Phenotype of drug-induced anaphylaxis depends on the eliciting drug -
data from the European Anaphylaxis Registry
Abstract
Introduction and objective Drugs are a frequent cause of severe
anaphylactic reactions. Clinical epidemiology of drug-induced
anaphylaxis (DIA) supports the identification of the most frequent
eliciting drug groups, risk factors, symptoms and treatment procedures.
Our aim was to analyze data to promote better recognition and long-term
management of affected individuals. Methods Data from the
European Anaphylaxis Registry (2007-2019) with 1,815 cases of
drug-induced anaphylaxis were analyzed regarding demographics,
elicitors, symptoms, comorbidities, and treatment. Results The
most frequent eliciting groups of drugs were analgesics (41.27%) –
with non-steroidal anti-inflammatory drugs (NSAIDs) being the most
common subgroup (65.42%) – antibiotics (33.17%), local anesthetics
(7.38%) and radiocontrast media (5.18%). Adrenaline was used more
often in patients with DIA (23.20%) than in anaphylaxis due to other
causes (17.82%). The majority of events occurred in female patients
(65.34%), although they were admitted to hospital (29.01%) or an
intensive care unit (ICU) (9.61%) less often. Skin symptoms were most
common (84.02%), while gastrointestinal symptoms were reported less
frequently (30.25%). Compared to other anaphylactic reactions in the
registry (food/insects) severe reactions occurred significantly more
often in DIA (5.62% vs. 1.67%). Hospitalization (31.63%) and ICU
admission rates (11.85%) were significantly higher in DIA than
anaphylactic reactions to other elicitors (27.58% and 5.45%).
Conclusions DIA affects middle aged females more frequently and
is more severe in elderly males in the sample observed. Analgesics and
antibiotics are the leading causes of DIA. Adrenaline was rarely
administered to patients, even though it is recommended by guidelines.