Association Between Severity of Anaphylaxis and Co-occurrence of Respiratory Diseases: A Systematic Review and Meta-analysis of Observational Studies.

BACKGROUND AND OBJECTIVE: Asthma is very prevalent in all grades of severity of anaphylaxis. Asthma and chronic obstructive pulmonary disease (COPD) have been associated with the severity of anaphylaxis. Objective: We carried out a systematic review and meta-analysis to assess the influence of respiratory diseases on the severity of anaphylaxis. METHODS: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for observational studies. The target studies were those that compared the severity of anaphylaxis between patients who had or did not have respiratory diseases. RESULTS: A total of 13 studies assessed the severity of anaphylaxis in respiratory disease. Respiratory disease increased the severity of anaphylaxis (OR, 1.87; 95%CI, 1.30-2.70), as did asthma (OR, 1.89; 95%CI, 1.26-2.83). For the meta-analysis of all studies (adjusted and nonadjusted), COPD increased the severity of anaphylaxis (OR, 2.47; 95%CI, 1.46-4.18). In the case of asthma studies, only 1 study assessed the influence of severity of asthma on severity of anaphylaxis. CONCLUSIONS: Evidence showing that respiratory disease increases the severity of anaphylaxis is low to moderate, although studies do not usually assess the importance of severity of asthma.

Association Between Severity of Anaphylaxis and Co-occurrence of Respiratory Diseases: A Systematic Review and Meta-analysis of Observational Studies

Background: Asthma is very prevalent in all grades of severity of anaphylaxis. Asthma and chronic obstructive pulmonary disease (COPD)have been associated with the severity of anaphylaxis.Objective: We carried out a systematic review and meta-analysis to assess the influence of respiratory diseases on the severity of anaphylaxis.Methods: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for observational studies. The target studies were those thatcompared the severity of anaphylaxis between patients who had or did not have respiratory diseases.Results: A total of 13 studies assessed the severity of anaphylaxis in respiratory disease. Respiratory disease increased the severity ofanaphylaxis (OR, 1.87; 95%CI, 1.30-2.70), as did asthma (OR, 1.89; 95%CI, 1.26-2.83). For the meta-analysis of all studies (adjustedand nonadjusted), COPD increased the severity of anaphylaxis (OR, 2.47; 95%CI, 1.46-4.18). In the case of asthma studies, only 1 studyassessed the influence of severity of asthma on severity of anaphylaxis.Conclusions: Evidence showing that respiratory disease increases the severity of anaphylaxis is low to moderate, although studies do notusually assess the importance of severity of asthma.(AU)

Antecedentes: El asma es muy frecuente en todos los grados de gravedad de la anafilaxia y así mismo el asma y la enfermedad pulmonarobstructiva crónica (EPOC) se han asociado con las anafilaxias graves.Objetivo: Realizamos una revisión sistemática y un meta-análisis para evaluar la influencia de las enfermedades respiratorias en lagravedad de la anafilaxia.Métodos: Se realizaron búsquedas en PubMed / MEDLINE, EMBASE y Web of Science de estudios observacionales, en donde se compararonla gravedad de la anafilaxia entre pacientes que tenían o no enfermedades respiratorias.Resultados: Un total de 13 estudios evaluaron la influencia de las enfermedades respiratorias en la gravedad de la anafilaxia. La enfermedadrespiratoria aumentó la gravedad de la anafilaxia (OR, 1,87; IC 95%, 1,30-2,70). En general, el asma también aumentó la gravedad dela anafilaxia (OR, 1,89; IC del 95%, 1,26-2,83). En el meta-análisis de todos los estudios con EPOC (ajustado y no ajustado), la mismaaumentó la gravedad de la anafilaxia (OR, 2,47; IC del 95%, 1,46-4,18). En los estudios con asma, solo uno evaluó la influencia de lagravedad del asma en la gravedad de la anafilaxia.Conclusiones: La evidencia que muestra que la enfermedad respiratoria aumenta la gravedad de la anafilaxia es baja a moderada, aunquelos estudios no suelen evaluar la importancia de la gravedad del asma.(AU)

Clinical Profile of Patients With Severe Anaphylaxis Hospitalized in the Spanish Hospital System: 1997-2011.

BACKGROUND AND OBJECTIVE: Studies assessing the severity of anaphylaxis lack a comprehensive approach to collecting data on comorbidities that may worsen prognosis. Objective: Using the Elixhauser score (a systematic index associated with longer stay, hospital charges, and mortality), we determined which comorbidities were associated with more severe anaphylaxis. METHODS: We based our study on the Spanish Ministry of Health database of hospital discharges in Spain between 1997 and 2011. We constructed logistic regression models in which the dependent variables were outcomes related to greater severity (death, cardiac arrest, need for invasive mechanical ventilation or vasopressor drugs, admission to the intensive care unit, and length of stay) and the independent variables were the 30 comorbidities that comprise the Elixhauser score, age, sex, and main causes of anaphylaxis. RESULTS: We found that a higher risk of severe anaphylaxis was associated (3 or more logistic regressions) with age >50 years or having experienced cardiac arrhythmia, coagulation disorder, associated fluid-electrolyte imbalance, chronic pulmonary disease, or Echinococcus anaphylaxis. Likewise, in the adjusted analysis, a higher Elixhauser score was associated with most of the outcomes analyzed for severity of anaphylaxis. CONCLUSIONS: Cardiovascular and respiratory diseases increase the severity of anaphylaxis, and the resulting poor health status (represented as a higher Elixhauser score) is associated with more severe anaphylaxis.

Clinical profile of patients with severe anaphylaxis hospitalized in the Spanish Hospital System: 1997-2011

Background: Studies assessing the severity of anaphylaxis lack a comprehensive approach to collecting data on comorbidities that may worsen prognosis. Objective: Using the Elixhauser score (a systematic index associated with longer stay, hospital charges, and mortality), we determined which comorbidities were associated with more severe anaphylaxis. Methods: We based our study on the Spanish Ministry of Health database of hospital discharges in Spain between 1997 and 2011. We constructed logistic regression models in which the dependent variables were outcomes related to greater severity (death, cardiac arrest, need for invasive mechanical ventilation or vasopressor drugs, admission to the intensive care unit, and length of stay) and the independent variables were the 30 comorbidities that comprise the Elixhauser score, age, sex, and main causes of anaphylaxis. Results: We found that a higher risk of severe anaphylaxis was associated (3 or more logistic regressions) with age >50 years or having experienced cardiac arrhythmia, coagulation disorder, associated fluid-electrolyte imbalance, chronic pulmonary disease, or Echinococcus anaphylaxis. Likewise, in the adjusted analysis, a higher Elixhauser score was associated with most of the outcomes analyzed for severity of anaphylaxis. Conclusions: Cardiovascular and respiratory diseases increase the severity of anaphylaxis, and the resulting poor health status (represented as a higher Elixhauser score) is associated with more severe anaphylaxis (AU)

Antecedentes: Los estudios que recogen datos sobre comorbilidades que empeoran la gravedad de la anafilaxia, carecen de un acercamiento exhaustivo. Objetivo: Usando la puntuación de Elixhauser (un sistema de puntuación asociado con mayor estancia hospitalaria, mayor gasto hospitalario y muerte), establecimos que comorbilidades fueron asociadas con anafilaxia grave. Métodos: Usamos para el estudio la base de datos de altas hospitalarias del Ministerio Español de Sanidad, entre 1997 a 2011. Se obtuvo varios modelos de regresión logística, en las cuales las variables dependientes fueron desenlaces relacionados con eventos asociados habitualmente a una gran gravedad de los episodios (muerte, parada cardio-respiratoria, necesidad de uso de ventilación mecánica invasiva o medicamentos vaso-presores, ingreso en la Unidad de Cuidados Intensivos y duración de la estancia) y las variables independientes fueron las 30 comorbilidades que comprenden la puntuación Elixhauser, junto con edad, sexo y las grandes causas de anafilaxia. Resultados: Encontramos que un mayor riesgo para anafilaxia grave estuvo asociado (3 o más regresiones logísticas con significación estadística) con una edad de más de 50 años, o haber experimentado arritmias cardiacas, alteraciones de la coagulación, disbalance hidro-electrolítico, enfermedad pulmonar crónica o anafilaxia por Echinococcus. Así mismo, en un análisis ajustado, una puntuación mayor del sistema Elixhauser se asoció con la mayoría de las variables de desenlace usadas para analizar la gravedad de la anafilaxia. Conclusiones: Enfermedades cardio-vasculares y respiratorias incrementan la gravedad de la anafilaxia y un mal estado de salud (representado por mayores puntuaciones del Sistema de puntuación de Elixhauser) se asocian con mayor gravedad de la anafilaxia (AU)

Increased incidence of admissions for anaphylaxis in Spain 1998-2011.

We report on trends in anaphylaxis admissions in the Spanish hospital system during the period 1998-2011. Data on admissions for anaphylaxis were obtained from the Spanish Information System for Hospital Data for the period 1998-2011. Patients were selected using the codes for anaphylaxis in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Poisson regression models were used to estimate incidence rate ratios. We recorded a 1.89-fold increase in admissions for anaphylaxis in Spanish hospitals during the study period, particularly in patients aged 0-14 years (1.65- to 3.22-fold until 2009 and 4.09- to 12.59-fold until 2011) and in food anaphylaxis in all age groups (2.78-fold until 2009 and 8.74-fold until 2011). The incidence of anaphylaxis is perceived as having increased in recent years, especially anaphylaxis caused by food and anaphylaxis affecting the pediatric population.