Aetiology of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka

Abstract

Background: The aetiology of anaphylaxis differs according to types of foods consumed, fauna and foliage and cultural practices. Although the aetiology of anaphylaxis in Western countries are well known, the causes in South Asian countries have not been reported. We sought to determine the causes of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka.

Methods: 238 episodes of anaphylaxis were reviewed in 188 patients who were referred and skin prick tests and in vitro tests (ImmunoCap) were carried out to assess the presence of allergen specific IgE. Clinical features and severity of anaphylaxis was also recorded along with treatment received.

Results: Anaphylaxis to food either following direct exposure 90/238 (37.5%) or after exercise in the form of food dependent exercise induced anaphylaxis 29/238 (12.2%) was the predominant cause of anaphylaxis. Allergy to cow's milk and red meat, after immediate exposure, accounted for 66/238 (27.7%) of instances of all episodes of anaphylaxis and 66/90 (73.33%) of anaphylaxis due to food. Vaccines accounted for 28/238 (11.8%) of instances of anaphylaxis, especially among children. Of those who developed anaphylaxis to the MMR (n = 14), 71.4% of them had specific IgE to cow's milk and 35.7% of them had specific IgE to beef. Of those who developed anaphylaxis to insect stings, 27/42 of these episodes occurred following stings of ants (family Formicidae). The predominant cause of anaphylaxis changed with the age, with food allergy being the most frequent trigger of anaphylaxis in childhood, while drug allergy and idiopathic anaphylaxis being more frequent after 30 years of age.

Conclusions: In this cohort, anaphylaxis to red meat appears to be the predominant cause of food induced anaphylaxis and presence of beef specific IgE and cow's milk, appears to be a predisposing factor for vaccine induced anaphylaxis.

Keywords: Anaphylaxis; Drug allergy; Food allergy; Insect allergy.

Fig. 1

Age and gender distribution of 188 patients who presented with anaphylaxis. Males are represented by grey bars (M) and females are represented by black bars (F)

Fig. 2

The aetiology of anaphylaxis in different age groups (n = 238). a In children < 5 years of age (n = 59), b in children between 5 and 18 years of age (n = 90), c in individuals between 19 and 30 years of age (n = 30) and d in individuals > 30 years of age (n = 56)

Fig. 3

Insect species causing anaphylaxis. a Diacamma rugosum, b Triatoma rubrofasciata