Beta lactams anaphylaxis in an emergency department: epidemiology, clinical features and management
Background:
Anaphylaxis is defined as a serious allergic reaction that is rapid in onset and may cause death in otherwise healthy individuals. Antibiotic anaphylaxis, especially for beta lactams, is considered to be one of the leading causes of anaphylaxis treated in emergency departments (ED) and its prevalence is increasing.
Objective: Describe the epidemiology, clinical features, management and outcome of patients with beta lactams anaphylaxis.
Methods: prospective, monocentric study over six years. Inclusion criteria: patients aged over 14 years presenting consecutively to ED with the diagnosis of anaphylaxis. Collection of epidemiological, clinical and therapeutic parameters.
Results: inclusion of 694 patients presented in the ED with diagnostic of anaphylaxis. Antibiotics anaphylaxis was found in 211 (30%) patients, 169 (80%) of whom were beta-lactams.
Mean age was 40±15 years. Sex-ratio was 0.74. A history of anaphylaxis was reported in 37 % of cases. The most incriminated beta-lactams were: amoxicillin (67 %) and amoxicillin/clavulanic acid (16%). Cutaneous features were present in 97% of patients. Cardiovascular, Respiratory, gastrointestinal and neurologic features were found respectively in 37, 26, 23 and 4%. Hypotension was recorded in 64 patients (40%) and anaphylactic shock in 4%. Anaphylaxis was moderate grade in 99 patients (58%). Adrenaline was used in 55%of patients, intravenously in 30%. Fluid resuscitation was given to 87% of the patients. Ninety seven patients (57%) received histamine H1 antagonist, 94% corticosteroids. All of the patients were discharged directly from ED after a mean period of observation as 4.5 hours except 3 who have been admitted at the ED. Recurrence reactions were reported in six patients (3.5%). There was no death cases registered. Patients were all referred to the allergy clinic.
Conclusion:
Identifying the characteristics of beta lactams anaphylaxis presentation to ED and its risk factors helps to improve the diagnosis of this medical emergency and suggest the necessity of a standardized guideline for anaphylaxis management in ED.
