Anaphylaxis: risk factors for recurrence
Article first published online: 5 AUG 2003
Clinical & Experimental Allergy
Volume 33, Issue 8, pages 1033–1040, August 2003
How to Cite
Mullins, R. J. (2003), Anaphylaxis: risk factors for recurrence. Clinical & Experimental Allergy, 33: 1033–1040. doi: 10.1046/j.1365-2222.2003.01671.x
- Issue published online: 5 AUG 2003
- Article first published online: 5 AUG 2003
- Submitted 15 February 2002; revised 15 November 2002; accepted 13 February 2003
- psychiatric morbidity;
Background There are few studies on the incidence or recurrence of anaphylaxis.
Objective To examine the incidence of anaphylaxis and risk factors for recurrence.
Methods A prospective study of 432 patients referred to a community-based specialist practice in the Australian Capital Territory with anaphylaxis, followed by a survey to obtain information on recurrence.
Results Of 432 patients (48% male, 73% atopic, mean 27.4 years, SD 19.5, median 26) with anaphylaxis, 260 patients were seen after their first episode; 172 experienced 584 previous reactions. fifty-four percent of index episodes were treated in hospital. Aetiology was identified in 91.6% patients: food (61%), stinging insects (20.4%) or medication (8.3%). The minimum occurrence and incidence of new cases of anaphylaxis was estimated at 12.6 and 9.9 episodes/100,000 patient-years, respectively. Follow-up data were obtained from 304 patients (674 patient-years). One hundred and thirty experienced further symptoms (45 serious), 35 required hospitalization and 19 administered adrenaline. Accidental ingestion of peanut/tree nut caused the largest number of relapses, but the highest risk of recurrence was associated with sensitivity to wheat and/or exercise. Rates of overall and serious recurrence were 57 and 10 episodes/100 patient-years, respectively. Of those prescribed adrenaline, 3/4 carried it, 2/3 were in date, and only 1/2 patients faced with serious symptoms administered adrenaline. Five patients each developed new triggers for anaphylaxis, or re-presented with significant psychiatric symptoms.
Conclusion In any 1 year, 1/12 patients who have suffered anaphylaxis will experience recurrence, and 1/50 will require hospital treatment or use adrenaline. Compliance with carrying and using adrenaline is poor. Occasional patients develop new triggers or suffer psychiatric morbidity.