Prevalence of anaphylaxis in the emergency department at the university clinical center of Kosovo

Abstract

Author(s): Atdhe Haxhibeqiri and Ylli Ahmetaj*

Background: Allergic Diseases (AD) are the most common chronic diseases in Europe. AD diagnosis poses a significant challenge due to the variety of definitions, diversity of symptoms, and the heterogeneous involvement of organs as well as the lack of diagnostic methods in our country. These problems in diagnosis, specifically in the Emergency Department (ED), occur even when differentiation is made of anaphylaxis with Anaphylactic Reactions (AR). Do you mean adverse reactions instead of anaphylactic reaction? Purpose of the study: Prevalence of allergic diseases and anaphylaxis in ED in University Clinical Center of Kosovo (UCCK), determination of the main causes that induce these reactions, the relation of the allergy trigger, and the time of symptoms’ manifestation, observation of the correct approach and appropriate treatment of these cases.

Materials and methods: The research is a cross-sectional study of patients over the age of 15 who presented in our center between January 1^st 2020 and April 30^th 2020. In the cases obtained from the recorded data, patients with a diagnosis of "Reactio allergica" (urticaria, angioedema, erythema, etc.) were selected. The data were obtained based on the anamnesis and present clinical status of the patient, where a questionnaire with 8 questions based on the questionnaire of "Agana Heights Elementary School, General Allergy and Anaphylaxis Questionnaire, Jan 2013" was used. Statistical analysis was done with SPSS program, data were not normally distributed therefore non-parametric tests were used with a confidence interval of 95% and 99%.

Results: Out of 15,131 persons presented at the ED in Prishtina in UCCK for various emergency health problems, 74 allergic reactions were registered that required emergency medical assistance; gender ratio f/m=53/21 (p<0.001) with a predominance of 15 years-30 years of age (39 of them). Dominant symptoms in our patients were skin changes in the form of urticarial changes (36 of them), erythematous changes (51 of them), and angioedema manifested in 27 patients. Fortunately, during the research period 41 (55.4%) cases had mild forms of generalized reaction, 23 (31.0%) moderate and only 10 (13.6%) cases had severe form, according to Brown's classification. Of these, 18 (24.3%) cases were in anaphylaxis according to the criteria of the “Second symposium on the definition and management of anaphylaxis”; this incidence would be 0.1% of all visits in the ED, even though no patient was diagnosed with anaphylaxis by emergency doctors. The most commonly known causes were medications (44.6%). The most common causative drugs were the NSAIDs group (48.3%), ketoprofen lysine (brand name, OKI) leading the way with 25.8% of all cases of allergic reactions to the drugs. The second group of drugs was β-lactam antibiotics with 7 (22.6%) cases, led by cephalosporins and followed by penicillin. The second most common cause was food in 12.1% of cases.

Conclusion: Due to the lack of a unique protocol for anaphylaxis and AR, in our study we managed to identify 18 cases of anaphylaxis, which were not recorded with this diagnosis in the patient’s medical history. Therefore, we consider that health care professionals would benefit from better education on setting criteria to distinguish an allergic reaction from an anaphylactic reaction or anaphylaxis and vice versa.

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