Sophie Carra1, Michael Schatz2, Paul-Michel Mertes3, Maria Jose Torres4, Florence Fuchs5, Gianenrico Senna6, Mariana C Castells7, Pascal Demoly8, Luciana Kase Tanno9. 1. Allergy Department, University Hospital of Montpellier, Montpellier, France. 2. Allergy Department, Kaiser Permanente, San Diego, Calif. 3. Department of Anaesthesia and Critical Care, Strasbourg University Hospital, Strasbourg, France. 4. Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, Malaga, Spain. 5. Department of Gynecology and Obstetrics, University Hospital of Montpellier, Montpellier, France; Desbrest Institute of Epidemiology and Public Health, University of Montpellier, France; INSERM, Research Center in Epidemiology and Population Health, Villejuif, France. 6. Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy. 7. Department of Allergy, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn, USA. 8. Allergy Department, University Hospital of Montpellier, Montpellier, France; Desbrest Institute of Epidemiology and Public Health, University of Montpellier, France; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn, USA; World Health Organization Collaborating Centre on Scientific Classification Support, Montpellier, France. 9. Allergy Department, University Hospital of Montpellier, Montpellier, France; Desbrest Institute of Epidemiology and Public Health, University of Montpellier, France; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn, USA; World Health Organization Collaborating Centre on Scientific Classification Support, Montpellier, France; Hospital Sírio-Libanês, São Paulo, Brazil. Electronic address: luciana.tanno@gmail.com.
Abstract
BACKGROUND: Although rare, anaphylaxis during pregnancy implies a risk to both mothers and newborns. OBJECTIVE: This systematic review is intended to identify key issues in the diagnosis and management of this condition to support prevention strategies and decrease the risk for death related to anaphylaxis during pregnancy. METHODS: We searched MEDLINE, Cochrane, LILACS, SciELO, and Science Direct databases for manuscripts concerning the term "anaphylaxis during pregnancy," without language restrictions. We screened studies, extracted data, and assessed the risk for bias independently in duplicate. RESULTS: We selected 12 articles. Frequency of anaphylaxis during maternity was estimated to be 1.5 to 3.8 per 100,000 pregnancies. Only one study provided anaphylaxis mortality data in pregnant women; the rate of anaphylaxis-related maternal mortality was estimated at 0.05/100,000 live births. No standard definition of anaphylaxis severity has been used. A total of 49% to 74% of anaphylaxis cases were described during caesarean section. Beta-lactam antibiotics (58%), latex (25%), and anesthetic agents (17%) were the main causes. In 17% of reports, causative agents were proven by allergy testing. Moreover, 72% of articles proposed the same management and treatment for a clinical episode of anaphylaxis during pregnancy as for nonpregnant patients, and the use of epinephrine in the patient's care during anaphylaxis in pregnancy. CONCLUSIONS: Few studies address anaphylaxis during pregnancy. Most have been produced by nonallergy specialists. Collaboration among different specialists involved in the care of pregnant women should be established to support preventive strategies and reduce avoidable deaths.
BACKGROUND: Although rare, anaphylaxis during pregnancy implies a risk to both mothers and newborns. OBJECTIVE: This systematic review is intended to identify key issues in the diagnosis and management of this condition to support prevention strategies and decrease the risk for death related to anaphylaxis during pregnancy. METHODS: We searched MEDLINE, Cochrane, LILACS, SciELO, and Science Direct databases for manuscripts concerning the term "anaphylaxis during pregnancy," without language restrictions. We screened studies, extracted data, and assessed the risk for bias independently in duplicate. RESULTS: We selected 12 articles. Frequency of anaphylaxis during maternity was estimated to be 1.5 to 3.8 per 100,000 pregnancies. Only one study provided anaphylaxis mortality data in pregnant women; the rate of anaphylaxis-related maternal mortality was estimated at 0.05/100,000 live births. No standard definition of anaphylaxis severity has been used. A total of 49% to 74% of anaphylaxis cases were described during caesarean section. Beta-lactam antibiotics (58%), latex (25%), and anesthetic agents (17%) were the main causes. In 17% of reports, causative agents were proven by allergy testing. Moreover, 72% of articles proposed the same management and treatment for a clinical episode of anaphylaxis during pregnancy as for nonpregnant patients, and the use of epinephrine in the patient's care during anaphylaxis in pregnancy. CONCLUSIONS: Few studies address anaphylaxis during pregnancy. Most have been produced by nonallergy specialists. Collaboration among different specialists involved in the care of pregnant women should be established to support preventive strategies and reduce avoidable deaths.