Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota.
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota; Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota.
Ann Allergy Asthma Immunol. 2018 Dec;121(6):717-721.e1. doi: 10.1016/j.anai.2018.08.021. Epub 2018 Sep 3.
Anaphylaxis is a potentially life-threatening allergic reaction with a strong risk of recurrence.
To assess risk factors associated with recurrent anaphylaxis-related emergency department (ED) visits within 1 year of an ED visit for anaphylaxis in a large observational cohort study.
We used an administrative claims database to identify patients seen from 2008 through 2012 in the ED for anaphylaxis based on an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. Patients with at least 2 years of continuous enrollment in a health plan were included. Multivariable logistic regression analysis was used to determine associations with recurrence of anaphylaxis within 1 year.
During the 5-year study period, 7,367 patients (median age, 42 years; <18 years old, 23.3%) met the inclusion criteria. The most common anaphylaxis trigger was unspecified (56.2%), followed by food (25.3%), medication (14.6%), and venom (3.9%). Overall, 3.0% of patients had an additional anaphylaxis-related ED visit within 1 year (3.61 episodes per 100 patient-years). On multivariable analysis, risk factors associated with anaphylaxis recurrence were food trigger (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.34-3.99), history of asthma (OR, 1.30; 95% CI, 1.13-1.51), and intensive care unit admission at the index anaphylaxis event (OR, 1.95; 95% CI, 1.41-2.69).
In this contemporary cohort study, history of asthma, food trigger, and greater index anaphylaxis severity, as measured by intensive care unit admission, were associated with a higher likelihood of a recurrent anaphylaxis-related ED visit within 1 year.
过敏反应是一种潜在的危及生命的过敏反应，具有很强的复发风险。
在一项大型观察性队列研究中，评估过敏反应急诊就诊后 1 年内与过敏反应相关的急诊就诊复发的相关危险因素。
我们使用行政索赔数据库，根据国际疾病分类，第九修订版，临床修正诊断代码算法，确定 2008 年至 2012 年在急诊就诊的过敏反应患者。患者在健康计划中至少连续注册 2 年。采用多变量逻辑回归分析确定与 1 年内过敏反应复发的关联。
在 5 年的研究期间，7367 名患者（中位数年龄 42 岁；<18 岁，23.3%）符合纳入标准。最常见的过敏反应触发因素为不明（56.2%），其次为食物（25.3%），药物（14.6%）和毒液（3.9%）。总体而言，有 3.0%的患者在 1 年内有另外一次与过敏反应相关的急诊就诊（每 100 患者年发生 3.61 次事件）。多变量分析显示，过敏反应复发的危险因素为食物触发（比值比 [OR]，2.31；95%置信区间 [CI]，1.34-3.99），哮喘病史（OR，1.30；95%CI，1.13-1.51）和指数过敏反应事件时入住重症监护病房（OR，1.95；95%CI，1.41-2.69）。
在这项当代队列研究中，哮喘病史，食物触发和更严重的指数过敏反应严重程度，如入住重症监护病房，与 1 年内发生复发性与过敏反应相关的急诊就诊的可能性更高相关。
