Management of anaphylaxis in daily practice.
Care of anaphylaxis among practising doctors
Article first published online: 10 OCT 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Munksgaard
Volume 63, Issue 11, pages 1562–1563, November 2008
How to Cite
Worm, M., Hompes, S., Vogel, N., Kirschbaum, J. and Zuberbier, T. (2008), Care of anaphylaxis among practising doctors. Allergy, 63: 1562–1563. doi: 10.1111/j.1398-9995.2008.01878.x
- Issue published online: 10 OCT 2008
- Article first published online: 10 OCT 2008
- Accepted for publication 18 July 2008
- private practice
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.
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).
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.