Anaphylaxis in an emergency setting - elicitors, therapy and incidence of severe allergic reactions
Anaphylaxis in an emergency setting - elicitors, therapy and incidence of severe allergic reactions
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DOI：
10.1111/all.12012
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发表时间：
2012-11-01
期刊：
影响因子：
12.4
通讯作者：
Worm, M.
中科院分区：
文献类型：
--
作者：
Beyer, K.;Eckermann, O.;Worm, M.
背景过敏反应是一种严重的可能危及生命的超敏反应，估计终生患病率为0.52.0%。过敏反应在德国的患病率和发生率未知。因此，我们评估了柏林地区400万人的急诊医生所见的过敏性患者。方法采用标准化调查表对2008 - 2010年急诊科医师进行问卷调查。结果共报告过敏反应333例。其中295例符合严重程度的入选标准，并进行了分析。13.9%（n=41）为呼吸道症状反应，25.4%（n=75）为心血管反应，60.7%（n=179）的病例报告了呼吸道和心血管症状。两种反应是致命的。最常见的诱生物是食品（32.2%）、药物（29.2%）和昆虫毒液（19.3%）。最常使用的药物是皮质激素和抗组胺药，但不是肾上腺素。2008年，计算的发病率为每10万人4.5例。结论我们的数据表明，食品是包括儿童和成人在内的一般人群中严重过敏反应的常见诱发物。它揭示了急诊医生对肾上腺素的严重使用不足，没有反映出根据现行指南的治疗方案。由于从过敏症专科医生获得的数据揭示了不同的等级顺序的诱导剂，这项研究表明，食物过敏的成年患者可能会出现一个危险的人群，应该得到过敏症专科医生更多的关注。
Background Anaphylaxis is a severe potentially life-threatening hypersensitivity reaction with an estimated lifetime prevalence of 0.52.0%. The prevalence and incidence of anaphylactic reactions in Germany are unknown. We therefore assessed anaphylactic patients seen by emergency physicians in the Berlin area covering 4million people. Methods A standardised questionnaire was filled from 2008 to 2010 by the emergency physicians. Results A total of 333 cases of anaphylaxis were reported. 295 of these met the inclusion criteria for severity and were analysed. 13.9% (n=41) were reactions with respiratory symptoms, 25.4% (n=75) with cardiovascular, and in 60.7% (n=179) of cases, respiratory and cardiovascular symptoms were reported. Two reactions were fatal. The most common elicitors were food products (32.2%), drugs (29.2%) and insect venom (19.3%). The most frequently given drugs were corticoids and antihistamines, but not adrenaline. For 2008, the calculated incidence was 4.5 per 100000. Conclusions Our data show that food products are frequent elicitors of severe allergic reactions in the general population including children and adults. It unravels a strong underuse of adrenaline by emergency physicians, not reflecting treatment protocols according to the current guidelines. As data obtained from allergists reveal a different rank order of elicitors, this study suggests that food-allergic adult patients may present a risk population and should receive more attention by allergists.