In a retrospective review of a single intensive care unit (ICU) trauma center in New York, 3.4% of adult patients admitted for severe asthma exacerbations had symptomology that could also be diagnosed as anaphylaxis, according to a study published in the Emergency Medicine Journal.
As respiratory symptoms are a dominant feature of both asthma and anaphylaxis, being able to distinguish between the two becomes crucial for appropriate treatment. Researchers sought to determine what percentage of adult patients admitted to intensive care at Jacobi Medical Center in Bronx, New York for asthma exacerbations between January 2012 and December 2014 may also have met the criteria for anaphylaxis.
A retrospective chart review of adult patients admitted for acute asthma during the study time period. The researchers used the World Allergy Organization’s Anaphylaxis Guidelines to determine which patients met the criteria for anaphylaxis. Although 105 patients were initially identified as being treated for asthma, 17 patients were excluded because asthma was not the primary reason for admission, leaving 88 eligible cases. A total of 8% (n=7) met the criteria for diagnosing anaphylaxis, and 3.4% (n=3) were identified as being highly likely to have experienced anaphylaxis.
Although the baseline characteristics of the 7 patients with potential anaphylaxis were similar to the overall population, they had a faster onset of symptoms (IQR: 3.5 [2-6] vs 24 hours [12-72]; P <.001), were more likely to have received antihistamines (28.6% vs 1.2%; P =.02), to have received intramuscular epinephrine from emergency medical services or in the hospital emergency department (86% vs 42%; P =.04), and to have been intubated (71% vs 31%; P =.04). None of the patients with potential anaphylaxis died and only 1 of the 7 was referred to an allergist and prescribed an epinephrine injector at discharge.
The investigators concluded that “[m]aintaining a high index of suspicion for anaphylaxis when taking care of asthmatics may be helpful in identifying such patients and formulating appropriate acute and postacute care plans.”
Akenroye AT, Ajala A, Azimi-Nekoo E, de Vos GS. Prevalence of anaphylaxis among adults admitted to critical care for severe asthma exacerbation [published online August 9, 2018]. Emerg Med J. doi:10.1136/emermed-2017-207076