Edgardo José Jares1, Carlos E Baena-Cagnani2, Mario Sánchez-Borges3, Luis Felipe C Ensina4, Alfredo Arias-Cruz5, Maximiliano Gómez6, Mabel Noemi Cuello7, Blanca María Morfin-Maciel8, Alicia De Falco9, Susana Barayazarra10, Jonathan A Bernstein11, Carlos Serrano12, Silvana Monsell13, Juan Schuhl14, Ricardo Cardona-Villa15. 1. Allergy Unit, CMP S.A., Libra Foundation, Buenos Aires, Argentina. Electronic address: edgardo.jares@gmail.com. 2. Centro de Investigación en Medicina Respiratoria, Faculty of Medicine, Catholic University of Cordoba, Cordoba, Argentina. 3. Allergy and Clinical Immunology Department, Centro Médico-Docente La Trinidad, Caracas, Venezuela. 4. Allergy, Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil. 5. Centro Regional de Alergia e Inmunología Clínica, Hospital Universitario, Monterrey, Mexico. 6. Allergy and Asthma Unit, Hospital San Bernardo, Salta, Argentina. 7. Allergy and Immunology Department, Consultorios San Juan, San Juan, Argentina. 8. Allergy, Hospital Mocel, Mexico City, Mexico. 9. Allergy and Clinical Immunology, Universidad Nacional de La Plata, La Plata, Argentina. 10. Allergy and Immunology, Nuevo Hospital San Roque, Córdoba, Argentina. 11. Department of Internal Medicine and Division of Immunology/Allergy Section, University of Cincinnati, Cincinnati, Ohio. 12. Allergy Unit, Fundación Valle del Lili, Cali, Colombia. 13. Allergy Unit, CMP S.A., Libra Foundation, Buenos Aires, Argentina. 14. Allergy Unit, Hospital Britanico, Montevideo, Uruguay. 15. Universidad de Antiquia, Medellin, Colombia.
Abstract
BACKGROUND: Information regarding the clinical features and management of drug-induced anaphylaxis (DIA) in Latin America is lacking. OBJECTIVE: The objective of this study was to assess implicated medications, demographics, and treatments received for DIA in Latin American patients referred to national specialty centers for evaluation. METHOD: A database previously used to compile information on drug-induced allergic reactions in 11 Latin American countries was used to identify and characterize patients presenting specifically with a clinical diagnosis of DIA. Information regarding clinical presentation, causative agent(s), diagnostic studies performed, treatment, and contributing factors associated with increased reaction severity was analyzed. RESULTS: There were 1005 patients evaluated for possible drug hypersensitivity reactions during the study interval, and 264 (26.3%) met criteria for DIA. DIA was more frequent in adults and in elderly females (N = 129 [76.6%] and N = 30 [75%], respectively) compared with children and/or adolescents (N = 21 [42.9%], P < .01). Severe DIA was less frequent with underlying asthma (N = 22 vs 35 [38.6% vs 61.4%], P < .05) or atopy (N = 62 vs 71 [43% vs 59% ], P < .01). Nonsteroidal anti-inflammatory drugs (NSAIDs) (N = 178 [57.8%]), beta-lactam antibiotics (N = 44 [14.3%]), and other antibiotics (N = 16 [5.2%]) were the most frequently implicated drug classes. Anaphylaxis was rated as severe in N = 133 (50.4%) and anaphylactic shock (AS) was present in N = 90 (34.1%). Epinephrine was only used in N = 73 (27.6%) overall, but in N = 70 (77.8%) of patients with AS. CONCLUSION: In Latin American patients referred for evaluation of DIA, NSAIDs and antibiotics were implicated in approximately 80% of cases. Most of these reactions were treated in the emergency department. Epinephrine was administered in only 27.6% of all cases, although more frequently for anaphylactic shock. Dissemination of anaphylaxis guidelines among emergency department physicians should be encouraged to improve management of DIA.
BACKGROUND: Information regarding the clinical features and management of drug-induced anaphylaxis (DIA) in Latin America is lacking. OBJECTIVE: The objective of this study was to assess implicated medications, demographics, and treatments received for DIA in Latin American patients referred to national specialty centers for evaluation. METHOD: A database previously used to compile information on drug-induced allergic reactions in 11 Latin American countries was used to identify and characterize patients presenting specifically with a clinical diagnosis of DIA. Information regarding clinical presentation, causative agent(s), diagnostic studies performed, treatment, and contributing factors associated with increased reaction severity was analyzed. RESULTS: There were 1005 patients evaluated for possible drug hypersensitivity reactions during the study interval, and 264 (26.3%) met criteria for DIA. DIA was more frequent in adults and in elderly females (N = 129 [76.6%] and N = 30 [75%], respectively) compared with children and/or adolescents (N = 21 [42.9%], P < .01). Severe DIA was less frequent with underlying asthma (N = 22 vs 35 [38.6% vs 61.4%], P < .05) or atopy (N = 62 vs 71 [43% vs 59% ], P < .01). Nonsteroidal anti-inflammatory drugs (NSAIDs) (N = 178 [57.8%]), beta-lactam antibiotics (N = 44 [14.3%]), and other antibiotics (N = 16 [5.2%]) were the most frequently implicated drug classes. Anaphylaxis was rated as severe in N = 133 (50.4%) and anaphylactic shock (AS) was present in N = 90 (34.1%). Epinephrine was only used in N = 73 (27.6%) overall, but in N = 70 (77.8%) of patients with AS. CONCLUSION: In Latin American patients referred for evaluation of DIA, NSAIDs and antibiotics were implicated in approximately 80% of cases. Most of these reactions were treated in the emergency department. Epinephrine was administered in only 27.6% of all cases, although more frequently for anaphylactic shock. Dissemination of anaphylaxis guidelines among emergency department physicians should be encouraged to improve management of DIA.
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