Yeğit Osman Ozan, Aslan Ayşe Feyza, Coşkun Raif, Karadağ Pelin, Toprak İlkim Deniz, Can Ali, Öztop Nida, Demir Semra, Ünal Derya, Olgaç Müge, Gelincik Aslı
Department of Internal Medicine, Division of Immunology and Allergy, Istanbul University, Istanbul, Türkiye.
Adult Immunology and Allergy Clinic, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Türkiye.
World Allergy Organ J. 2023 Aug 26;16(8):100810. doi: 10.1016/j.waojou.2023.100810. eCollection 2023 Aug.
In 2020, World Allergy Organization (WAO) updated their diagnostic criteria for anaphylaxis, which differed as a result from the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) criteria which were still used in the 2021 update of the European Academy of Allergy and Clinical Immunology (EAACI) anaphylaxis guideline. Our aim was to evaluate and to compare both diagnostic criteria and attempt to identify factors affecting severity of anaphylaxis.
The medical records of the patients who were evaluated with suspected anaphylaxis at 3 medical centers in Türkiye between 2014 and 2021, and underwent a detailed diagnostic work-up, were analyzed retrospectively. Diagnosis of anaphylaxis was evaluated based on the WAO 2020 and EAACI 2021 and NIAID/FAAN diagnostic criteria. The severity of anaphylaxis was determined according to the WAO systemic allergic reaction grading system. Grade 5 anaphylaxis was defined as having respiratory failure, collapse/hypotension, loss of consciousness. Patients' demographic and clinical characteristics were further analyzed depending on the severity of the reaction.
One thousand and six patients were evaluated and 232 patients without a convincing diagnosis of anaphylaxis were excluded from the study. The remaining 774 patients (70.6% female, median [Inter quartile range (IQR) 25-75] age: 42 [33-52]) were included for further examination. Anaphylaxis was diagnosed in 729 (94.2%) patients meeting both criteria whereas 35 patients (4.5%) with isolated laryngeal involvement and 10 (1.3%) patients with isolated respiratory involvement were only diagnosed according to the WAO 2020 criteria. Twenty-three patients (3.0%) had a diagnosis of indolent systemic mastocytosis. Mastocytosis was related to grade 5 anaphylaxis [p = 0.022, OR (CI) = 2.9 (1.1-7.6)]. Venom allergy was a risk factor for grade 5 anaphylaxis among those for whom an eliciting allergen could be determined [p = 0.03, OR (CI) = 2.7 (1.1-6.8)]. For drug induced anaphylaxis, parenteral route of drug administration and proton pump inhibitor (PPI) allergy were considered as risk factors for grade 5 anaphylaxis [p < 0.001, OR (CI) = 6.5 (2.5-17.0); p = 0.011, OR (CI) = 10.3 (1.6-63.3)].
This multicenter study demonstrated that both criteria identified the majority of patients with anaphylaxis, but the WAO 2020 diagnostic criteria identified an additional 6%. Hymenoptera stings, PPI allergy, parenteral drug administration, and underlying mastocytosis were associated with more severe episodes.
2020年，世界过敏组织（WAO）更新了过敏反应的诊断标准，这与美国国立过敏和传染病研究所/食物过敏与过敏反应网络（NIAID/FAAN）的标准不同，后者仍用于欧洲变态反应和临床免疫学会（EAACI）2021年更新的过敏反应指南中。我们的目的是评估和比较这两种诊断标准，并试图确定影响过敏反应严重程度的因素。
回顾性分析2014年至2021年间在土耳其3个医疗中心因疑似过敏反应接受评估并进行详细诊断检查的患者的病历。根据WAO 2020年、EAACI 2021年以及NIAID/FAAN诊断标准对过敏反应进行评估。根据WAO全身过敏反应分级系统确定过敏反应的严重程度。5级过敏反应定义为出现呼吸衰竭、虚脱/低血压、意识丧失。根据反应的严重程度进一步分析患者的人口统计学和临床特征。
共评估了1006例患者，其中232例未确诊为过敏反应的患者被排除在研究之外。其余774例患者（70.6%为女性，中位年龄[四分位间距（IQR）25 - 75]：42岁[33 - 52岁]）被纳入进一步检查。729例（94.2%）患者符合两种标准，均被诊断为过敏反应，而35例（4.5%）仅有喉部受累和10例（1.3%）仅有呼吸道受累的患者仅根据WAO 2020年标准被诊断为过敏反应。23例（3.0%）患者被诊断为惰性系统性肥大细胞增多症。肥大细胞增多症与5级过敏反应相关[p = 0.022，比值比（CI）= 2.9（1.1 - 7.6）]。在能够确定诱发过敏原的患者中，毒液过敏是5级过敏反应的危险因素[p = 0.03，比值比（CI）= 2.7（1.1 - 6.8）]。对于药物性过敏反应，药物的胃肠外给药途径和质子泵抑制剂（PPI）过敏被认为是5级过敏反应的危险因素[p < 0.001，比值比（CI）= 6.5（2.5 - 17.0）；p = 0.011，比值比（CI）= 10.3（1.6 - 63.3）]。
这项多中心研究表明，两种标准都能识别出大多数过敏反应患者，但WAO 2020年诊断标准能多识别出6%的患者。膜翅目昆虫叮咬、PPI过敏、胃肠外给药以及潜在的肥大细胞增多症与更严重的发作相关。
