“The changing face of anaphylaxis in adults and adolescents”

Publication date: Available online 30 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Debendra Pattanaik, Phil Lieberman, Jay Lieberman, Thanai Pongdee, Alexandria Tran Keene

Abstract

Background

Our institution has published serial studies of adults and adolescents experiencing anaphylactic events. The first series was published in 1993 and the last in 2006. It was our perception that the nature of anaphylactic episodes had changed over the two decades since the last review.

Objective

To determine whether the etiologies and presentations of anaphylaxis has changed over the last decade in our population.

Methods

Patient charts were identified based upon ICD-9 codes for anaphylactic shock. Charts identified were analyzed for clinical symptoms reported, comorbidities, etiology, investigative testing, and subsequent treatment. These cases were categorized as definitive, probable, or idiopathic based on history and results from testing, similar to our prior reports.

Results

We identified 281 possible cases, of which 218 met criteria for anaphylaxis. Among the cases, median age was 42 years (range 9-78) and 64% were female. In the review of cases, 85 (39%) were determined to have a definitive etiology, 57 a probable etiology (26%), and 76 (35%) were idiopathic. Interestingly, among those with a definitive cause, the most common etiology identified was galactose-alpha-1,3-galactose (α- gal), accounting for 28 cases (33%). Foods were the 2nd leading cause accounting for 24 cases (28%).

Conclusion

In this follow up report on anaphylaxis etiology from a single center, the most common etiology was α-gal. This varies greatly from the prior reports our center. Interestingly, the percent of cases attributed to idiopathic anaphylaxis decreased from 59% in our past report to 35% in this report, which could largely be explained by the number of α-gal cases.

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