Care of anaphylaxis among practising doctors

Authors

  • M. Worm,

    Corresponding author
      *Department of Dermatology and Allergy
      Charité– Universitätsmedizin Berlin
      Charitéplatz 1
      D – 10117 Berlin
      Germany
      Tel.: +49 30 450 518 105
      Fax: +49 30 450 518 919
      E-mail: margitta.worm@charite.de
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  • S. Hompes,

  • N. Vogel,

  • J. Kirschbaum,

  • T. Zuberbier


  • Management of anaphylaxis in daily practice.

*Department of Dermatology and Allergy
Charité– Universitätsmedizin Berlin
Charitéplatz 1
D – 10117 Berlin
Germany
Tel.: +49 30 450 518 105
Fax: +49 30 450 518 919
E-mail: margitta.worm@charite.de

Anaphylaxis is a severe and rapid multi-organ reaction. Common causes of anaphylaxis are hymenoptera venom, drugs and food. Only few epidemiological data on anaphylaxis are currently available (1–3).

In this study, we address the frequency and causes of anaphylaxis treated by doctors in private practices. A questionnaire was sent to 2031 practising doctors in Berlin considering different medical disciplines.

Results

A total of 704 questionnaires were evaluated. Of the responding doctors, 133 (18.9%) were internists, 128 (18.2%) paediatricians, 118 (16.8%) dermatologists, 108 (15.3%) general practitioners, 102 (14.5%) ENT-doctors, 34 (4.8%) other practitioners, 30 (4.3%) pneumologists, 20 (2.8%) anaesthesiologists, 16 (2.3%) oncologists and 15 (2.1%) radiologists.

373 (53%) of these doctors who responded had treated patients with anaphylaxis. However, only 19% (n = 72) of these practitioners in private practice were specialized in allergy. The rates of doctors having treated anaphylaxis within the different specializations were the following: 71.2% dermatologists, 50.8% paediatricians, 43.6% internists, 55.9% ENT-doctors, 49.1% general practitioners, 80% pneumologists, 55% anaesthesiologists, 56.3% oncologists, 53.3% radiologists and 11.8% other practitioners.

The number of treated patients with severe systemic reactions (with pulmonary but without cardiovascular reactions) per practice in the last 5 years was four patients on average. The number of treated patients with anaphylactic shock per practice in the last 5 years was one patient on average.

Interestingly, the most frequent causative factors given by the doctors were specific subcutaneous immunotherapy (SCIT) (22.5%) followed by insect stings (22.1%), drugs (17.7%) and food (14.7%). In 19%, the elicitors were unknown. Regarding the different specializations, dermatologists, ENT-doctors and pneumologists mostly treated reactions caused by SCIT. Within the group of general practitioners and internists, the most common elicitors were insect stings. Within the group of paediatricians, cases triggered by food were most frequently reported. Practitioners in the other medical disciplines like oncology, radiology and anaesthesia treated only a small number of anaphylactic patients and here drugs were given as the main trigger of reactions. Overall, drugs were also the second most common cause of reactions treated by general practitioners and internists (Fig. 1).

Figure 1.

 Causes of anaphylaxis in private practices. The four most common diagnosed factors eliciting anaphylaxis clustered according to the medical specialisations (n = 373).

Discussion

Among practising doctors, a predominant percentage of dermatologists and pneumologists treated patients with anaphylaxis. However, also within other disciplines (ENT-doctors, paediatricians, anaesthesiologists and oncologists), practising doctors treated anaphylactic patients regularly. The average number of treated patients per practice was low, but considering the high number of practising doctors, they deliver a broad number of anaphylactic cases.

The reported triggers of anaphylaxis are in line with data from the literature. However, the most common trigger factor of anaphylaxis reported by these doctors, who perform SCIT on a regular basis, was SCIT. This observation points to the necessity of gaining more information on severe reactions during SCIT, which are probably underreported.

There is a possibility that the reported anaphylactic reactions were not diagnosed properly, as only 19% of the practitioners were specialized in allergy. A recall-bias also needs consideration. Still, our data clearly show that SCIT seems to be an important cause of anaphylaxis in private practice and are in line with a previous survey from Bernstein et al. (4).

In conclusion, anaphylaxis is relevant in private practices and more epidemiological data are urgently needed.

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