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KMID : 0385920230340010079
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Journal of the Korean Society of Emergency Medicine
2023 Volume.34 No. 1 p.79 ~ p.86
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Clinical features of anaphylaxis and risk factors of severe anaphylaxis in the emergency department
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Kim Seong-Woo
Jin Young-Ho
Jeong Tae-Oh
Yoon Jae-Chol
Kim So-Eun
Oh Tae-Hwan
Kim Sang-Min
Lee Jae-Baek
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Abstract
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Objective: This study investigates the triggers and clinical features of anaphylaxis, and determines the risk factors associated with severe anaphylaxis.
Methods: This is a retrospective observational study spanning a duration of 2 years (2020-2021) using the electronic data of patients diagnosed with anaphylaxis in the university-affiliated emergency center. Severe anaphylaxis was defined as refractory anaphylaxis requiring ≥3 times epinephrine administration and/or continuous epinephrine infusion.
Baseline and clinical characteristics were compared between the severe and the non-severe anaphylaxis groups. Binary logistic regression analysis was performed to reveal independent risk factors associated with severe anaphylaxis.
Results: The median age of study patients was determined to be 53.0 years (range, 37.5-65.0 years). Fifty-eight patients (58.0%) were male. Drugs were found to be the most common trigger. In clinical manifestations, cutaneous manifestation was the most common. Severe anaphylaxis occurred in 19 patients (19.0%). Latent time was shorter in the severe anaphylaxis group-10.0 minutes (5.0-20.0) vs. 30.0 minutes (10.0-60.0), P<0.001. Drug as a trigger (68.4% vs.
39.5%, P=0.023), hypotension (57.9% vs. 9.9%, P<0.001), cardiovascular manifestation (84.2% vs. 40.7%, P=0.001), and hyperlactatemia (73.7% vs. 46.9%, P=0.036) were more frequently observed in the severe anaphylaxis group.
Shorter latent time, drug as a trigger, and presence of hypotension were independent risk factors for severe anaphylaxis.
Conclusion: Anaphylaxis patients with shorter latent time, diagnosed with drugs as a trigger, and presenting with hypotension, must be subjected to careful monitoring and early active treatment.
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KEYWORD
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Allergy, Precipitating factors, Shock, Epidemiology
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