Anafilaxia: dados de um registro de pacientes atendidos em um serviço especializado
Anaphylaxis: data from a patient registry in a specialized service
Patricia Guerzet Ayres Bastos; Inês Cristina Camelo-Nunes; Renata Rodrigues Cocco; Dirceu Solé; Luis Felipe Chiaverini Ensina
Resumo
Introdução: Dados relacionados à prevalência e incidência da anafilaxia são escassos, especialmente no Brasil. Objetivo: Descrever o perfil epidemiológico e características das reações em pacientes com diagnóstico de anafilaxia assistidos em um ambulatório especializado de alergia. Métodos: Análise de um registro de pacientes (maio/2017 a junho/2018) com diagnóstico de anafilaxia. Informações sobre idade, sexo, apresentação clínica, desencadeantes, conhecimento prévio do desencadeante, estudos diagnósticos realizados, antecedentes pessoais de atopia, tempo entre a exposição e a reação, ambiente onde ocorreu a reação, tratamento e gravidade foram analisados. Resultados: Do total de 150 pacientes (43 dias de vida a 67 anos), 52% eram homens e 66% tinham menos de 18 anos. As principais manifestações clínicas referidas foram as cutâneas e as respiratórias. O tempo entre a exposição ao desencadeante e a reação foi mais comumente menor de 10 minutos. A maioria dos pacientes teve anafilaxia em ambiente não hospitalar, porém, 78% foram tratados em ambiente hospitalar e 57% destes receberam adrenalina intramuscular (IM). Os desencadeantes foram confirmados em 78% dos casos, e os alimentos e as drogas foram os mais implicados. Os pacientes que apresentaram reações desencadeadas por alimentos eram mais jovens e relatavam mais frequentemente reações em menos de 10 minutos e em ambiente não hospitalar. Estes pacientes também relatavam mais frequentemente que conheciam previamente o desencadeante, apresentam antecedente pessoal de atopia e receberam tratamento com adrenalina intramuscular (IM). Dezesseis pacientes apresentaram reações graves, sendo mais frequentes nas mulheres e nos maiores de 18 anos. Conclusão: A anafilaxia por drogas ou por alimentos manifesta diferenças clínicas quanto à idade, ter antecedentes de atopia, local da reação e tempo para início da reação. A gravidade das reações anafiláticas associou-se à idade dos pacientes.
Palavras-chave
Abstract
Introduction: Data on prevalence and incidence of anaphylaxis are scarce, especially in Brazil. Objective: To describe the epidemiological profile and characteristics of reactions in patients diagnosed with anaphylaxis seen at an allergy outpatient clinic. Methods: A patient registry of confirmed cases of anaphylaxis (from May 2017 to June 2018) was analyzed. Age, gender, clinical presentation, triggers, previous knowledge of the trigger, diagnostic studies, atopy background, time gap between exposure and reaction, place where the reaction occurred, treatment and severity were analyzed. Results: From a total of 150 patients (43 days to 67 years of age), 52% were men and 66% were under 18 years of age. The most frequent symptom categories were cutaneous and respiratory. The time gap between exposure to trigger and reaction was more commonly less than 10 minutes. Most of the patients had anaphylaxis in a non-hospital setting; however, 78% were treated in a hospital and 57% of them received intramuscular (IM) epinephrine. The triggers were identified in 78% of cases and predominantly consisted of food and drugs. Patients who had a food-triggered reaction were younger and more frequently reported reactions in less than 10 minutes and in non-hospital settings. These patients also more frequently reported previous knowledge of the trigger, had an atopy background and were treated with IM epinephrine. Sixteen patients had severe reactions, which were more frequent in women and in those over 18 years of age. Conclusion: Clinical manifestations of anaphylaxis triggered by drugs or food may vary depending on age, atopy background, place where the reaction occurs, and time gap before initiation of the reaction. The severity of anaphylactic reactions was associated with age of the patients.
Keywords
Referências
1. Simons FER, Sampson HA. Anaphylaxis epidemic: fact or fiction? J Allergy Clin Immunol. 2008;122:1166‑8.
2. Worm W, Timmermans F, Moneret-Vautrin A, Muraro A, Maimheden Yman II, Lovik M, et al. Towards a European registry of severe allergic reactions: current status of national registries and future needs. Allergy. 2010;65:671-80.
3. Sole D, Ivancevich JC, Borges MS, Coelho MA, Rosario NA, Ardusso LR, et al. Anaphylaxis in Latin America: a report of the online Latin American survey on anaphylaxis (OLASA). Clinics (Sao Paulo). 2011;66:943-7.
4. Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report-Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117:391-7.
5. European data from the network of severe allergic reactions (NORA). Disponível em: www.anaphylaxie.net .
6. Waserman S, Bégin P, Watson W. IgE-mediated food allergy. Allergy Asthma Clin Immunol. 2018;14(2):55.
7. Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test – European standards. Clin Transl Allergy. 2013;3:3.
8. Mill C, Primeau MN, Medoff E, Lejtenyi C, O’Keefe A, Netchiporouk E, et al. Assessing the diagnostic properties of a graded oral provocation challenge for the diagnosis of immediate and nonimmediate reactions to amoxicillin in children. JAMA Pediatr. 2016;170:e160033.
9. Brown SGA. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol. 2004;114(2):371-6.
10. Lieberman P, Kemp SF, Oppenheimer J, Lang DM, Bernstein L, Nicklas RA. The diagnosis and management of anaphylaxis: An updated practice parameter. J Allergy Clin Immunol. 2005;115:483‑524.
11. Chipps BE. Update in pediatric anaphylasis: a systematic review. Clin Pediatr (Phila). 2013 May;52(5):451-61.
12. Bernd LA, Solé D, Pastorino AC, Prado EA, Castro FF, Rizzo MC, et al. Anafilaxia: guia prático para o manejo. Rev Bras Alerg Imunopatol. 2006;29:283-91.
13. Lieberman PP. Anaphylaxis. In: Adkinson Jr. NF, Bochner BS, Busse WW, Holgate ST, Lemanske Jr. RF, Simons FER, eds. Middleton's Allergy: Principles and Practice, 7ª ed. New York: Mosby-Elsevier; 2008. p. 1026-50.
14. Mcgrath KG. Anaphylaxis and other generalizaed hypersensitivity. In: Grammer LC & Greenberger PA, eds. Patterson’s Allergic Diseases, 7ª ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 197-219.
15. Caballero M, Lane S, Leen T. Anaphylaxis. In: Kay AB, Kaplan AP, Bousquet J, Holt PG, eds. Allery and allergic diseases. 2ª ed. Oxford, UK; 2008. p. 1897-920.
16. Bernd LAG, Fleig F, Alves MB, Bertozzo R, Coelho M, Correia J, et al. Anafilaxia no Brasil – Levantamento da ASBAI. Rev bras alerg imunopatol. 2010;33:190-8.
17. Hoffer V, Scheuerman O, Marcus N, Levy Y, Segal N, Lagovsky I, et al. Anaphylaxis in Israel: experience with 92 hospitalized children. Pediatr Allergy Immunol. 2011;22:172-7.
18. De Swert LF, Bullens D, Raes M, Dermaux AM. Anaphylaxis in referred pediatric patients: demographic and clinical features, triggers, and Therapeutic approach. Eur J Pediatr. 2008;167:1251‑61.
19. Orhan F, Canitez Y, Bakirtas A, Yilmaz O, Boz AB, Can D, et al. Anaphylaxis in Turkish children: a multi-centre, retrospective, case study. Clin Exp Allergy. 2011;41:1767-76.
20. Mullins RJ. Anaphylaxis: risk factors for recurrence. Clin Exp Allergy. 2003;33:1033-40.
21. Smit DV, Cameron PA, Rainer TH. Anaphylaxis presentations to an emergency department in Hong Kong: incidence and predictors of biphasic reactions. J Emerg Med. 2005;28:381-8.
22. Moro Moro M, Tejedor Alonso MA, Esteban Hernández J, Múgica García MV, Rosado Ingelmo A, Vila Albelda C. Incidence of anaphylaxis and subtypes of anaphylaxis in a general hospital emergency department. J Investig Allergol Clin Immunol. 2011;21:142-9.
23. Simons FER. Anaphylaxis: Recent advances in assessment and treatment. J Allergy Clin Immunol. 2009;124:625-36.
24. Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;6:327-80.
25. Jares EJ, Baena-Cagnani CE, Sánchez-Borges M, Ensina LF, Arias-Cruz A, Gómez M, Cuello MN, Morfin-Maciel BM, De Falco A, Barayazarra S, Bernstein JA, Serrano C, Monsell S, Schuhl J, Cardona-Villa R; Latin America Drug Allergy Interest Group. Drug-Induced Anaphylaxis in Latin American Countries. J Allergy Clin Immunol Pract. 2015 Sep-Oct;3(5):780-8. doi: 10.1016/j. jaip.2015.05.012. Epub 2015 Jul 2. PMID: 26143020
26. Ensina LF, de Lacerda AE, de Andrade DM, Machado L, Camelo-Nunes I, Solé D. Drug-induced anaphylaxis in children: nonsteroidal anti-inflammatory drugs and drug provocation test. J Allergy Clin Immunol Pract. 2014 Nov-Dec;2(6):825. doi: 10.1016/j. jaip.2014.08.016. Epub 2014 Nov 6. PMID: 25439388
27. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Manual de vigilância epidemiológica de eventos adversos pós-vacinação / Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância das Doenças Transmissíveis, 3ª ed, Brasília: Ministério da Saúde, 2014. 250 p.: il.
28. Ellis AK. Biphasic Anaphylaxis: a Review of the Incidence, Characteristics and Predictors. Open Allergy J. 2010;3:24-8.
29. Worm M, Francuzik W, Renaudin JM, Bilo MB, Cardona V, Scherer Hofmeier K, et al. Factors increasing the risk for a severe reaction in anaphylaxis: An analysis of data from The European Anaphylaxis Registry. Allergy. 2018;73:1322-30.
30. Ye YM, Kim MK, Kang HR, Kim TB, Sohn SW, Koh YI, Park HK, Jang GC, Kim CW, Jee YK, Hur GY, Kim JH, Kim SH, Choi GS, Lee SK, Park HS, KAAACI Work Group on Urticaria/Angioedema/ Anaphylaxis. Predictors of the severity and serious outcomes of anaphylaxis in Korean adults: a multicenter retrospective case study. Allergy Asthma Immunol Res. 2015 Jan;7(1):22-9.
Submetido em:
22/05/2019
Aceito em:
01/06/2019
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