[ADULT ANAPHYLAXIS AT THE DEPARTMENT OF EMERGENCY MEDICINE OF TEIKYO UNIVERSITY HOSPITAL IN AN URBAN AREA OF TOKYO].

BACKGROUND: Anaphylaxis is a severe, potentially fatal, systemic allergic reaction. But its real-world evidence is limited. Both treatment of allergic symptoms and prevention of future anaphylactic episodes are clinically important. We have strongly recommended that patients visit our outpatient allergy clinic. OBJECTIVE: To classify the clinical features and triggers of anaphylaxis in patients (≥16 years old) in an urban area of Tokyo. METHODS: We used the medical records to analyze patients with anaphylaxis as the primary diagnosis who visited the emergency department in our hospital from January 2015 through December 2017. RESULTS: Among approximately 60000 patients who visited the emergency department, 181 subjects (mean age, 43.0; 44% male) were diagnosed with anaphylaxis. Fourteen of those patients had a systolic blood pressure of lower than 90mmHg. Upon arrival, 126 patients were treated with adrenaline. All patients recovered from the anaphylactic episode. Subsequently, 133 patients visited our outpatient allergy clinic. The trigger of the anaphylaxis were assessed; the most popular trigger was foods (n = 78), followed by drugs (n = 38), insect stings/bites or animal bites (n = 3) and others (n = 11). Adrenaline auto-injectors were prescribed to 84 patients. CONCLUSION: It is important for patients with anaphylaxis to undergo allergy testing after discharge from an emergency department. Collaboration between emergency medicine and allergy departments may be helpful for improving the patients' QOL through effective instruction and prevention of recurrent anaphylaxis.

Characteristics, Etiology and Treatment of Pediatric and Adult Anaphylaxis in Iran.

Despite the increasing prevalence of anaphylaxis, there is little information about the characteristics and practice of healthcare providers in treating anaphylaxis, so this study was conducted to record the characteristics and therapeutic approaches of anaphylaxis from May 2012 until April 2015, the data of all patients diagnosed with anaphylaxis in the Allergy department of three referral university hospitals in Tehran, Iran were recorded. Thereafter, the demographics, clinical features, triggers and therapeutic approach were evaluated. This study investigated 136 individuals, 64 males (47%) between 6 months and 68 years old, as well as 72 others (52.94%) under 18 years of age (pediatric). The following were the most common organs involved: Skin 86.02% (pediatric 91.66% vs adult 79.68%), respiratory tract 51.47% (pediatric 43.05% vs adult 60.93%), cardiovascular 50.73% (pediatric 54.16% vs adult 46.87%), gastrointestinal 20.58% (pediatric 27.7% vs adult 12.5% ) and neurologic system 5.88% (only in adults). The following were the most identified causing foods 69 (50.37%)[42 pediatric (children) and 27 adults], drugs 34( 25%)[14 pediatric and 20 adults], idiopathic 16( 11.77%)[3 pediatric and 13 adults], insect sting 7( 5.15%)[3 pediatric and 4 adults] , exercise 6( 4.42%) [1 pediatric and 5 adults]. Milk, egg and wheat were the most common causative foods in pediatric cases but sesame, as well as egg and milk were the most common causes in adults. Epinephrine injection, auto injector epinephrine prescription as a discharging plan and referral to an allergist were: 10.78, 1.96 and 7.8 %, respectively. In this case series we found that, cutaneous, respiratory, cardiovascular and gastrointestinal complains were the most common manifestations and food, drug and idiopathic were the most common causes.In this study, the diagnosis of anaphylaxis, epinephrine subscription and referral to an allergist were significantly lower in comparison to other studies.