Researchers in Australia aimed to evaluate the risk factors in adults with severe, recurrent anaphylaxis presentations and to evaluate the management of patients regarding the recommended standard of care. Their results were recently published in the Internal Medicine Journal.
They performed a retrospective audit of adults with confirmed anaphylaxis who presented to the emergency department of St Vincent’s Hospital in Sydney from January 1, 2009 through December 31, 2018. The data they recorded included demographics, background history, medication use, severity, co-factors, triggers, management, discharge disposition, and referral for follow-up, employing statistical methods to analyze the data.
Over the audit period, 616 individuals were identified as presenting with 689 episodes of anaphylaxis, with 8.3% of the patients experiencing anaphylaxis on two or more occasions.
73.4% of all cases with known triggers were caused by food, with peanuts and seafood the most common. The second most common trigger for all cases was medications accounting for 22.4% of episodes.
For patients 65 and older, triggers were more often identifiable than for their younger counterparts, with asthma identified as a risk factor for severe anaphylaxis. For this cohort, medications were identified as the predominant trigger at 75% vs 20% for those younger patients.
The researchers found that a history of food allergy with food as the trigger was linked with recurrent presentations with anaphylaxis and that the frequency of anaphylaxis presentations at the facility increased over time but with no major variations in triggers or severity.
They found only 19% received the standard of care with post-epinephrine monitoring and the recommendation of follow-up with an allergy specialist as the largest gaps.
Based on their analysis, they concluded that increased age and asthma were risk factors for severe presentations and that food allergy was a risk for recurrent presentations.