First study of pattern of anaphylaxis in a large tertiary care hospital in Saudi Arabia

BACKGROUND: Anaphylaxis is a serious allergic reaction that may cause death. The signs and symptoms of anaphylaxis have not been examined in the Saudi population before. OBJECTIVE: The present study examined the signs, symptoms, triggers, and demographic patterns of patients treated for anaphylaxis at a large tertiary care hospital in Riyadh, Saudi Arabia. METHODS: All the patients who were prescribed new prescriptions of adrenaline auto-injectors (AAs) between February 1, 2010 and December 31, 2011 were included in this study. Information was collected using a standardized form. RESULTS: There were 238 patients who were analyzed. The median age at the time of first AA prescription was 15.5 years. Female to male ratio was 52:48 and 54% of the subjects were more than 18 years of age. There were some differences in the presenting signs and symptoms observed in our study compared with similar studies from around the world. Urticaria and angioedema were the most common at about 70% across all ages, followed by shortness of breath at 28%. Some triggers were found to be more common in our region. Food was the commonest trigger for anaphylaxis including tree nuts, egg, and sesame. Drug allergy was also a common trigger, with penicillins and nonsteroidal anti-inflammatory drugs being the commonest. Regarding insect allergy, samsam ant was the commonest trigger in our study. CONCLUSION: To our knowledge, this is the first study on anaphylaxis in Saudi Arabia. Some of the manifestations of anaphylaxis are significantly different in our population study compared to previously published data from other parts of the world. While managing anaphylaxis, we should be mindful of these differences. This improved understanding should help reduce the morbidity and mortality associated with anaphylaxis in our region.

Hypertrophic cardiomyopathy in the Saudi Arabian population: clinical and echocardiographic characteristics and outcome analysis

Current published literature on hypertrophic cardiomyopathy [HCM] comes primarily from Western populations. There is no published data on clinical and echocardiographic characteristics and long-term outcome of HCM in an Arab population. We conducted a retrospective analysis of all patients 16 years or older diagnosed with HCM at our institution. Detailed clinical and echocardiographic data were collected and outcome was analyzed. A total of 69 patients were identified as having HCM. The mean age was 42 +/- 16 years with 71% male patients. All patients were Saudi citizens with Arab ancestry. Details about family history and presenting symptoms were available for 44 and 48 patients consecutively. Nine [18%] patients were asymptomatic and were diagnosed based on abnormal cardiac auscultation. The commonest presenting symptoms were dyspnea with or without chest pain and palpitations occurring in 40 [81%] patients. Only four [9%] of 44 patients had a family history of HCM and /or sudden cardiac death [SCD]. The most common ECG abnormality was left ventricular hypertrophy [LVH] present in 60 [86%] patients. The commonest septal hypertrophy morphology was mid-septal [catenoid] in 30 [43%] followed by neutral in 23 [33%], basal septal [sigmoid] in 3 [4%] and apical in 6 [8%] patients. Twenty [28%] patients had evidence of resting left ventricular cavity gradient of >/= 30mmHg. Eleven [16%] patients had evidence of biventricular hypertrophy. Left ventricular ejection fraction was normal in 65 [94%] patients. Over a median [25-75 percentile] follow-up of 7 years [4.5-10], only three patients died, all of non-cardiac causes. There were no cases of SCD during the follow-up period. Six patients required an implantable cardioverter-defibrillator [ICD]; five for primary prevention and one for secondary prevention. Only one patient progressed to end stage dilated cardiomyopathy. The natural history of hypertrophic cardiomyopathy in the Saudi population appears to be benign with catenoid morphology being the most common septal hypertrophy pattern. Risk of SCD appears to be quite low in this population