Severe immediate type hypersensitivity reactions in 105 German adults: when to diagnose anaphylaxis.

BACKGROUND There are no epidemiological data available on anaphylaxis in German adults and so far there has been no consensus on when to diagnose anaphylaxis, mainly due to a lack of generally accepted diagnostic criteria. Recently, an international expert group addressed this issue by suggesting new diagnostic criteria for anaphylaxis. We addressed the usefulness of the suggested diagnostic criteria in German adults and attempted to identify putative trigger factors. METHODS Medical records were reviewed for patients seen in 2006 who had suffered any reaction that led to the suspicion of anaphylaxis. Clinical reaction patterns, eliciting factors, serum tryptase concentrations, and the applicability of diagnostic criteria for anaphylaxis were evaluated. RESULTS One hundred five patients (78 women and 27 men, aged 18-77 years) were included in the study. The eliciting factors were as follows: drugs (46%), hymenoptera stings (33%), food (11%), physical factors (4%), or unknown (7%). Ninety-five patients (91%) fulfilled criteria for anaphylaxis currently employed in Germany; 58 (58%) of those patients had grade 2-4 reactions. In contrast, only 53 (51%)-and only 19/48 (40%) of those who reacted to drugs-fulfilled the newly proposed criteria. Recurrent anaphylactic episodes were found in 15% of the patients and elevated serum tryptase was observed in 6%. CONCLUSION The main eliciting factors for anaphylaxis were hymenoptera stings, drugs, and food. The application of the newly proposed diagnostic criteria did not identify as many patients with severe immediate-type reactions as the graded score currently employed for diagnosis of anaphylaxis in Germany. Further efforts are needed to extend and standardize diagnostic criteria for anaphylaxis.