Identifying At‑Risk Patients

Identifying At‑Risk Patients

Identifying Patients at Risk for an Anaphylactic Reaction  

Risk factors for an anaphylactic reaction include a previous emergency room visit for a significant allergic reaction, rapid progression/progressively systemic reactions to repeat exposure, or not seeing a physician about a prior mild or significant allergic reaction.1-3 However, identifying patient-specific risk factors goes beyond a history of anaphylaxis, as the severity of previous reactions is not always indicative of the severity of future reactions.4

There are factors that increase the risk of anaphylaxis such as exposure to certain allergens for those who are allergic and age, as well as factors which may increase the risk of a severe or fatal anaphylactic reaction such as concomitant diseases and medications which hinder a patient from recognizing the signs and symptoms of anaphylaxis.5 A complete description of these risk factors is described in Tables 1 and 2.

TABLE 1. Factors that increase the risk of having anaphylaxis

Allergens

Exposure to certain allergens increases the risk of triggering an anaphylactic reaction for those who are allergic, and include6

  • Foods such as peanuts, tree nuts, fish, shellfish, eggs, and milk
  • Stinging or biting insects such as bees, ants, and ticks
  • Latex
  • Medications such as β-lactam antibiotics (eg, penicillin)

Age

  • Adolescents and young adults are at increased risk for anaphylaxis because of inconsistent behaviors in avoiding their confirmed triggers and carrying an epinephrine auto-injector2,5

 

Table 2. Factors that may increase anaphylaxis severity or fatality

Age

  • The elderly are at increased risk of fatal anaphylactic reactions because of concomitant diseases including chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) and medications used to treate them.5 In addition, the elderly are at an increased risk of having a more severe anaphylactic reaction if they are exposed to insect venom (eg, stung by an insect). 5

Comorbidities

The following concomitant diseases are associated with an increased risk of a severe or fatal anaphylactic reaction.2,5,7

  • Respiratory diseases such as asthma, especially if severe or uncontrolled
  • Chronic respiratory diseases such as COPD, especially if severe or uncontrolled
  • CVDs such as coronary heart disease and hypertension
  • Mastocytosis or clonal mast cell disorders
  • Atopic diseases (eg, allergic rhinitis, eczema)

In patients of any age, concomitant diseases hampering recognition of signs and symptoms of anaphylaxis place patients at an increased risk of a more severe anaphylactic reaction. Such diseases include

  • Impaired vision or hearing
  • Neurologic disorders such as seizures
  • Psychiatric disorders such as depression
  • Autism spectrum disorder

Concurrent medication or chemical use2,5

In patients of any age, concurrent medications and chemicals hampering recognition of signs and symptoms of anaphylaxis place patients at an increased risk of anaphylaxis. Such medications and/or chemicals include:

  • First-generation H1-antihistamines such as diphenhydramine and chlorpheniramine
  • Antidepressants
  • Sedatives
  • Hypnotics
  • CNS-active chemicals such as ethanol
  • Recreational drugs

Medications that may increase the severity of anaphylactic reactions and make them more difficult to treat include5

  • β-Blockers, which potentially decrease epinephrine efficacy by blocking effects at adrenergic receptors8
  • Angiotensin-converting enzyme (ACE) inhibitors potentially interfere with endogenous compensatory responses8