Jiaci

Corriger J, et al.

J Investig Allergol Clin Immunol 2019; Vol. 29(5): 357-364

doi: 10.18176/jiaci.0348

Reference Population

The geographical regions were defined using the official

map of France for the year 2014. Data were collected and

anonymized after approval by our institutional Advisory

Committee on the Treatment of Information on Research in

the Field of Health (CCTIRS) [16].

Statistical Analysis

Data were analyzed using LibreOffice and EpiData. The

statistical descriptions included mean, median, and standard

deviation for quantitative variables and frequencies and

percentages for categorical variables. The group comparisons

were made using the χ

test for categorical variables and

the

test for quantitative variables. An analysis of variance

(ANOVA) was performed to compare the means of multiple

samples. A

value of <.05 was considered significant.

Results

The epidemiological and clinical characteristics of the

patients and results for the management of the anaphylactic

reactions are summarized in Table 2. In 2015, anaphylaxis

was responsible for 0.16% of ED admissions. Extrapolating

to the urban areas covered, the incidence was estimated

at 34 per 100 000 person-years. Of the 323 patients with

clinically confirmed anaphylaxis, 67.2% were adults aged

18 to 88.4 years, and 32.8% were children aged 2 months to

18 years. The sex ratio was 1.32 in favor of males. Adults

presented mainly drug-induced and insect sting–related

anaphylaxis, whereas food was the main trigger in the

pediatric population (Table 2). No deaths were reported. A

previous history of anaphylaxis was found in 20.1% and a

biphasic reaction in 5.0% of the patients. Epinephrine was

used significantly more often in adults than in children

(

=.045). Although 45.8% (148/323) of the patients presented

severe anaphylaxis (Ring &Messmer grade ≥3), epinephrine

was prescribed in only 32.4% (48/148) of these cases, mostly

by intravenous injection (41.7%), and more often in children

than in adults (

=.02). Children were more frequently

referred to allergists and received more prescriptions than

adults (Table 2). Serum tryptase was measured in 12.7% of

patients, and 60.1% were kept under observation in hospital

for less than 6 hours (median, 4.7 hours).

Of the 323 cases, 57.9%were subsequently referred for an

allergy work-up or evaluation (after or during hospitalization),

and 17.3% were prescribed autoinjectable epinephrine

(Table 2). Twenty percent of patients experienced more than 1

episode of anaphylaxis, even after the allergological diagnosis

was established (37%with exposure to food allergens and 22%

after drug intake).

Concomitant asthma was the only cofactor identified

as being significantly (

<.05) associated with more

severe (grade ≥3) anaphylactic episodes in children (OR, 2.37;

95%CI, 1.04-5.38). In adults, the only significantly associated

cofactor was use of 1 or more of a series of drugs (β-blockers,

aspirin and other nonsteroidal anti-inflammatory drugs,

angiotensin-converting enzyme inhibitors, angiotensin-2

receptor antagonists, proton pump inhibitors, dipeptidyl

peptidase-4 inhibitors, and glucagon-like peptide-1 agonists)

(OR, 2.18; 95%CI, 1.20-3.94). Clinical presentations were

influenced by specific factors: concomitant asthma was

associated with a higher frequency of lower respiratory tract

symptoms (OR, 2.26; 95%CI, 1.28-3.98), cardiovascular

disorders with cardiovascular injury (OR, 2.19; 95%CI, 1.06-

4.52), and food as a trigger with gastrointestinal manifestations

(OR, 1.83; 95%CI, 1.15-2.92) (

<.05 for all).

Of the 323 confirmed cases of anaphylaxis, only 14.3%

presented anaphylaxis classed as direct according to the

ICD-10

codes (Figure).

Discussion

Ours is the first study to present epidemiological data on

the morbidity and management of anaphylaxis in French EDs.

We highlight the need to harmonize knowledge of management

of anaphylaxis. Awareness of anaphylaxis as a life-threatening

medical condition has been increasing in various specialties,

Table 2.

Cases of Anaphylaxis: Characteristics and Demographic Data

Demographic Data

Children (<18 y)

Adults (≥18 y)

Total (0-88 y)

Value

n=106 (32.8%)

n=217 (67.2%)

N=323 (100.0%)

Hospitalization

31 (29.2%)

15 (6.9%)

46 (14.2%)

< .001

Observation period at the ED

<6 h 88 (83.0%)

149 (68.7%)

237 (73.4%)

>6 h 18 (17.0%)

68 (31.3%)

86 (26.6%)

.006

Referred to the allergist

78 (73.6%)

109 (50.2%)

187 (57.9%)

< .001

Prescription of

autoinjectable epinephrine

26 (24.5%)

30 (13.8%)

56 (17.3%)

.02

Abbreviations: ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin-2 receptor blockers; NSAID, nonsteroidal anti-inflammatory drugs;

PPI, proton pump inhibitor.

value for test of equality of proportions.

Ring & Messmer classification.

361