Anaphylaxis: reactions to nuts and insect stings were common

Clinical bottom line (level 4)

  1. Common symptoms of anaphylaxis included angioedema, bronchospasm, hypotension, pruritis and vomiting.
  2. 70% of patients had 2 or more episodes.
  3. 60% of patients had a history of atopy.
  4. Common identified causes of anaphylaxis include peanuts, other nuts, other food, wasp or bee stings and drugs.
  5. 60% of anaphylactic reactions were minor - less than 1% are fatal.
Pumphrey and Stanworth: Clinical and Experimental Allergy 1996; 26: 1364-1370
Expires November 2004

The study

Case series with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: allergy clinics, university hospital, UK

172 patients (aged 5 months to 69 years, 50% male) with anaphylaxis (acute allergic or angioedematous reaction and at least 2 of hypotension, bronchospasm and angioedema/urticaria), or prescribed epinephrine for self-administration



Outcomes studied:
  • peanut
  • unclear cause
  • other food
  • other nuts
  • wasp venom
  • other drugs
  • muscle relaxants
  • bee venom
  • latex
  • history of asthma, atopic eczema or allergic rhinitis
  • 2 or more reactions
  • minor reaction
  • major reaction
  • fatal reaction
  • angioedema
  • bronchospasm
  • hypotension
  • pruritis
  • vomiting
  • conjunctivitis
  • diarrhoea

The evidence

outcome time to outcome number of patients/total number %
(95% CI)
peanut ? 42/172 24%
(18% to 31%)
unclear cause ? 33/172 19%
(13% to 25%)
other food ? 25/172 15%
(9.3% to 20%)
other nuts ? 23/172 13%
(8.3% to 19%)
wasp venom ? 22/172 13%
(7.8% to 18%)
other drugs ? 8/172 4.7%
(1.5% to 7.8%)
muscle relaxants ? 7/172 4.1%
(1.1% to 7.0%)
bee venom ? 6/172 3.5%
(0.7% to 6.2%)
latex ? 6/172 3.5%
(0.7% to 6.2%)
history of asthma, atopic eczema or allergic rhinitis ? 102/172 59%
(52% to 67%)
2 or more reactions ? 120/172 70%
(63% to 77%)
minor reaction ? 430/712 60%
(57% to 64%)
major reaction ? 280/712 39%
(36% to 43%)
fatal reaction ? 2/712 0.3%
(0.0% to 0.7%)
angioedema ? 150/172 87%
(82% to 92%)
bronchospasm ? 99/172 58%
(50% to 65%)
hypotension ? 89/172 52%
(44% to 59%)
pruritis ? 80/ 47%
(39% to 54%)
vomiting ? 54/172 31%
(25% to 38%)
conjunctivitis ? 32/172 19%
(13% to 24%)
diarrhoea ? 10/172 5.8%
(2.3% to 9.3%)

Comments
  1. Substantial heterogeneity exists between studies with respect to “history of asthma or atopy”.  In some reports, this is validated by objective testing, in others this is accepted based on patient (or parental) self-report. 

Citation

  1. Pumphrey RS, and Stanworth SJ: The clinical spectrum of anaphylaxis in north-west England. Clinical and Experimental Allergy 1996; 26: 1364-1370
Contributor: Mike Bennett and Chris Ball, November 1999
Reviewer: Chris Ball, David Lang

Clinical Question.
    Patient anaphylaxis
    Intervention or Exposure cause / aetiology
    Outcome prevalence