Anaphylaxis in an emergency setting – elicitors, therapy and incidence of severe allergic reactions

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Abstract
Background: Anaphylaxis is a severe potentially life‐threatening hypersensitivity reaction with an estimated lifetime prevalence of 0.5–2.0%. The prevalence and incidence of anaphylactic reactions in Germany are unknown. We therefore assessed anaphylactic patients seen by emergency physicians in the Berlin area covering 4 million people.Methods: A standardised questionnaire was filled from 2008 to 2010 by the emergency physicians.Results: A total of 333 cases of anaphylaxis were reported. 295 of these met the inclusion criteria for severity and were analysed. 13.9% (n = 41) were reactions with respiratory symptoms, 25.4% (n = 75) with cardiovascular, and in 60.7% (n = 179) of cases, respiratory and cardiovascular symptoms were reported. Two reactions were fatal. The most common elicitors were food products (32.2%), drugs (29.2%) and insect venom (19.3%). The most frequently given drugs were corticoids and antihistamines, but not adrenaline. For 2008, the calculated incidence was 4.5 per 100 000.Conclusions: Our data show that food products are frequent elicitors of severe allergic reactions in the general population including children and adults. It unravels a strong underuse of adrenaline by emergency physicians, not reflecting treatment protocols according to the current guidelines. As data obtained from allergists reveal a different rank order of elicitors, this study suggests that food‐allergic adult patients may present a risk population and should receive more attention by allergists.

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