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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, Hospital da Luz Lisboa, 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, Centro Hospitalar Universitário do 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)
: 23-32
doi: 10.18176/jiaci.0515
Background: Anaphylaxis is an acute, life-threatening, multiorgan hypersensitivity reaction.
Objective: The aim of this study was to identify the causes of anaphylaxis in Portugal in order to improve our knowledge of epidemiology and management.
Methods: We implemented a nationwide notification system for anaphylaxis over a 10-year period, with voluntary reporting by allergists. Data on 1783 patients with anaphylaxis were included. Etiopathogenesis, manifestations, and clinical management were characterized in detail for both children and adults.
Results: The mean age was 32.7 (20.3) years, and 30% were 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 to 88 years). The main culprits of anaphylaxis were foods (48%), drugs (37%) (main trigger in adults, 48%), and hymenoptera venom (7%). The main culprit foods were shellfish (27%), fresh fruit (17%), cow’s milk (16%), tree nuts (15%), fish (8%), egg (7%), and peanut (7%). The main drugs were nonsteroidal anti-inflammatory drugs (43%), antibiotics (39%), and anesthetic agents (6%). Other causes included exercise (3%), latex (2%), cold-induced anaphylaxis (2%), and idiopathic anaphylaxis (2%). Most patients (80%) were admitted to the emergency department; only 43% received adrenaline. Anaphylaxis recurred in 41% of patients (21% with ≥3 anaphylactic episodes); 7% used an adrenaline autoinjector device.
Conclusions: Food is the leading cause of anaphylaxis in Portugal, while drugs were the main elicitors in adults. We emphasize undertreatment with adrenaline and recurrent episodes, highlighting the need to improve diagnostic and therapeutic approaches to anaphylaxis.
Key words: Adrenaline, Anaphylaxis, Drug allergy, Epidemiology, Epinephrine, Food allergy, Nationwide registry
