drug hypersensitivity reactions during the study interval, and 264 (26.3%) met criteria for DIA. DIA was more frequent in adults and in elderly females (N = 129 [76.6%] and N = 30 [75%], respectively) compared with children and/or adolescents (N = 21 [42.9%], P < .01). Severe DIA was less frequent with underlying asthma (N = 22 vs 35 [38.6% vs 61.4%], P < .05) or atopy (N = 62 vs 71 [43% vs 59% ], P < .01). Nonsteroidal anti-inflammatory drugs (NSAIDs) (N = 178 [57.8%]), beta-lactam antibiotics (N = 44 [14.3%]), and other antibiotics (N = 16 [5.2%]) were the most frequently implicated drug classes. Anaphylaxis was rated as severe in N = 133 (50.4%) and anaphylactic shock (AS) was present in N = 90 (34.1%). Epinephrine was only used in N = 73 (27.6%) overall, but in N = 70 (77.8%) of patients with AS.

Conclusion: In Latin American patients referred for evaluation of DIA, NSAIDs and antibiotics were implicated in approximately 80% of cases. Most of these reactions were treated in the emergency department. Epinephrine was administered in only 27.6% of all cases, although more frequently for anaphylactic shock. Dissemination of anaphylaxis guidelines among emergency department physicians should be encouraged to improve management of DIA.

Keywords: Anaphylaxis; Drug allergy; Epidemiology; Epinephrine; Latin America.

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