Khalaf Roy, Prosty Connor, McCusker Christine, Bretholz Adam, Kaouache Mohammed, Clarke Ann E, Morris Judy, Lim Rodrick, Chan Edmond S, Goldman Ran D, O'Keefe Andrew, Gerdts Jennifer, Chu Derek K, Upton Julia, Hochstadter Elana, Moisan Jocelyn, Zhang Xun, Protudier Jennifer L P, Abrams Elissa, Simons Elinor, Ruiz Juan, Ben-Shoshan Moshe
Faculty of Medicine, McGill University, Montreal, Québec, Canada.
Department of Pediatrics, Division of Allergy Immunology and Dermatology, McGill University Health Centre, Montreal, Québec, Canada.
Int Arch Allergy Immunol. 2025;186(5):454-464. doi: 10.1159/000542115. Epub 2024 Nov 15.
Anaphylaxis is an acute life-threatening allergy, most commonly provoked by food, venom, or drugs. There is limited data regarding differences in symptomatology between anaphylaxis provoked by different triggers. This study aimed to assess sociodemographic characteristics, clinical symptoms, and management of anaphylaxis, according to triggers in adults.
We conducted a cross-sectional study recruiting adult patients with anaphylactic reactions across 8 emergency departments (EDs) and 1 electronic medical service (EMS) in Canada. Univariate and multivariate regression models were used to evaluate symptoms involving all patients with the outcome of drug-induced anaphylaxis (DIA), venom-induced anaphylaxis (VIA), peanut-induced anaphylaxis (PIA), shellfish-induced anaphylaxis, tree-nut induced anaphylaxis (TIA) and nut-induced anaphylaxis (NIA). We assessed comorbidities associated with severe reactions, stratified by triggers listed above. Additionally, we evaluated the association of each trigger with treatment through regression models involving all patients with medications used as outcome and anaphylaxis triggers used as independent variables.
From April 2011 to November 2023, 1,135 adults presenting with anaphylaxis to EDs were recruited. The median age was 35.5 (interquartile range 25.3-51.1). Most of the patients presented with FIA (50.3%). Regarding symptomatology, hypotension was more likely associated with DIA (aOR = 1.20, 95% CI = 1.11-1.30, p < 0.01). When adjusted for age at reaction and male sex, alcohol was more likely associated (aOR = 1.51, 95% CI = 1.04-2.19, p = 0.035) with NIA. Regarding management, TIA was more likely associated with inpatient epinephrine (aOR = 2.05, 95% CI = 1.16-3.64, p = 0.014). DIA was less likely associated with outpatient antihistamine (aOR = 0.68, 95% CI = 0.48-0.89, p < 0.01) whereas TIA was more likely associated with outpatient antihistamine (aOR = 1.81, 95% CI = 1.03-3.19, p = 0.040).
Our study underscores associations between specific triggers, clinical manifestations and managements, such as the potential link between TIA and throat tightness and hypotension and VIA. Identifying such associations can aid with the prompt diagnosis of anaphylaxis in patients presenting to the ED, leading to swifter treatment initiation and improving overall outcomes.
过敏反应是一种急性危及生命的过敏症，最常见的诱因是食物、毒液或药物。关于不同诱因引发的过敏反应在症状学上的差异，数据有限。本研究旨在根据成人过敏反应的诱因，评估社会人口学特征、临床症状及治疗情况。
我们开展了一项横断面研究，招募了加拿大8个急诊科（EDs）和1个电子医疗服务机构（EMS）中发生过敏反应的成年患者。采用单变量和多变量回归模型，评估药物性过敏反应（DIA）、毒液性过敏反应（VIA）、花生性过敏反应（PIA）、贝类性过敏反应、坚果性过敏反应（TIA）和坚果类过敏反应（NIA）所有患者的症状。我们评估了与严重反应相关的合并症，并按上述诱因进行分层。此外，我们通过回归模型评估每种诱因与治疗的关联，该模型将所有使用的药物作为结果变量，过敏反应诱因作为自变量。
2011年4月至2023年11月，招募了1135名到急诊科就诊的过敏反应成年患者。中位年龄为35.5岁（四分位间距25.3 - 51.1）。大多数患者表现为食物性过敏反应（FIA，50.3%）。关于症状学，低血压更可能与药物性过敏反应相关（调整后比值比[aOR]=1.20，95%置信区间[CI]=1.11 - 1.30，p<0.01）。在对反应时年龄和男性性别进行调整后，酒精更可能与坚果类过敏反应相关（aOR = 1.51，95% CI = 1.04 - 2.19，p = 0.035）。关于治疗，坚果性过敏反应更可能与住院使用肾上腺素相关（aOR = 2.05，95% CI = 1.16 - 3.64，p = 0.014）。药物性过敏反应与门诊使用抗组胺药的相关性较小（aOR = 0.68，95% CI = 0.48 - 0.89，p<0.01），而坚果性过敏反应与门诊使用抗组胺药的相关性更大（aOR = 1.81，95% CI = 1.03 - 3.19，p = 0.040）。
我们的研究强调了特定诱因、临床表现和治疗之间的关联，如坚果性过敏反应与喉咙发紧以及低血压和毒液性过敏反应之间的潜在联系。识别这些关联有助于在急诊科就诊的患者中迅速诊断过敏反应，从而更快地开始治疗并改善总体预后。
