Predictors of Anaphylaxis in Korean Adults

1 Our understanding of anaphylaxis has greatly evolved since its fortuitous discovery by Portier and Richert, 1 but it is nowhere near enough. Uncertainty is more intensified in a lack of comprehensive understanding of predictors associated with severity or serious outcomes of anaphylaxis. In this sense, the article by Ye et al. 2 in this issue of the AAIR is greatly informative. They collected as many as 1,806 cases from 15 nationwide university hospitals. Although their study was retrospectively designed, an enormous number of cases enhance the value of this report considering that the incidence of anaphylaxis in Korea was reported to be 0.014%. 3 Major findings are summarized as follows: (1) the anaphylaxis rate in adults was significantly increased ; (2) the important causes were drugs, food, and insect stings; (3) the severity was dependent on age, the presence of comorbidities, and specific causes; and (4) drug-associated anaphylaxis, multiorgan involvement, and older age were independent predictors of serious outcomes. A clinical diagnosis of anaphylaxis in epidemiologic studies, especially with a retrospective design, is difficult to make. Both overdiagnosis and underdiagnosis can occur. 4 Inaccuracy of diagnostic coding which was used to collect cases in the article by Ye et al. 2 is one of the contributing factors. A study of food-induced acute allergic reactions encountered in the emergency department found that among 678 patients identified according to the International Statistical Classification of Diseases (ICD) codes, 51% should actually have been classified as having anaphylaxis. 5 Even if anaphylaxis is accurately recognized, only a part of patients sometimes receive the proper ICD codes. Decker et al. 6 reported that as many as 25% of the anaphylaxis cases identified had received less specific codes. Even though there are concerns about accuracy in diagnosis, recent epide-miologic studies showing a steady increase in the rate of occurrence of anaphylaxis may enable us to say " We are in the ana-phylaxis epidemic era. " 6-9 Likewise, Ye et al. 2 reported that the anaphylaxis rate in Korean adults was significantly increased from 7. is the first report in Asia. Recently, social actions to meet the needs of growing numbers of people at high risk of anaphylaxis have been initiated and become more important. The anaphy-laxis campaign in the United Kingdom is a good example. 10 Taken together, further prospective investigations in conjunction with Asian nations are warranted to determine exact ana-phylaxis rates in Asia. …