Anaphylaxis: insect stings and drugs were common causes

Clinical bottom line (level 4)

  1. Common causes of out-of-hospital anaphylactic reactions included insect stings, snake bites, drugs and nuts.
  2. Respiratory and cardiovascular symptoms were common, but few patients died.
Soreide et al: Acta Anaesthesiologica Scandinavia 1988; 32: 339-342
Expires November 2004

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: air-ambulance service, Norway

27 patients (aged 5 to 74; mean 41, 52% male) with severe anaphylaxis (respiratory or circulatory failure)



Outcomes studied:
  • wasp or bee sting, or snake bite
  • drugs or vaccines
  • nuts
  • respiratory symptoms dyspnoea, stridor, insufficient respiration
  • cardiovascular collapse hypotension, shock, cardiac arrest
  • fatal cases

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    wasp or bee sting, or snake bite ? 14/27 52%
    (33% to 71%)
    drugs or vaccines ? 8/27 30%
    (12% to 47%)
    nuts ? 2/27 7.4%
    (0.0% to 17%)
    respiratory symptoms ? 18/27 67%
    (49% to 84%)
    cardiovascular collapse ? 24/27 89%
    (77% to 100%)
    fatal cases ? 2/27 7.4%
    (0.0% to 17%)

    Citation

    1. Soreide E, Buxrud T, Harboe S: severe anaphylactic reactions outside hospital: etiology, symptoms and treatment. Acta Anaesthesiologica Scandinavia 1988; 32: 339-342
    Search Terms: ?
    Contributor: Mike Bennett and Chris Ball, November 1999
    Reviewer: Chris Ball

    Clinical Question.
    Patient anaphylaxis
    Intervention or Exposure causes
    Outcome prevalence