Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Division of Asthma and Allergy, Department of Pediatrics, Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI.
J Allergy Clin Immunol Pract. 2014 Jan-Feb;2(1):46-51. doi: 10.1016/j.jaip.2013.08.012. Epub 2013 Oct 23.
Drugs are a common cause of anaphylaxis, which is potentially life threatening.
We sought to describe US patients with an emergency department (ED) visit or hospitalization for drug-induced anaphylaxis (DIA), including postdischarge follow-up care.
By using International Classification of Diseases, Ninth Revision codes in the MarketScan Database, we identified all patients with an ED visit and/or hospitalization for DIA between 2002 and 2008 (index date = initial ED visit and/or hospitalization). Inclusion required continuous full insurance coverage ≥1 year in the pre- and postindex period. We examined patient factors during the preindex period, characteristics of the index event, and outcomes during the postindex period.
The cohort included 716 patients with an ED visit and/or hospitalization for DIA (mean age, 48 years; 71% women). Most patients (71%) were managed in the ED, and only 8% of the patients with DIA treated in the ED received epinephrine. For those admitted, patients were hospitalized for a median of 3 days, and 41% spent time in the intensive care unit. Cardiorespiratory failure occurred in 5% of the patients in the ED and 23% of the patients who were hospitalized. The patients with a concomitant allergic condition were more likely to see an allergist/immunologist than those without a concomitant allergic condition, but 82% did not receive any subsequent care with an allergist/immunologist in the 1 year after the ED visit and/or hospitalization for DIA.
Drugs are a common, yet under-recognized, cause of anaphylaxis. Only a small number of patients with DIA received epinephrine in the ED or had subsequent care with an allergist/immunologist. These findings are novel and identify areas for improvement in the care of individuals with DIA.
药物是引发过敏反应的常见原因，这种过敏反应可能危及生命。
我们旨在描述美国因药物引起的过敏反应（DIA）而到急诊科（ED）就诊或住院的患者，包括出院后的随访护理。
我们利用 MarketScan 数据库中的国际疾病分类第 9 版编码，在 2002 年至 2008 年期间（索引日期=首次 ED 就诊和/或住院）确定所有因 DIA 而到 ED 就诊和/或住院的患者。纳入标准为在就诊前和就诊后 1 年内连续、充分的保险覆盖。我们研究了就诊前的患者因素、索引事件的特征和就诊后的结果。
该队列纳入了 716 例因 DIA 而到 ED 就诊和/或住院的患者（平均年龄 48 岁，71%为女性）。大多数患者（71%）在 ED 接受治疗，仅 8%的 DIA 患者在 ED 接受了肾上腺素治疗。对于住院患者，中位住院时间为 3 天，41%的患者入住重症监护病房。ED 中 5%的患者和住院患者中有 23%发生心肺衰竭。同时患有过敏性疾病的患者比没有同时患有过敏性疾病的患者更有可能看过敏科医生/免疫学家，但有 82%的患者在因 DIA 到 ED 就诊和/或住院后的 1 年内未接受任何后续的过敏科医生/免疫学家治疗。
药物是过敏反应的常见但未被充分认识的原因。只有少数 DIA 患者在 ED 接受了肾上腺素治疗或在后续接受了过敏科医生/免疫学家的治疗。这些发现是新颖的，确定了改善 DIA 患者护理的改进领域。
