PURPOSE OF THE STUDY.
To assess the incidence of anaphylactic reactions in the Berlin area, as well as elicitors, symptoms, and emergency treatment.
Emergency physicians throughout the Berlin area (an urban area of ∼4 million people) were asked to complete questionnaires.
A questionnaire was used to gather the following information on anaphylaxis cases: gender, age, symptoms, reaction site, outcome, eliciting factors, and applied drugs. Forms were completed prospectively by emergency physicians. Eighteen emergency bases called via the 112 emergency line in the Berlin area were included. Cases reported between January 2008 to December 2010 were analyzed. Severity classification was designated as follows: severe respiratory (level 1), severe cardiovascular (level 2), or combined (level 3).
From January 2008 to December 2010, 295 cases of anaphylaxis were reported. Ninety-one percent were adults (mean age 51), and 9% were children (mean age 9). Level 1, 2, and 3 reactions accounted for 14%, 25%, and 61%, respectively. Among the 179 level 3 reactions, 11 had cardiac arrest, with 2 being fatal. Foods were the most common triggers in children (46%), followed by drugs and venom (8% each). In adults, both drugs and foods were frequent elicitors (each 31%). The most common food was tree nuts. Insect venom accounted for 20% of adult reactions and 8% of pediatric reactions. Ninety-eight percent of drug reactions occurred in adults. Seven adults and 7 children reported reactions in the context of specific immunotherapy. Hypotension occurred in 49% of adults and 29% of children. For treatment, glucocorticoids, antihistamines, and epinephrine were administered in 97%, 82%, and 23% of cases, respectively. Among level 3 reactions, only 30% were administered epinephrine. The estimated annual incidence ranged from 1.6 per 100 000 in 2009 to 4.5 per 100 000 in 2008.
The most common trigger of anaphylaxis is foods, followed by drugs and insect venom. Epinephrine is used in only 23% of cases. Of the 295 cases reported, 11 experienced cardiac arrest, with 2 being fatal.
The incidence of anaphylaxis in this study may be underestimated because cases that were not phoned in to the emergency line may not be accounted for. However, severe cases require immediate medical attention and would be represented well. This study finds the causes of anaphylaxis to be somewhat different from previous reports derived from a Central European Registry reported by allergists, which documented venom as most common (50%), followed by foods and drugs at 24% and 17%, respectively. Allergists may be more aware of reactions that occur in patients with venom allergy treated with immunotherapy. Emergency physicians in the current study may have attributed reactions to foods that could in fact be due to other causes. Another notable finding of this study is that epinephrine was profoundly underutilized even in the most severe reactions. Because delay in epinephrine administration may lead to fatality, this study calls attention to the need for increased education regarding the appropriate treatment of anaphylaxis.
- Copyright © 2013 by the American Academy of Pediatrics