Is Severity Of Drug Induced Anaphylaxis Dependent Of Its Etiology?

Abstract

Rationale: Adverse drug reactions (ADR) are common in clinical practice. Drug induced anaphylaxis is severe and responsible for most of deaths due to ADRs, although its prevalence is unknown. We describe a sample of drug induced anaphylaxis and analyze their etiology, severity and the use of epinephrine. Methods: Retrospective cohort of patients with history of ADRs who had answered a standardized questionnaire. We included patients with a diagnosis of anaphylaxis through international diagnostic criteria. We evaluated gender and age variables, the causative agent, clinical features, frequency of anaphylactic shock and the use of epinephrine in the treatment. Results: We evaluated 806 patients, of whom 122 (15.1%) met the criteria of anaphylaxis. The average age was 38.9 years and 81.9% were female. The probable etiology was defined in 88 patients (72.1%), and nonsteroidal anti-inflammatory drugs (NSAIDs) were involved in 67%, followed by latex, local anaesthetics and antibiotics. Epinephrine was used in 33.6% of reactions. There has been hypotension and/or shock in 31.1%. Anaphylactic shock accounted for 60% of latex anaphylaxis, 50% of those due to antibiotics and 22.4% of NSAIDs induced anaphylaxis. Conclusions: The number of drug induced anaphylaxis is high, although the diagnosis of anaphylaxis is neglected and epinephrine is underutilized. NSAIDs were the drugs most commonly implicated, but antibiotics were not as involved as previously described. Latex was an important agent in perioperative anaphylaxis. Cases of anaphylactic shock were associated to IgE-mediated hypersensitivity mechanism, as we observed in latex and antibiotics allergies.