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September 11, 1995

Anaphylaxis: A Review of 266 Cases

Author Affiliations

From the Division of Allergy and Immunology, Department of Internal Medicine, University of Tennessee College of Medicine, Memphis (Drs Wolf and Lieberman); and the Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida College of Medicine and the James A. Haley Veterans Hospital, Tampa (Drs Kemp and Lockey).

Arch Intern Med. 1995;155(16):1749-1754. doi:10.1001/archinte.1995.00430160077008

Background:  A presentation of findings from a large population of anaphylaxis cases.

Methods:  Retrospective chart review and follow-up questionnaire provided data on 266 subjects (113 males and 153 females) aged 12 to 75 years (mean age, 38 years) who were referred to a university-affiliated private allergy-immunology practice in Memphis, Tenn, for evaluation and management of anaphylaxis from January 1978 through March 1992.

Results:  Of 266 subjects, 162 (61%) had three or more anaphylactic episodes, 41 (15%) had two episodes, and 63 (24%) had one episode. Atopy was present in 98 individuals (37%). Physicians thought foods, spices, and food additives caused anaphylaxis in 89 individuals (34%); crustaceans and peanut accounted for about half of these cases. Medications were thought to have caused the anaphylactic episodes in 52 individuals (20%); nonsteroidal anti-inflammatory drugs in about half of these cases. Other probable causes included exercise (n=19), latex (n=2), hormonal changes (n=2), and insect bites (n=4). A suspected cause could not be determined in 98 individuals (37%). These subjects were diagnosed as having idiopathic anaphylaxis. Of the 266 subjects, 102 responded to a follow-up survey; 68 (67%) of the 102 were thought to have identifiable causes of anaphylaxis (32 of whom [47%] failed to carry epinephrine syringes for self-administration despite instructions to do so). In contrast, of 34 subjects with idiopathic anaphylaxis who responded to the survey, only three (9%) did not carry epinephrine.

Conclusions:  (1) Atopy is common in subjects who experience anaphylaxis, regardless of its origin; (2) crustaceans and nonsteroidal anti-inflammatory drugs are the most common food and medication groups, respectively, thought to cause anaphylaxis; (3) causative agents can be identified for two thirds of the subjects, and recurrent attacks are the rule; and (4) subjects with idiopathic anaphylaxis are more likely to carry epinephrine for self-administration than those with identifiable causes.(Arch Intern Med. 1995;155:1749-1754)