Symptomatology and Management of Adult Anaphylaxis according to Trigger: A Cross-Sectional Study

Roy Khalaf; Connor Prosty; Christine McCusker; Adam Bretholz; Mohammed Kaouache; Ann E Clarke; Judy Morris; Rodrick Lim; Edmond S Chan; Ran D Goldman; Andrew O'Keefe; Jennifer Gerdts; Derek K Chu; Julia Upton; Elana Hochstadter; Jocelyn Moisan; Xun Zhang; Jennifer L P Protudier; Elissa Abrams; Elinor Simons; Juan Ruiz; Moshe Ben-Shoshan

doi:10.1159/000542115

Symptomatology and Management of Adult Anaphylaxis according to Trigger: A Cross-Sectional Study

Int Arch Allergy Immunol. 2024 Nov 15:1-11. doi: 10.1159/000542115. Online ahead of print.

Authors

Roy Khalaf¹, Connor Prosty¹, Christine McCusker², Adam Bretholz³, Mohammed Kaouache², Ann E Clarke⁴, Judy Morris⁵, Rodrick Lim⁶, Edmond S Chan⁷, Ran D Goldman⁸, Andrew O'Keefe⁹, Jennifer Gerdts¹⁰, Derek K Chu¹¹, Julia Upton¹², Elana Hochstadter¹³, Jocelyn Moisan¹⁴, Xun Zhang¹⁵, Jennifer L P Protudier¹⁶, Elissa Abrams¹⁷, Elinor Simons¹⁷, Juan Ruiz¹⁸, Moshe Ben-Shoshan^{1

2}

Affiliations

¹ Faculty of Medicine, McGill University, Montreal, Québec, Canada.
² Department of Pediatrics, Division of Allergy Immunology and Dermatology, McGill University Health Centre, Montreal, Québec, Canada.
³ Department of Pediatrics- McGill University Health Centre, Montreal, Québec, Canada.
⁴ Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁵ Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, Québec, Canada.
⁶ Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, Ontario, Canada.
⁷ Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
⁸ Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
⁹ Department of Pediatrics, Faculty of Medicine, Memorial University, St John's, Newfoundland, Canada.
¹⁰ Executive Director, Food Allergy Canada, Toronto, Ontario, Canada.
¹¹ Division of Clinical Immunology and Allergy, Department of Medicine, and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
¹² Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
¹³ Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
¹⁴ Regional Medical Director of Emergency Medical Services of Outaouais, Outaouais, Québec, Canada.
¹⁵ Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Québec, Canada.
¹⁶ Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
¹⁷ Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
¹⁸ Faculty of Allergy and Immunology, Vancouver General Hospital, Vancouver, British Columbia, Canada.

PMID: 39551043
DOI: 10.1159/000542115

Abstract

Introduction: Anaphylaxis is an acute life-threatening allergy, most commonly provoked by food, venom, or drugs. There is limited data regarding differences in symptomatology between anaphylaxis provoked by different triggers. This study aimed to assess sociodemographic characteristics, clinical symptoms, and management of anaphylaxis, according to triggers in adults.

Methods: We conducted a cross-sectional study recruiting adult patients with anaphylactic reactions across 8 emergency departments (EDs) and 1 electronic medical service (EMS) in Canada. Univariate and multivariate regression models were used to evaluate symptoms involving all patients with the outcome of drug-induced anaphylaxis (DIA), venom-induced anaphylaxis (VIA), peanut-induced anaphylaxis (PIA), shellfish-induced anaphylaxis, tree-nut induced anaphylaxis (TIA) and nut-induced anaphylaxis (NIA). We assessed comorbidities associated with severe reactions, stratified by triggers listed above. Additionally, we evaluated the association of each trigger with treatment through regression models involving all patients with medications used as outcome and anaphylaxis triggers used as independent variables.

Results: From April 2011 to November 2023, 1,135 adults presenting with anaphylaxis to EDs were recruited. The median age was 35.5 (interquartile range 25.3-51.1). Most of the patients presented with FIA (50.3%). Regarding symptomatology, hypotension was more likely associated with DIA (aOR = 1.20, 95% CI = 1.11-1.30, p < 0.01). When adjusted for age at reaction and male sex, alcohol was more likely associated (aOR = 1.51, 95% CI = 1.04-2.19, p = 0.035) with NIA. Regarding management, TIA was more likely associated with inpatient epinephrine (aOR = 2.05, 95% CI = 1.16-3.64, p = 0.014). DIA was less likely associated with outpatient antihistamine (aOR = 0.68, 95% CI = 0.48-0.89, p < 0.01) whereas TIA was more likely associated with outpatient antihistamine (aOR = 1.81, 95% CI = 1.03-3.19, p = 0.040).

Conclusion: Our study underscores associations between specific triggers, clinical manifestations and managements, such as the potential link between TIA and throat tightness and hypotension and VIA. Identifying such associations can aid with the prompt diagnosis of anaphylaxis in patients presenting to the ED, leading to swifter treatment initiation and improving overall outcomes.

Keywords: Adults; Anaphylaxis; Drug; Food; Management; Venom.