Risk factors for severe anaphylaxis in patients receiving anaphylaxis treatment in US emergency departments and hospitals
Risk factors for severe anaphylaxis in patients receiving anaphylaxis treatment in US emergency departments and hospitals
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DOI：
10.1016/j.jaci.2014.05.018
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发表时间：
2014-11-01
影响因子：
14.2
通讯作者：
Camargo, Carlos A., Jr.
中科院分区：
文献类型：
--
作者：
Clark, Sunday;Wei, Wenhui;Camargo, Carlos A., Jr.
背景资料：虽然报道的严重过敏反应的危险因素包括年龄较大、存在合并症和伴随用药，但以前的研究使用了不同的过敏反应定义和异质性方法。目的：描述在急诊科（ED）或医院接受过敏反应治疗的美国患者中严重过敏反应的危险因素。使用扩展的国际疾病分类第九版临床改良诊断代码算法，从2个MarketScan研究数据库中识别因速发过敏反应而接受艾德访视/住院治疗的个体。当前研究的资格要求在索引日期之前和之后至少1年的连续医疗和处方覆盖。严重过敏反应被定义为需要住院的反应。结果：在11,972人，2,622（22%）有严重过敏反应。未校正分析显示，严重过敏反应与年龄较大和合并症负担较高相关。这些患者也不太可能填写肾上腺素自动注射器（EAI）处方或访问过敏症专科医生/免疫学家，但更可能有艾德访问/住院（任何原因）。在多变量分析中，填写EAI处方（比值比[OR]，0.64; 95% CI，0.53-0.78）或访问过敏症专科医生/免疫学家（OR，0.78; 95% CI，0.63-0.95）与重度过敏反应风险较低相关，而任何既往艾德访视（OR，1.18; 95%CI，1.07-1.30）或住院治疗（OR，1.55; 95%CI，1.36-1.75）与严重过敏反应的高风险相关。结论：在这个大的队列中，艾德就诊或因过敏反应住院治疗，22%有严重过敏反应。索引前预防性速发过敏反应护理（即，EAI处方填写和过敏症专科医生/免疫学家访视）与显著较低的风险相关，支持预防性速发过敏反应护理在现实世界实践中的获益。
Background: Although reported risk factors for severe anaphylaxis include older age, presence of comorbid medical conditions, and concomitant medications, previous studies have used varying definitions for anaphylaxis and heterogeneous methodology.Objective: To describe risk factors for severe anaphylaxis among US patients treated in emergency departments (EDs) or hospitals for anaphylaxis.Methods: Individuals with an ED visit/hospitalization for anaphylaxis were identified from 2 MarketScan Research Databases using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. Eligibility for the current study required continuous medical and prescription coverage for at least 1 year before and after the index date. Severe anaphylaxis was defined as a reaction requiring hospital admission.Results: Among 11,972 individuals, 2,622 (22%) had severe anaphylaxis. Unadjusted analysis showed that severe anaphylaxis was associated with older age and higher comorbidity burden. These patients were also less likely to have filled an epinephrine autoinjector (EAI) prescription or visited an allergist/immunologist, but more likely to have had an ED visit/hospitalization (any cause). On multivariable analysis, filling an EAI prescription (odds ratio [OR], 0.64; 95% CI, 0.53-0.78) or visiting an allergist/immunologist (OR, 0.78; 95% CI, 0.63-0.95) before the index event was associated with a lower risk of severe anaphylaxis, while any previous ED visit (OR, 1.18; 95% CI, 1.07-1.30) or hospitalization (OR, 1.55; 95% CI, 1.36-1.75) was associated with a higher risk of severe anaphylaxis.Conclusions: In this large cohort with an ED visit or hospitalization for anaphylaxis, 22% had severe anaphylaxis. Pre-index preventive anaphylaxis care (ie, EAI prescription fill and allergist/immunologist visit) was associated with a significantly lower risk, supporting the benefits of preventive anaphylaxis care in real-world practice.