Clinical-anamnestic analysis of patients diagnosed as "Anaphylaxis" hospitalized in Moscow medical hospitals

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Abstract

BACKGROUND: Anaphylaxis is a severe hypersensitivity reaction. The incidence of anaphylaxis remains underestimated and there remains a low level of vigilance among all specialties, leading to underdiagnosis and consequent lack of appropriate treatment. This work is the first systematized clinical and epidemiological study performed on a cohort of patients with a history of anaphylactic reactions over 18 years of age.

AIM: To study the epidemiological features of anaphylaxis within one region of the Russian Federation, identification of its most frequent phenotypes, as well as analysis of the main errors in the management of patients with anaphylactic reactions.

MATERIALS AND METHODS: The study was conducted based on the retrospective stage analysis of data from medical records of patients with anaphylactic reactions of the Unified Medical Information and Analytical System (EMIAS) of Moscow for the period from 2019 to 2022. The final sample comprised a cohort of 241 patients.

RESULTS: In the analyzed cohort, females (n=150; 62.2%) were predominant compared to males (n=91; 37.8%). Medications (n=171; 71%) dominated the list of causative agents. The leading clinical phenotype of anaphylactic reactions in the analyzed hospitalized cohort was characterized by cardiovascular symptoms (73; 30.3%). The risks of severe course increased with age (older than 44 years) (p=0.006). Information on prehospital therapy was obtained in 183 patients (75.9%), with only 128 (70%) patients receiving epinephrine therapy. A correlation was found between the absence of epinephrine administration in the prehospital phase and the development of a biphasic course of anaphylactic reactions subsequently (p <0.001). Only 15 (38.5%) patients with an aggravated history of anaphylaxis were previously informed about the need to carry epinephrine solution.

CONCLUSIONS: Anaphylaxis is a life-threatening pathology requiring emergency medical care, regardless of the severity of the initial symptoms. Variations in the clinical symptoms that constitute the diagnostic criteria for anaphylaxis, differences in algorithms, and limitations of existing coding systems make it difficult to summarize epidemiological data and compare study results. Older age remains a risk factor for the development of severe anaphylactic reactions confirmed in our cohort.

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About the authors

Ekaterina A. Nikitina

Moscow City Hospital 52

Author for correspondence.
Email: katrin88866@gmail.com
ORCID iD: 0000-0002-0865-8355
Russian Federation, Moscow

Marina S. Lebedkina

Moscow City Hospital 52

Email: marina.ivanova0808@yandex.ru
ORCID iD: 0000-0002-9545-4720
Russian Federation, Moscow

Olga A. Mukhina

Moscow City Hospital 52

Email: mukhina.o.a@gmail.com
ORCID iD: 0000-0002-3794-4991
Russian Federation, Moscow

Sergey S. Andreev

Moscow City Hospital 52

Email: nerowolf@mail.ru
ORCID iD: 0000-0002-9147-4636
Russian Federation, Moscow

Anton A. Chernov

Moscow City Hospital 52

Email: sbornay1med@yandex.ru
ORCID iD: 0000-0001-6209-387X

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Nikita S. Chicunov

Moscow Center for Innovative Technologies in Healthcare

Email: artlicasio@gmail.com
ORCID iD: 0000-0002-0643-9423
Russian Federation, Moscow

Yulia M. Klimanova

The First Sechenov Moscow State Medical University (Sechenov University)

Email: klimanova_yuliya@mail.ru
ORCID iD: 0009-0009-1349-7187

MD

Russian Federation, Moscow

Snezhana М. Porfireva

The First Sechenov Moscow State Medical University (Sechenov University)

Email: swetty_snejik@mail.ru

MD

Russian Federation, Moscow

Mariana A. Lysenko

Moscow City Hospital 52; The Russian National Research Medical University named after N.I. Pirogov

Email: gkb52@zdrav.mos.ru
ORCID iD: 0000-0001-6010-7975

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow

Daria S. Fomina

Moscow City Hospital 52; The First Sechenov Moscow State Medical University (Sechenov University); Astana Medical University

Email: daria_fomina@mail.ru
ORCID iD: 0000-0002-5083-6637

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, Moscow; Moscow; Astana, Republic of Kazakhstan

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Supplementary files

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1. JATS XML
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2. Fig. 1. Patient selection at each step of the study.

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3. Fig. 2. Triggers for anaphylaxis.

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4. Fig. 3. The most common food allergens as triggers of anaphylaxis.

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5. Fig. 4. Interval between exposure to trigger and anaphylactic response.

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6. Fig. 5. Distribution of patients at hospitalization by severity of anaphylaxis according to J. Ring and K. Messmer, %.

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7. Fig. 6. Therapy carried out at the hospital stage. Note. АГЛС ― antihistaminic drugs; ГКС ― glucocorticoids.

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