M Worm1, W Francuzik1, J-M Renaudin2, M B Bilo3, V Cardona4, K Scherer Hofmeier5, A Köhli6, A Bauer7, G Christoff8,9, E Cichocka-Jarosz10, T Hawranek11, J O 'b Hourihane12, L Lange13, V Mahler14, A Muraro15, N G Papadopoulos16, C Pföhler17, I Poziomkowska-Gęsicka18, F Ruëff19, T Spindler20, R Treudler21, M Fernandez-Rivas22, S Dölle1. 1. Department of Dermatology and Allergology, Charite-Universitätsmedizin Berlin, Berlin, Germany. 2. Allergy Vigilance Network, University Hospital Nancy, Nancy, France. 3. Department of Internal Medicine/Allergy Unit, University Hospital Ospedali Riuniti, Ancona, Italy. 4. Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 5. Department of Dermatology, University Hospital Basel, Basel, Switzerland. 6. Division of Allergology, University Children's Hospital, Zurich, Switzerland. 7. Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany. 8. Faculty of Public Health, Medical University-Sofia, Sofia, Bulgaria. 9. Tokuda Medical Centre, Allergy Out-patient Clinic, Sofia, Bulgaria. 10. Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland. 11. Department of Dermatology, Paracelsus Private Medical University Salzburg, Salzburg, Austria. 12. Paediatrics and Child Health, University College Cork, Cork, Ireland. 13. Department of Pediatrics, St. Marien-Hospital, Bonn, Germany. 14. Department of Dermatology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen, Erlangen, Germany. 15. Department of Mother and Child Health, Padua General University Hospital, Padua, Italy. 16. Allergy Department, University of Athens, Athens, Greece. 17. Department of Dermatology, Saarland University Hospital, Homburg/Saar, Germany. 18. Clinical Allergology Department, Pomeranian Medical University Szczecin, Szczecin, Poland. 19. Department of Dermatology and Allergology, Klinikum der Universität München, München, Germany. 20. Department of Pediatric Pneumology and Allergology, Lung Centre South-West, Wangen, Germany. 21. Department of Dermatology, Venerology and Allergology, LICA-Comprehensive Allergy Center, Universität Leipzig, Leipzig, Germany. 22. Allergy Department, Hospital Clinico San Carlos IdISSC, Madrid, Spain.
Abstract
BACKGROUND: Preventive measures to decrease the frequency and intensity of anaphylactic events are essential to provide optimal care for allergic patients. Aggravating factors may trigger or increase the severity of anaphylaxis and therefore need to be recognized and avoided. OBJECTIVE: To identify and prioritize factors associated with an increased risk of developing severe anaphylaxis. METHODS: Data from the Anaphylaxis Registry (122 centers in 11 European countries) were used in logistic regression models considering existing severity grading systems, elicitors, and symptoms to identify the relative risk of factors on the severity of anaphylaxis. RESULTS: We identified higher age and concomitant mastocytosis (OR: 3.1, CI: 2.6-3.7) as the most important predictors for an increased risk of severe anaphylaxis. Vigorous physical exercise (OR: 1.5, CI: 1.3-1.7), male sex (OR: 1.2, CI: 1.1-1.3), and psychological burden (OR: 1.4, CI: 1.2-1.6) were more often associated with severe reactions. Additionally, intake of beta-blockers (OR: 1.9, CI: 1.5-2.2) and ACE-I (OR: 1.28, CI: 1.05, 1.51) in temporal proximity to allergen exposition was identified as an important factor in logistic regression analysis. CONCLUSION: Our data suggest it may be possible to identify patients who require intensified preventive measures due to their relatively higher risk for severe anaphylaxis by considering endogenous and exogenous factors.
BACKGROUND: Preventive measures to decrease the frequency and intensity of anaphylactic events are essential to provide optimal care for allergicpatients. Aggravating factors may trigger or increase the severity of anaphylaxis and therefore need to be recognized and avoided. OBJECTIVE: To identify and prioritize factors associated with an increased risk of developing severe anaphylaxis. METHODS: Data from the Anaphylaxis Registry (122 centers in 11 European countries) were used in logistic regression models considering existing severity grading systems, elicitors, and symptoms to identify the relative risk of factors on the severity of anaphylaxis. RESULTS: We identified higher age and concomitant mastocytosis (OR: 3.1, CI: 2.6-3.7) as the most important predictors for an increased risk of severe anaphylaxis. Vigorous physical exercise (OR: 1.5, CI: 1.3-1.7), male sex (OR: 1.2, CI: 1.1-1.3), and psychological burden (OR: 1.4, CI: 1.2-1.6) were more often associated with severe reactions. Additionally, intake of beta-blockers (OR: 1.9, CI: 1.5-2.2) and ACE-I (OR: 1.28, CI: 1.05, 1.51) in temporal proximity to allergen exposition was identified as an important factor in logistic regression analysis. CONCLUSION: Our data suggest it may be possible to identify patients who require intensified preventive measures due to their relatively higher risk for severe anaphylaxis by considering endogenous and exogenous factors.
Authors: Stefanie Aurich; Sabine Dölle-Bierke; Wojciech Francuzik; Maria Beatrice Bilo; George Christoff; Montserrat Fernandez-Rivas; Thomas Hawranek; Claudia Pföhler; Iwona Poziomkowska-Gȩsicka; Jean-Marie Renaudin; Eva Oppel; Kathrin Scherer; Regina Treudler; Margitta Worm Journal: Front Immunol Date: 2019-04-24 Impact factor: 7.561