根据诱因确定成人过敏性休克的症状和处理方法:一项横断面研究。

IF 2.5 4区 医学 Q3 ALLERGY
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
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引用次数: 0

摘要

简介:过敏性休克是一种危及生命的急性过敏症,最常见的诱因是食物、毒液或药物。关于由不同诱因引发的过敏性休克在症状方面的差异,相关数据十分有限。本研究旨在根据诱因评估成人过敏性休克的社会人口特征、临床症状和处理方法:我们进行了一项横断面研究,招募了加拿大 8 家急诊科(ED)和 1 家电子医疗服务机构(EMS)的过敏反应成人患者。我们使用单变量和多变量回归模型评估了所有患者的症状与药物诱发的过敏性休克(DIA)、毒液诱发的过敏性休克(VIA)、花生诱发的过敏性休克(PIA)、贝类诱发的过敏性休克、树坚果诱发的过敏性休克(TIA)和坚果诱发的过敏性休克(NIA)的结果。我们评估了与严重反应相关的合并症,并按上述诱发因素进行了分层。此外,我们还通过回归模型评估了每种诱发因素与治疗的关联性,该模型涉及所有患者,以药物作为结果,以过敏性休克诱发因素作为自变量:从 2011 年 4 月到 2023 年 11 月,我们共招募了 1135 名在急诊室就诊的过敏性休克成人。中位年龄为 35.5 岁(四分位距为 25.3-51.1 岁)。大多数患者表现为过敏性休克(50.3%)。在症状方面,低血压更可能与 DIA 相关(aOR = 1.20,95% CI = 1.11-1.30,p < 0.01)。如果对反应年龄和男性性别进行调整,酒精更有可能与 NIA 相关(aOR = 1.51,95% CI = 1.04-2.19,p = 0.035)。在治疗方面,TIA 更可能与住院肾上腺素相关(aOR = 2.05,95% CI = 1.16-3.64,p = 0.014)。DIA不太可能与门诊抗组胺药相关(aOR = 0.68,95% CI = 0.48-0.89,p < 0.01),而TIA更可能与门诊抗组胺药相关(aOR = 1.81,95% CI = 1.03-3.19,p = 0.040):我们的研究强调了特定诱因、临床表现和处理方法之间的关联,例如 TIA 与喉咙发紧、低血压与 VIA 之间的潜在联系。识别这些关联有助于及时诊断急诊室就诊患者的过敏性休克,从而更快地开始治疗并改善总体预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Symptomatology and Management of Adult Anaphylaxis according to Trigger: A Cross-Sectional Study.

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.

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来源期刊
CiteScore
5.60
自引率
3.60%
发文量
105
审稿时长
2 months
期刊介绍: ''International Archives of Allergy and Immunology'' provides a forum for basic and clinical research in modern molecular and cellular allergology and immunology. Appearing monthly, the journal publishes original work in the fields of allergy, immunopathology, immunogenetics, immunopharmacology, immunoendocrinology, tumor immunology, mucosal immunity, transplantation and immunology of infectious and connective tissue diseases.
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