Clinical features of anaphylaxis and risk factors of severe anaphylaxis in the emergency department

¹Department of Emergency Medicine, Jeonbuk National University Hospital, Jeonju, Korea
²Department of Emergency Medicine, Jeonbuk National University Medical School, Jeonju, Korea

Correspondence

Jae Baek Lee ,Tel: 063-250-1075, Email: baeklee@jbnu.ac.kr,

Received: February 18, 2022; Revised: August 20, 2022 Accepted: September 11, 2022. Published online: February 28, 2023.

ABSTRACT

Objective:
This study investigates the triggers and clinical features of anaphylaxis, and determines the risk factors associated with severe anaphylaxis.
Method:
This is a retrospective observational study spanning a duration of 2 years (2020-2021) using the electronic data of patients diagnosed with anaphylaxis in the university-affiliated emergency center. Severe anaphylaxis was defined as refractory anaphylaxis requiring ≥3 times epinephrine administration and/or continuous epinephrine infusion. Baseline and clinical characteristics were compared between the severe and the non-severe anaphylaxis groups. Binary logistic regression analysis was performed to reveal independent risk factors associated with severe anaphylaxis.
Results:
The median age of study patients was determined to be 53.0 years (range, 37.5-65.0 years). Fifty-eight patients (58.0%) were male. Drugs were found to be the most common trigger. In clinical manifestations, cutaneous manifestation was the most common. Severe anaphylaxis occurred in 19 patients (19.0%). Latent time was shorter in the severe anaphylaxis group-10.0 minutes (5.0-20.0) vs. 30.0 minutes (10.0-60.0), P<0.001. Drug as a trigger (68.4% vs. 39.5%, P=0.023), hypotension (57.9% vs. 9.9%, P<0.001), cardiovascular manifestation (84.2% vs. 40.7%, P=0.001), and hyperlactatemia (73.7% vs. 46.9%, P=0.036) were more frequently observed in the severe anaphylaxis group. Shorter latent time, drug as a trigger, and presence of hypotension were independent risk factors for severe anaphylaxis.
Conclusion:
Anaphylaxis patients with shorter latent time, diagnosed with drugs as a trigger, and presenting with hypotension, must be subjected to careful monitoring and early active treatment.

Key words: Allergy; Precipitating factors; Shock; Epidemiology