Motosue Megan S, Bellolio M Fernanda, Van Houten Holly K, Shah Nilay D, Campbell Ronna L
Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota.
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
Ann Allergy Asthma Immunol. 2017 Oct;119(4):356-361.e2. doi: 10.1016/j.anai.2017.07.014.
Anaphylaxis is an acute systemic allergic reaction and may be life-threatening.
To assess risk factors associated with severe and near-fatal anaphylaxis in a large observational cohort study.
We analyzed administrative claims data from Medicare Advantage and privately insured enrollees in the United States from 2005 to 2014. Severe anaphylaxis was defined as anaphylaxis resulting in hospital or intensive care unit (ICU) admission, requiring endotracheal intubation, or meeting criteria for near-fatal anaphylaxis.
Of 38,695 patients seen in the emergency department for anaphylaxis during the study period, 4,431 (11.5%) required hospitalization, 2,057 (5.3%) were admitted to the ICU, 567 (1.5%) required endotracheal intubation, and 174 (0.45%) were classified as having a near-fatal episode. Multivariable analysis revealed that medication-related anaphylaxis (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.38-1.63; P < .001), age of 65 years or older (OR, 3.15; 95% CI, 2.88-3.44; P < .001), and the presence of cardiac disease (OR, 1.56; 95% CI, 1.50-1.63; P < .001) or lung disease (OR, 1.23; 95% CI, 1.16-1.30; P < .001) were associated with increased odds of severe anaphylaxis requiring any hospital admission, ICU admission, or intubation or being a near-fatal reaction.
In this large contemporary cohort study, 11.6% of patients had severe anaphylaxis. Age of 65 years or older, medication as a trigger, and presence of comorbid conditions (specifically cardiac and lung disease) were associated with significantly higher odds of severe anaphylaxis. Additional studies examining risk factors for severe anaphylaxis are needed to define risk assessment strategies and establish a framework for management.
过敏反应是一种急性全身性过敏反应，可能危及生命。
在一项大型观察性队列研究中评估与严重及近乎致命的过敏反应相关的危险因素。
我们分析了2005年至2014年美国医疗保险优势计划和私人参保者的管理索赔数据。严重过敏反应被定义为导致住院或入住重症监护病房（ICU）、需要气管插管或符合近乎致命过敏反应标准的过敏反应。
在研究期间因过敏反应到急诊科就诊的38,695例患者中，4,431例（11.5%）需要住院治疗，2,057例（5.3%）入住ICU，567例（1.5%）需要气管插管，174例（0.45%）被归类为发生近乎致命的发作。多变量分析显示，药物相关过敏反应（比值比[OR]，1.50；95%置信区间[CI]，1.38 - 1.63；P <.001）、65岁及以上年龄（OR，3.15；95% CI，2.88 - 3.44；P <.001）以及存在心脏病（OR，1.56；95% CI，1.50 - 1.63；P <.001）或肺病（OR，1.23；95% CI，1.16 - 1.30；P <.001）与需要任何住院治疗、入住ICU、插管或发生近乎致命反应的严重过敏反应几率增加相关。
在这项大型当代队列研究中，11.6%的患者发生了严重过敏反应。65岁及以上年龄、药物作为触发因素以及存在合并症（特别是心脏病和肺病）与严重过敏反应的几率显著升高相关。需要进一步研究严重过敏反应的危险因素，以确定风险评估策略并建立管理框架。
