Allergy Asthma Immunol Res.  2015 Jan;7(1):22-29. 10.4168/aair.2015.7.1.22.

Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study

• Ye YM
• Kim MK
• Kang HR
• Kim TB
• Sohn SW
• Koh YI
• Park HK
• Jang GC
• Kim CW
• Jee YK
• Hur GY
• Kim JH
• Kim SH
• Choi GS
• Lee SK
• Park HS
• KAAACI Work Group on Urticaria/Angioedema/Anaphylaxis

• KMID: 2260148
• DOI: http://doi.org/10.4168/aair.2015.7.1.22

Abstract

PURPOSE
Differences in definitions of the condition, relevant triggers, and the geographical locations of study centers, cause estimates of the prevalence of anaphylaxis to vary. Recent epidemiological data indicate that the incidence of anaphylaxis is rising.
METHODS
To investigate the causes and clinical features of anaphylaxis in Korean adults, factors associated with the severity of the condition, and serious outcomes, a retrospective medical record review was performed on adult patients diagnosed with anaphylaxis between 2007 and 2011 in 15 University Hospitals of South Korea.
RESULTS
A total of 1,806 cases (52% male, age 16-86 years) were reported. Cutaneous symptoms (84.0%), combined with respiratory (53.9%) and/or cardiovascular (55.4%) symptoms, were the most frequent presentations. Using a recognized grading system, 1,776 cases could be classified as either mild, 340; moderate, 690; or severe, 746. Although eliciting factors varied significantly by age, gender, and regional and seasonal factors, drugs (46.5%; including nonsteroidal anti-inflammatory drugs, antibiotics, and radiocontrast media) were the most common cause of anaphylaxis, followed by foods (24.2%), insect stings (16.4%), exercise (5.9%), and unknown etiology (7.0%). All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. Epinephrine auto-injectors were prescribed for 7.4% of reported cases.
CONCLUSIONS
The principal causes of anaphylaxis in Korean adults were drugs, food, and insect stings. Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes.

Keyword

Anaphylaxis; adult; epidemiology; multicenter study; severity; serious outcomes

MeSH Terms

Adult*
Anaphylaxis*
Anti-Bacterial Agents
Epidemiology
Epinephrine
Hospitals, University
Humans
Incidence
Insect Bites and Stings
Korea
Length of Stay
Male
Medical Records
Prevalence
Retrospective Studies*
Seasons
Anti-Bacterial Agents
Epinephrine

Figure

• 

  Fig. 1 The prevalence of anaphylaxis among the adult patients visiting 12 of the 15 hospitals studied over a 5-year period. (A) The rate of anaphylaxis per 100,000 adult patients visiting hospitals. (B) The rate of anaphylaxis per 100,000 adult visitors in emergency departments. P values were examined by proportion test using R 3.0.2 from 2007 to 2008, 2009, 2010, and 2011. *P<0.05; **P<0.01; ***P<0.001.

• 

  Fig. 2 The positivity rates upon post-recovery allergen testing by cause of anaphylaxis.

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