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      Factors increasing the risk for a severe reaction in anaphylaxis: An analysis of data from The European Anaphylaxis Registry

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          Most cited references 26

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          An Introduction to Logistic Regression Analysis and Reporting

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            Clinical features and severity grading of anaphylaxis.

            Existing grading systems for acute systemic hypersensitivity reactions vary considerably, have a number of deficiencies, and lack a consistent definition of anaphylaxis. The aims of this study were to develop a simple grading system and definition of anaphylaxis and to identify predictors of reaction severity. Case records from 1149 systemic hypersensitivity reactions presenting to an emergency department were analyzed retrospectively. Logistic regression analyses of the associations between individual reaction features and hypotension and hypoxia were used to construct a grading system. Epinephrine use, etiology, age, sex, comorbidities, and concurrent medications were then assessed for their association with reaction grade. Confusion, collapse, unconsciousness, and incontinence were strongly associated with hypotension and hypoxia and were used to define severe reactions. Diaphoresis, vomiting, presyncope, dyspnea, stridor, wheeze, chest/throat tightness, nausea, vomiting, and abdominal pain had weaker, albeit significant, associations and were used to define moderate reactions. Reactions limited to the skin (urticaria, erythema, and angioedema) were defined as mild. These grades correlated well with epinephrine usage. Older age, insect venom, and iatrogenic causes were independent predictors of severity. Preexisting lung disease was associated with an increased risk of hypoxia. This simple grading system has potential value for defining reaction severity in clinical practice and research settings. The moderate and severe grades provide a workable definition of anaphylaxis. Age, reaction precipitant, and preexisting lung disease appear to be the major determinants of reaction severity.
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              Gender difference, sex hormones, and immediate type hypersensitivity reactions.

               H Behrendt,  J Ring,  M Mempel (2008)
              Gender differences in the development and prevalence of human diseases have long been recognized. Immense interest grows in the understanding of the role of sex hormones in the homeostasis of immunity. Asthma predominates in boys before puberty and this gender preference reverses after puberty and in adulthood, when adult women tend to have a more severe disease, often recalcitrant to treatment. Atopic eczema in preschool children shows insignificant gender difference or male preponderance in different studies, with more adult females suffering from atopic eczema. The limited data on the prevalence of immediate hypersensitivity to hymenoptera venom show controversial results. Discrepancy exists regarding the gender difference in food allergy, with females reporting significantly more allergic reactions in questionnaire studies. In general, adverse reactions to nonionic iodinated radiocontrast media are more commonly observed in females. The course of allergic diseases varies unpredictably during pregnancy, whereas hormone replacement therapy in postmenopausal women usually has a favorable influence on the course of asthma. Experiments in rodents confirm an effect of estrogens on mast cell activation and allergic sensitization, while progesterone is shown to suppress histamine release but potentiate IgE induction. Dehydroepiandrosterone may antagonize the production of Th2 cytokines but the effect of testosterone and the other androgens remains less defined. Actual data from human studies are lacking.
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                Author and article information

                Journal
                Allergy
                Allergy
                Wiley
                01054538
                June 2018
                June 2018
                March 08 2018
                : 73
                : 6
                : 1322-1330
                Affiliations
                [1 ]Department of Dermatology and Allergology; Charite-Universitätsmedizin Berlin; Berlin Germany
                [2 ]Allergy Vigilance Network; University Hospital Nancy; Nancy France
                [3 ]Department of Internal Medicine/Allergy Unit; University Hospital Ospedali Riuniti; Ancona Italy
                [4 ]Allergy Section, Department of Internal Medicine; Hospital Universitari Vall d'Hebron; Barcelona Spain
                [5 ]Department of Dermatology; University Hospital Basel; Basel Switzerland
                [6 ]Division of Allergology; University Children's Hospital; Zurich Switzerland
                [7 ]Department of Dermatology; University Allergy Center; University Hospital Carl Gustav Carus; Technical University Dresden; Dresden Germany
                [8 ]Faculty of Public Health; Medical University-Sofia; Sofia Bulgaria
                [9 ]Tokuda Medical Centre; Allergy Out-patient Clinic; Sofia Bulgaria
                [10 ]Department of Pediatrics; Jagiellonian University Medical College; Krakow Poland
                [11 ]Department of Dermatology; Paracelsus Private Medical University Salzburg; Salzburg Austria
                [12 ]Paediatrics and Child Health; University College Cork; Cork Ireland
                [13 ]Department of Pediatrics; St. Marien-Hospital; Bonn Germany
                [14 ]Department of Dermatology; University Hospital of Erlangen; Friedrich-Alexander-University Erlangen; Erlangen Germany
                [15 ]Department of Mother and Child Health; Padua General University Hospital; Padua Italy
                [16 ]Allergy Department; University of Athens; Athens Greece
                [17 ]Department of Dermatology; Saarland University Hospital; Homburg/Saar Germany
                [18 ]Clinical Allergology Department; Pomeranian Medical University Szczecin; Szczecin Poland
                [19 ]Department of Dermatology and Allergology; Klinikum der Universität München; München Germany
                [20 ]Department of Pediatric Pneumology and Allergology; Lung Centre South-West; Wangen Germany
                [21 ]Department of Dermatology, Venerology and Allergology; LICA-Comprehensive Allergy Center; Universität Leipzig; Leipzig Germany
                [22 ]Allergy Department; Hospital Clinico San Carlos IdISSC; Madrid Spain
                Article
                10.1111/all.13380
                29318637
                © 2018

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