title: Justified concern or exaggerated fear: the risk of anaphylaxis in percutaneous treatment of cystic echinococcosis-a systematic literature review.
abstract: Percutaneous treatment (PT) emerged in the mid-1980s as an alternative to surgery for selected cases of abdominal cystic echinococcosis (CE). Despite its efficacy and widespread use, the puncture of echinococcal cysts is still far from being universally accepted. One of the main reasons for this reluctance is the perceived risk of anaphylaxis linked to PTs. To quantify the risk of anaphylactic reactions and lethal anaphylaxis with PT, we systematically searched MEDLINE for publications on PT of CE and reviewed the PT-related complications. After including 124 publications published between 1980 and 2010, we collected a total number of 5943 PT procedures on 5517 hepatic and non-hepatic echinococcal cysts. Overall, two cases of lethal anaphylaxis and 99 reversible anaphylactic reactions were reported. Lethal anaphylaxis occurred in 0.03% of PT procedures, corresponding to 0.04% of treated cysts, while reversible allergic reactions complicated 1.7% of PTs, corresponding to 1.8% of treated echinococcal cysts. Analysis of the literature shows that lethal anaphylaxis related to percutaneous treatment of CE is an extremely rare event and is observed no more frequently than drug-related anaphylactic side effects.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. andreas.neumayr@unibas.ch
authors.forename: Andreas
authors.initials: A
authors.lastname: Neumayr
authors.forename: Giuliana
authors.initials: G
authors.lastname: Troia
authors.forename: Chiara
authors.initials: C
authors.lastname: de Bernardis
authors.forename: Francesca
authors.initials: F
authors.lastname: Tamarozzi
authors.forename: Sam
authors.initials: S
authors.lastname: Goblirsch
authors.forename: Luca
authors.initials: L
authors.lastname: Piccoli
authors.forename: Christoph
authors.initials: C
authors.lastname: Hatz
authors.forename: Carlo
authors.initials: C
authors.lastname: Filice
authors.forename: Enrico
authors.initials: E
authors.lastname: Brunetti
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced* / Q000453:epidemiology* / Q000523:psychology; D004443:Echinococcosis / Q000150:complications / Q000628:therapy*; D006801:Humans; D015994:Incidence; D018570:Risk Assessment