Anaphylaxis in an emergency setting - elicitors, therapy and incidence of severe allergic reactions

Background Anaphylaxis is a severe potentially life-threatening hypersensitivity reaction with an estimated lifetime prevalence of 0.52.0%. The prevalence and incidence of anaphylactic reactions in Germany are unknown. We therefore assessed anaphylactic patients seen by emergency physicians in the Berlin area covering 4million people. Methods A standardised questionnaire was filled from 2008 to 2010 by the emergency physicians. Results A total of 333 cases of anaphylaxis were reported. 295 of these met the inclusion criteria for severity and were analysed. 13.9% (n=41) were reactions with respiratory symptoms, 25.4% (n=75) with cardiovascular, and in 60.7% (n=179) of cases, respiratory and cardiovascular symptoms were reported. Two reactions were fatal. The most common elicitors were food products (32.2%), drugs (29.2%) and insect venom (19.3%). The most frequently given drugs were corticoids and antihistamines, but not adrenaline. For 2008, the calculated incidence was 4.5 per 100000. Conclusions Our data show that food products are frequent elicitors of severe allergic reactions in the general population including children and adults. It unravels a strong underuse of adrenaline by emergency physicians, not reflecting treatment protocols according to the current guidelines. As data obtained from allergists reveal a different rank order of elicitors, this study suggests that food-allergic adult patients may present a risk population and should receive more attention by allergists.