Anaphylaxis in the third stage emergency department10-year evaluation of cases

Introduction and Objective: Anaphylaxis is the most severe and potentially life-threatening clinical condition among acute systemic allergic reactions, the frequency of which is increasing worldwide. Our study includes the evaluation of the epidemiological characteristics and clinical findings of anaphylaxis cases, the examination of diagnosis and treatment methods, the determination of the frequency of biphasic anaphylaxis, and the establishment of optimal observation periods in the emergency department. Materials and Methods: A total of 169 patients diagnosed with anaphylaxis aged 18 and over, who were admitted to the Emergency Department of Dokuz Eylül University in Izmir between June 2013 and June 2023, were included in the study. The demographic, etiological, clinical characteristics of the patients, and the treatments applied, as well as their emergency department follow-ups, were retrospectively reviewed. The data obtained were evaluated using SPSS 24 data program. Results: Of the patients, 77 (45.6%) were female, and 92 (54.4%) were male, with a male-to-female ratio of 1.19. The mean age of the patients was found to be 49.5±14.7. In our study, it was observed that 38 (22.4%) patients had a history of previous anaphylaxis, and 21 (55.3%) of these patients had contact with a known allergen. In 17 (44.7%) patients, there was no history of contact with a known allergen. Among the patients, 54 (32%) had a history of concomitant cardiac disease, and the most common concomitant cardiac disease was hypertension. It was observed that 52 (30.8%) of the anaphylaxis patients had a history of concomitant allergic diseases. The most common concomitant allergic disease was drug allergy, followed by asthma. Among the patients, 23 (13.6%) were on regular medication, and among these, ACE inhibitors were the most commonly used, with 12 (57.1%). When the factors causing anaphylaxis were examined, drug use was the most common factor with 76 (45%) patients, followed by bee stings in 20 (11.8%) patients, and food in 15 (8.9%) patients. Among the patients who developed anaphylaxis due to drug use, antibiotics were the most common factor with 44 (45%) patients. Among antibiotics, penicillin group antibiotics ranked first with 24 (32.8%) patients. When the organ involvement of anaphylaxis was examined, skin and mucosal involvement were detected in 161 (95.3%) patients, respiratory system involvement in 138 (81.7%) patients, and cardiovascular system involvement in 53 (31.4%) patients. In our study, it was observed that adrenaline was administered to all patients, steroids to 162 (95.9%) patients, antihistamines to 162 (95.9%) patients, and intravenous fluid therapy to 130 (76.9%) patients. Biphasic reactions occurred in 4 (2.4%) of the patients. Conclusion: We evaluated the epidemiological characteristics, clinical findings, and diagnostic and treatment approaches of anaphylaxis cases in our clinic. The epidemiological characteristics of the cases, anaphylaxis factors, facilitating factors, and clinical findings with organ involvement were qualitatively similar to the literature data. It will be important to obtain clearer views on the risk factors for biphasic anaphylaxis, which this study couldn't provide, through studies planned with larger patient groups.