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Clinical & Experimental Allergy

Anaphylaxis: risk factors for recurrence

Authors

  • R. J. Mullins

    1. University of Canberra (Associate Professor), Canberra, University of Sydney (Senior Lecturer), Sydney, Australian National University (Clinical Senior Lecturer), Canberra, Australia
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Dr Raymond J. Mullins, MB BS, PhD, FRACP, FRCPA, Suite 6, John James Medical Centre, 175 Strickland Crescent, Deakin, ACT 2600, Australia. E-mail: rmullins@allergycapital.com.au

Summary

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.

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