Refractory Anaphylaxis: Data From the European Anaphylaxis Registry
Refractory anaphylaxis (unresponsive to treatment with at least two doses of minimum 300 μg adrenaline) is a rare and often fatal hypersensitivity reaction. Comprehensive data on its definition, prevalence, and risk factors are missing. Using the data from the European Anaphylaxis Registry (11,596 c...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-10-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fimmu.2019.02482/full |
| _version_ | 1818335502808383488 |
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| author | Wojciech Francuzik Sabine Dölle-Bierke Macarena Knop Kathrin Scherer Hofmeier Ewa Cichocka-Jarosz Blanca E. García Roland Lang Ioana Maris Jean-Marie Renaudin Margitta Worm |
| author_facet | Wojciech Francuzik Sabine Dölle-Bierke Macarena Knop Kathrin Scherer Hofmeier Ewa Cichocka-Jarosz Blanca E. García Roland Lang Ioana Maris Jean-Marie Renaudin Margitta Worm |
| author_sort | Wojciech Francuzik |
| collection | DOAJ |
| description | Refractory anaphylaxis (unresponsive to treatment with at least two doses of minimum 300 μg adrenaline) is a rare and often fatal hypersensitivity reaction. Comprehensive data on its definition, prevalence, and risk factors are missing. Using the data from the European Anaphylaxis Registry (11,596 cases in total) we identified refractory anaphylaxis cases (n = 42) and analyzed these in comparison to a control group of severe anaphylaxis cases (n = 4,820). The data show that drugs more frequently elicited refractory anaphylaxis (50% of cases, p < 0.0001) compared to other severe anaphylaxis cases (19.7%). Cases elicited by insects (n = 8) were more often due to bees than wasps in refractory cases (62.5 vs. 19.4%, p = 0.009). The refractory cases occurred mostly in a perioperative setting (45.2 vs. 9.05, p < 0.0001). Intramuscular adrenaline (as a first line therapy) was administered in 16.7% of refractory cases, whereas in 83.3% of cases it was applied intravenously (significantly more often than in severe anaphylaxis cases: 12.3%, p < 0.0001). Second line treatment options (e.g., vasopression with dopamine, methylene blue, glucagon) were not used at all for the treatment of refractory cases. The mortality rate in refractory anaphylaxis was significantly higher (26.2%) than in severe cases (0.353%, p < 0.0001). Refractory anaphylaxis is associated with drug-induced anaphylaxis in particular if allergens are given intravenously. Although physicians frequently use adrenaline in cases of perioperative anaphylaxis, not all patients are responding to treatment. Whether a delay in recognition of anaphylaxis is responsible for the refractory case or whether these cases are due to an overflow with mast cell activating substances—requires further studies. Reasons for the low use of second-line medication (i.e., methylene blue or dopamine) in refractory cases are unknown, but their use might improve the outcome of severe refractory anaphylaxis cases. |
| first_indexed | 2024-12-13T14:24:27Z |
| format | Article |
| id | doaj.art-0b980a4525954b6daba00d99d78fefad |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-12-13T14:24:27Z |
| publishDate | 2019-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-0b980a4525954b6daba00d99d78fefad2022-12-21T23:41:58ZengFrontiers Media S.A.Frontiers in Immunology1664-32242019-10-011010.3389/fimmu.2019.02482438012Refractory Anaphylaxis: Data From the European Anaphylaxis RegistryWojciech Francuzik0Sabine Dölle-Bierke1Macarena Knop2Kathrin Scherer Hofmeier3Ewa Cichocka-Jarosz4Blanca E. García5Roland Lang6Ioana Maris7Jean-Marie Renaudin8Margitta Worm9Department of Dermatology, Venerology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, GermanyDepartment of Dermatology, Venerology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, GermanyDepartment of Dermatology and Allergology, Klinikum der Universität München, Munich, GermanyDepartment of Dermatology, University Hospital Basel, Basel, SwitzerlandDepartment of Pediatrics, Jagiellonian University Medical College, Kraków, PolandService of Allergology, Complejo Hospitalario de Navarra, Pamplona, SpainDepartment of Dermatology, Paracelsus Private Medical University Salzburg, Salzburg, AustriaDepartment of Paediatrics and Child Health, University College Cork, Cork, IrelandRéseau d'Allergo-Vigilance (Allergy Vigilance Network), Vandoeuvre les Nancy, FranceDepartment of Dermatology, Venerology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, GermanyRefractory anaphylaxis (unresponsive to treatment with at least two doses of minimum 300 μg adrenaline) is a rare and often fatal hypersensitivity reaction. Comprehensive data on its definition, prevalence, and risk factors are missing. Using the data from the European Anaphylaxis Registry (11,596 cases in total) we identified refractory anaphylaxis cases (n = 42) and analyzed these in comparison to a control group of severe anaphylaxis cases (n = 4,820). The data show that drugs more frequently elicited refractory anaphylaxis (50% of cases, p < 0.0001) compared to other severe anaphylaxis cases (19.7%). Cases elicited by insects (n = 8) were more often due to bees than wasps in refractory cases (62.5 vs. 19.4%, p = 0.009). The refractory cases occurred mostly in a perioperative setting (45.2 vs. 9.05, p < 0.0001). Intramuscular adrenaline (as a first line therapy) was administered in 16.7% of refractory cases, whereas in 83.3% of cases it was applied intravenously (significantly more often than in severe anaphylaxis cases: 12.3%, p < 0.0001). Second line treatment options (e.g., vasopression with dopamine, methylene blue, glucagon) were not used at all for the treatment of refractory cases. The mortality rate in refractory anaphylaxis was significantly higher (26.2%) than in severe cases (0.353%, p < 0.0001). Refractory anaphylaxis is associated with drug-induced anaphylaxis in particular if allergens are given intravenously. Although physicians frequently use adrenaline in cases of perioperative anaphylaxis, not all patients are responding to treatment. Whether a delay in recognition of anaphylaxis is responsible for the refractory case or whether these cases are due to an overflow with mast cell activating substances—requires further studies. Reasons for the low use of second-line medication (i.e., methylene blue or dopamine) in refractory cases are unknown, but their use might improve the outcome of severe refractory anaphylaxis cases.https://www.frontiersin.org/article/10.3389/fimmu.2019.02482/fullanaphylaxisadrenaline (epinephrine)beta-blockersinsect venom allergydrug allergic reactionsvasoconstriction |
| spellingShingle | Wojciech Francuzik Sabine Dölle-Bierke Macarena Knop Kathrin Scherer Hofmeier Ewa Cichocka-Jarosz Blanca E. García Roland Lang Ioana Maris Jean-Marie Renaudin Margitta Worm Refractory Anaphylaxis: Data From the European Anaphylaxis Registry Frontiers in Immunology anaphylaxis adrenaline (epinephrine) beta-blockers insect venom allergy drug allergic reactions vasoconstriction |
| title | Refractory Anaphylaxis: Data From the European Anaphylaxis Registry |
| title_full | Refractory Anaphylaxis: Data From the European Anaphylaxis Registry |
| title_fullStr | Refractory Anaphylaxis: Data From the European Anaphylaxis Registry |
| title_full_unstemmed | Refractory Anaphylaxis: Data From the European Anaphylaxis Registry |
| title_short | Refractory Anaphylaxis: Data From the European Anaphylaxis Registry |
| title_sort | refractory anaphylaxis data from the european anaphylaxis registry |
| topic | anaphylaxis adrenaline (epinephrine) beta-blockers insect venom allergy drug allergic reactions vasoconstriction |
| url | https://www.frontiersin.org/article/10.3389/fimmu.2019.02482/full |
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