Clinical Manifestations and Causes of Anaphylaxis. Analysis of 382 Cases from the Anaphylaxis Registry in West Pomerania Province in Poland

Abstract

Anaphylaxis is most commonly defined as an acute, severe, potentially life-threatening systemic hypersensitivity reaction. Current expert consensus has defined anaphylaxis as a serious reaction that is rapid in onset and can be fatal, and is a severe, potentially life-threatening systemic hypersensitivity reaction that is still rarely diagnosed. For safety reasons, patients should visit an allergologist to identify potential causes of this reaction. There are no data from other health care centres in Poland presenting characteristics of anaphylactic reactions. Clinical manifestations of anaphylaxis should be analysed, because some patients (10-30%) with anaphylaxis can present without cutaneous findings. This lack of skin/mucosa involvement can lead to misdiagnosis or delayed diagnosis of anaphylaxis. Objectives-to gather epidemiological data on anaphylactic reactions, to identify clinical manifestations of anaphylaxis (organ systems involved), to present diagnostic methods useful for the identification of anaphylaxis triggers, and most importantly, to find causes of anaphylaxis. In this retrospective analysis, we used a questionnaire-based survey regarding patients visiting the Clinical Allergology Department, Pomeranian Medical University (PMU) in Szczecin, between 2006 and 2015. The registry comprised patients with grade II (Ring and Messmer classification) or higher anaphylaxis. Patients with grade I anaphylaxis (e.g., urticaria) were not included in the registry. The incidence of anaphylaxis was higher in women. Clinical manifestations included cutaneous and cardiovascular symptoms, but more than 20% of patients did not present with cutaneous symptoms, which may create difficulties for fast and correct diagnosis. Causes of anaphylaxis were identified and confirmed by means of detailed medical interview, skin tests (STs), and measurement of specific immunoglobulin E (sIgE) and tryptase levels. In the analysed group, the most common cause of anaphylaxis (allergic and nonallergic) was Hymenoptera stinging (wasp), drugs (nonsteroidal anti-inflammatory drugs, NSAIDs) and foods (peanuts, tree nuts, celery). The incidence of anaphylaxis is low, but because of its nature and potentially life-threatening consequences it requires a detailed approach. Comprehensive management of patients who have had anaphylaxis can be complex, so partnerships between allergy specialists, emergency medicine and primary care providers are necessary. Monitoring its range is very important to monitor changes in allergy development.

Keywords: anaphylaxis; cause; clinical symptoms; epidemiology.

Figure 1

The structure of research and the division into groups.

Figure 2

Organ systems involved in anaphylaxis.

Figure 3

Organ systems involved (%) in anaphylaxis with groups divided into women, men, and children.

Figure 4

% of case anaphylaxis with 1, 2, 3 or 4 affected organ systems (in the whole group).

Figure 5

% of Cases anaphylaxis with 1, 2, 3 or 4 affected organ systems with groups divided into women, men, and children.

Figure 6

Triggers of anaphylaxis in the analysed whole group (%).

Figure 7

Triggers of anaphylaxis in the analysed groups of women, men, and children (%).

Figure 8

Nonsteroidal anti-inflammatory drug (NSAID) causes of anaphylaxis in the study whole group (%).

Figure 9

Antibiotic causes of anaphylaxis in the study whole group (%).

Figure 10

Food causes of anaphylaxis in the whole study group (%).

Figure 11

Triggers of anaphylaxis in the children’s group (%).