Department of Allergy, University Hospital of Montpellier, Montpellier.
Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 University of Montpellier INSERM.
Curr Opin Allergy Clin Immunol. 2022 Aug 1;22(4):215-220. doi: 10.1097/ACI.0000000000000835.
To identify patterns and key issues though a systematic review in order to support prevention strategies and reduce avoidable deaths related to drug-induced anaphylaxis (DAF).
DAF rate has been estimated by 0.13-0.53/106 population/year. General global trends of DAF are increasing over time, mostly occurring at healthcare settings (62%) with a similar gender distribution and an average age of 53 years. Antibiotics, anaesthetics, radio-contrast media and NSAIDs were the most frequently implicated agents. Main comorbidities were personal history of drug allergy, cardiovascular diseases and asthma. Main manifestations were cardiovascular and respiratory commitments. Use of adrenaline is mentioned in only 29% of the articles.
DAF is increasing worldwide and most cases are iatrogenic. This first systematic review of DAF identified key gaps and served as a wake-up call to prevent avoidable deaths. Phenotype at risk for DAF was represented by patients aged more than 54 years, with personal history of drug allergy/hypersensitivity with no or incomplete allergological work-up, cardiovascular disease and/or asthma with need of hospitalization and/or frequent healthcare assistance. Additional risk for those who need frequent use of intravenous antibiotics and/or undergoing surgery or image investigation with radiocontrast media.
通过系统综述确定模式和关键问题，以支持预防策略并减少与药物引起的过敏反应（DAF）相关的可避免死亡。
DAF 的发生率估计为 0.13-0.53/106 人/年。DAF 的总体全球趋势随着时间的推移呈上升趋势，主要发生在医疗保健环境中（62%），性别分布相似，平均年龄为 53 岁。最常涉及的药物包括抗生素、麻醉剂、放射性对比剂和 NSAIDs。主要合并症为药物过敏、心血管疾病和哮喘的个人病史。主要表现为心血管和呼吸系统的承诺。只有 29%的文章提到了使用肾上腺素。
DAF 在全球范围内呈上升趋势，大多数病例是医源性的。这是对 DAF 的首次系统综述，确定了关键差距，并敲响了警钟，以预防可避免的死亡。DAF 的风险表型由年龄超过 54 岁的患者、有药物过敏/过敏史但无或不完全过敏检查、心血管疾病和/或哮喘、需要住院和/或经常接受医疗保健的患者代表。那些需要经常使用静脉内抗生素和/或接受手术或放射造影检查的患者的风险更高。
