Different phenotypes of drug-induced anaphylaxis-Data from the European Anaphylaxis Registry

Theresa Hanschmann¹, Wojciech Francuzik¹, Sabine Dölle-Bierke¹, Kathrin Scherer Hofmeier^{2

3}, Linus Grabenhenrich^{1

4}, Franziska Ruëff⁵, Jean-Marie Renaudin⁶, Claudia Pföhler⁷, Regina Treudler⁸, M Beatrice Bilò^{9

10}, Roland Lang¹¹, Luis Felipe Ensina¹², George Christoff^{13

14}, Victoria Cardona^{15

16}, Nicola Wagner¹⁷, Norbert Reider¹⁸, Sabine Müller^{19

20}, Heinrich Dickel²¹, Margitta Worm¹

Affiliations

¹ Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
² Allergy Unit, Department of Dermatology, University Hospital Basel, Basel, Switzerland.
³ Allergy Unit, Cantonal Hospital Aarau, Aarau, Switzerland.
⁴ Department for Methodology and Research Infrastructure, Robert Koch-Institut, Berlin, Germany.
⁵ Department of Dermatology and Allergology, Ludwig-Maximilian-University, Munich, Germany.
⁶ Allergy Vigilance Network, Vandoeuvre les Nancy, France.
⁷ Department of Dermatology, Saarland University Medical School, Homburg/Saar, Germany.
⁸ Department of Dermatology, Venereology and Allergology and Leipzig Interdisciplinary Center of Allergology (LICA) Comprehensive Allergy Center, University Leipzig Medical Faculty, Leipzig, Germany.
⁹ Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
¹⁰ Department of Internal Medicine/Allergy Unit, University Hospital Ospedali Riuniti, Ancona, Italy.
¹¹ Department of Dermatology and Allergology, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Austria.
¹² Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
¹³ Faculty of Public Health, Medical University - Sofia, Sofia, Bulgaria.
¹⁴ Allergy Out-patient Department, Acibadem City Clinic, Tokuda Medical Centre, Sofia, Bulgaria.
¹⁵ Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.
¹⁶ ARADyAL Research Network, Barcelona, Spain.
¹⁷ Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
¹⁸ Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria.
¹⁹ Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany.
²⁰ Faculty of Medicine, University of Freiburg, Freiburg, Germany.
²¹ Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany.

PMID: 36479710
DOI: 10.1111/all.15612

Different phenotypes of drug-induced anaphylaxis-Data from the European Anaphylaxis Registry

Theresa Hanschmann et al. Allergy. 2023 Jun.

. 2023 Jun;78(6):1615-1627.

doi: 10.1111/all.15612. Epub 2022 Dec 20.

Authors

Affiliations

¹ Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
² Allergy Unit, Department of Dermatology, University Hospital Basel, Basel, Switzerland.
³ Allergy Unit, Cantonal Hospital Aarau, Aarau, Switzerland.
⁴ Department for Methodology and Research Infrastructure, Robert Koch-Institut, Berlin, Germany.
⁵ Department of Dermatology and Allergology, Ludwig-Maximilian-University, Munich, Germany.
⁶ Allergy Vigilance Network, Vandoeuvre les Nancy, France.
⁷ Department of Dermatology, Saarland University Medical School, Homburg/Saar, Germany.
⁸ Department of Dermatology, Venereology and Allergology and Leipzig Interdisciplinary Center of Allergology (LICA) Comprehensive Allergy Center, University Leipzig Medical Faculty, Leipzig, Germany.
⁹ Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
¹⁰ Department of Internal Medicine/Allergy Unit, University Hospital Ospedali Riuniti, Ancona, Italy.
¹¹ Department of Dermatology and Allergology, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Austria.
¹² Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
¹³ Faculty of Public Health, Medical University - Sofia, Sofia, Bulgaria.
¹⁴ Allergy Out-patient Department, Acibadem City Clinic, Tokuda Medical Centre, Sofia, Bulgaria.
¹⁵ Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.
¹⁶ ARADyAL Research Network, Barcelona, Spain.
¹⁷ Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
¹⁸ Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria.
¹⁹ Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany.
²⁰ Faculty of Medicine, University of Freiburg, Freiburg, Germany.
²¹ Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany.

PMID: 36479710
DOI: 10.1111/all.15612

Abstract

Background: Drugs are a frequent cause of severe anaphylactic reactions. Here, we analyze a large dataset on drug induced anaphylaxis regarding elicitors, risk factors, symptoms, and treatment.

Methods: Data from the European Anaphylaxis Registry (2007-2019) with 1815 reported cases of drug-induced anaphylaxis were studied accordingly.

Results: Drugs are the third most frequent cause of anaphylaxis reported in the Anaphylaxis Registry. Among the eliciting groups of drugs analgesics and antibiotics were far most often reported. Female and senior patients were more frequently affected, while the number of children with DIA was low. DIA patients had symptoms affecting the skin and mucous membranes (n = 1525, 84.02%), the respiratory (n = 1300, 71.63%), the cardiovascular (n = 1251, 68.93%) and the gastrointestinal system (n = 549, 30.25%). Drugs caused significant more severe reactions, occurred more often in medical facilities and led to increased hospitalization rates in comparison to food and insect venom induced anaphylaxis. Adrenaline was used more often in patients with DIA than in anaphylaxis due to other causes. Patients with skin symptoms received more antihistamines and corticosteroids in the acute treatment, while gastrointestinal symptoms led to less adrenaline use.

Conclusion: The study contributes to a better understanding of DIA, with a large number of cases from Europe supporting previous data, e.g., analgesics and antibiotics being the most frequent culprits for DIA. Female gender and higher age are relevant risk factors and despite clear recommendations, the emergency treatment of DIA is not administered according to the guidelines.

Keywords: anaphylaxis; drug hypersensitivity; drugs; multicenter study.

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References

REFERENCES

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Different phenotypes of drug-induced anaphylaxis-Data from the European Anaphylaxis Registry

Affiliations

Different phenotypes of drug-induced anaphylaxis-Data from the European Anaphylaxis Registry

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical