Triggers and Treatment of Anaphylaxis: An Analysis of 4000 Cases From Germany, Austria and Switzerland

ORIGINAL ARTICLE

Dtsch Arztebl Int 2014; 111(21): 367-75; DOI: 10.3238/arztebl.2014.0367

Worm, M; Eckermann, O; Dölle, S; Aberer, W; Beyer, K; Hawranek, T; Hompes, S; Koehli, A; Mahler, V;Nemat, K; Niggemann, B; Pföhler, C; Rabe, U; Reissig, A; Rietschel, E; Scherer, K; Treudler, R; Ruëff, F

Allergy Center Charité, Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin: Prof. Dr. med. Worm, Dr. rer. medic. Dölle, Dr. rer. medic. Hompes
ADAC Air Rescue Service Senftenberg: Eckermann
Department of Dermatology and Venereology, Medical University of Graz, Austria: Prof. Dr. med. univ. Aberer
Department of Pediatrics, Pneumonology and Immunology, Charité – Universitätsmedizin Berlin: Prof. Dr. med. Beyer, Prof. Dr. med. Niggemann
Allergy Clinic, Department of Dermatology, SALK, Paracelsus Medical University, Salzburg, Austria:
Dr. med. Hawranek
Pediatric Allergology, University Children’s Hospital Zurich, Zurich, Switzerland: Dr. med. Koehli
Department of Dermatology, University Hospital Erlangen-Nürnberg: Prof. Dr. med. Mahler
Department of Pediatric Pneumology and Allergology at the KID Center, Dresden-Friedrichstadt:
Dr. med. Nemat
Department of Dermatology, Venerology and Allergy at the Saarland University, Homburg/Saar:
Prof. Dr. med. Pföhler
Department of Allergology, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen:
Dr. med. Rabe
Department of Internal Medicine I: Pneumology & Allergology/Immunology, Friedrich Schiller University Jena:
PD Dr. med. Reissig
Department of Pediatric Pulmonology and Allergology, Children's Hospital of the University of Cologne: PD Dr. med. Rietschel
Allergy Unit, Department of Dermatology, University Hospital Basel, Basel, Schweiz: PD Dr. med. Scherer
Department of Dermatology, Venereology and Allergology, University of Leipzig: Prof. Dr. med. habil. Treudler
Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich: Prof. Dr. med. Ruëff
* Margitta Worm and Oliver Eckermann have equally contributed to the manuscript.

Background: Anaphylaxis is the most severe manifestation of a mast cell–dependent immediate reaction and may be fatal. According to data from the Berlin region, its incidence is 2–3 cases per 100 000 persons per year.

Methods: We evaluated data from the anaphylaxis registry of the German-speaking countries for 2006–2013 and data from the protocols of the ADAC air rescue service for 2010–2011 to study the triggers, clinical manifestations, and treatment of anaphylaxis.

Results: The registry contained data on 4141 patients, and the ADAC air rescue protocols concerned 1123 patients. In the registry, the most common triggers for anaphylaxis were insect venom (n = 2074; 50.1%), foods (n = 1039; 25.1%), and drugs (n = 627; 15.1%). Within these groups, the most common triggers were wasp (n = 1460) and bee stings (n = 412), legumes (n = 241), animal proteins (n = 225), and analgesic drugs (n = 277). Food anaphylaxis was most frequently induced by peanuts, cow milk, and hen's egg in children and by wheat and shellfish in adults. An analysis of the medical emergency cases revealed that epinephrine was given for grade 3 or 4 anaphylaxis to 14.5% and 43.9% (respectively) of the patients in the anaphylaxis registry and to 19% and 78% of the patients in the air rescue protocols.

Conclusion: Wasp and bee venom, legumes, animal proteins, and analgesic drugs were the commonest triggers of anaphylaxis. Their relative frequency was age-dependent. Epinephrine was given too rarely, as it is recommended in the guidelines for all cases of grade 2 and above.

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