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Anaphylaxis: a decade of a nationwide allergy society registry

Gaspar A1, Santos N2, Faria E3, Câmara R4, Rodrigues-Alves R5, Carrapatoso I3, Gomes E6, Pereira AM7, Carneiro-Leão L8, Morais-Almeida M9, Delgado L7,8,10, Pedro E11, Branco-Ferreira M11,12, Portuguese Society of Allergology and Clinical Immunology (SPAIC) Anaphylaxis Interest Group

1Immunoallergy Department, Luz Saude, Hospital Luz, Lisbon, Portugal
2Immunoallergy Department, Centro Hospitalar Universitário Algarve, Portugal
3Immunoallergy Department, Centro Hospitalar Universitário Coimbra, Portugal
4Immunoallergology Unit, Hospital Dr. Nélio Mendonça, Funchal, Portugal
5Immunoallergology Unit, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
6Immunoallergy Department, Hospital Maria Pia, Centro Hospitalar Porto, Portugal
7Immunoallergology Unit, Hospital CUF Porto and Instituto CUF Porto, Portugal
8Immunoallergy Department, Centro Hospitalar São João, Porto, Portugal
9Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal
10Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
11Immunoallergy Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Portugal
12Immunoallergology University Clinic, Faculty of Medicine of the University of Lisbon, Portugal

J Investig Allergol Clin Immunol 2022; Vol. 32(1)
doi: 10.18176/jiaci.0515

Background: Anaphylaxis is an acute, life-threatening, multi-organ hypersensitivity reaction.
Objective: The aim of this study was to identify the causes of anaphylaxis in Portugal, contributing to a better knowledge of the anaphylaxis epidemiology and management.
Methods: During a 10-year period a nationwide notification system for anaphylaxis was implemented, with voluntary reporting by allergists. Data on 1783 patients with anaphylaxis were included. Detailed characterization of etiopathogenesis, manifestations and clinical management was obtainedfrom pediatric and adult ages.
Results: The mean age was 32.7±20.3 years, 30% under 18 years of age; 58% were female. The mean age at the first anaphylaxis episode was 27.5±20.4 years (ranging from 1-month-old to 88years). The main culprits of anaphylaxis were foods (48%), drugs (37%) (main trigger in adults, 48%) and hymenoptera-venoms (7%). The main culprit foods were shellfish (27%), fresh fruits (17%), cow’s milk (16%), treenuts (15%), fish (8%), egg (7%) and peanut (7%). The main drugs were nonsteroidal anti-inflammatory drugs(43%), antibiotics (39%) and anaesthetic agents (6%). Other causes were exercise (3%), latex (2%), cold-induced (2%) and idiopathic anaphylaxis (2%). Most patients (80%) were admitted to the emergency department; only 43% received adrenaline treatment. Recurrence of anaphylaxis occurred in 41% of patients (21% with ≥3 anaphylactic episodes); 7% used an adrenaline autoinjector device.
Conclusions: Food has been the leading cause of anaphylaxis in Portugal, while drugs were the main elicitors in adults. We highlight the undertreatment with adrenaline and recurrent episodes, pointing for the need to improve diagnostic and therapeutic approaches of anaphylaxis.

Key words: Adrenaline, Anaphylaxis, Drug allergy, Epidemiology, Epinephrine, Food allergy, Nationwide registry