title: Triggers and treatment of anaphylaxis: an analysis of 4,000 cases from Germany, Austria and Switzerland.
abstract: BACKGROUND
  Anaphylaxis is the most severe manifestation of a mast cell-dependent immediate reaction and may be fatal. According to data from the Berlin region, its incidence is 2-3 cases per 100 000 persons per year.
  
  
  METHODS
  We evaluated data from the anaphylaxis registry of the German-speaking countries for 2006-2013 and data from the protocols of the ADAC air rescue service for 2010-2011 to study the triggers, clinical manifestations, and treatment of anaphylaxis.
  
  
  RESULTS
  The registry contained data on 4141 patients, and the ADAC air rescue protocols concerned 1123 patients. In the registry, the most common triggers for anaphylaxis were insect venom (n = 2074; 50.1%), foods (n = 1039; 25.1%), and drugs (n = 627; 15.1%). Within these groups, the most common triggers were wasp (n = 1460) and bee stings (n = 412), legumes (n = 241), animal proteins (n = 225), and analgesic drugs (n = 277). Food anaphylaxis was most frequently induced by peanuts, cow milk, and hen's egg in children and by wheat and shellfish in adults. An analysis of the medical emergency cases revealed that epinephrine was given for grade 3 or 4 anaphylaxis to 14.5% and 43.9% (respectively) of the patients in the anaphylaxis registry and to 19% and 78% of the patients in the air rescue protocols.
  
  
  CONCLUSIONS
  Wasp and bee venom, legumes, animal proteins, and analgesic drugs were the commonest triggers of anaphylaxis. Their relative frequency was age-dependent. Epinephrine was given too rarely, as it is recommended in the guidelines for all cases of grade 2 and above.
authors.affiliation: Allergy Center Charité, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, ADAC Air Rescue Service Senftenberg, Department of Dermatology and Venereology, Medical University of Graz, Austria, Department of Pediatrics, Pneumonology and Immunology, Charité - Universitätsmedizin Berlin, Allergy Clinic, Department of Dermatology, SALK, Paracelsus Medical University, Salzburg, Austria, Pediatric Allergology, University Children's Hospital Zurich, Zurich, Switzerland, Department of Dermatology, University Hospital Erlangen-Nürnberg, Department of Pediatric Pneumology and Allergology at the KID Center, Dresden-Friedrichstadt, Department of Dermatology, Venerology and Allergy at the Saarland University, Homburg/Saar, Department of Allergology, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen, Department of Internal Medicine I: Pneumology & Allergology/Immunology, Friedrich Schiller University Jena, Department of Pediatric Pulmonology and Allergology, Children's Hospital of the University of Cologne, Allergy Unit, Department of Dermatology, University Hospital Basel, Basel, Schweiz, Department of Dermatology, Venereology and Allergology, University of Leipzig, Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Margitta Worm and Oliver Eckermann have equally contributed to the manuscript.
authors.forename: Margitta
authors.initials: M
authors.lastname: Worm
authors.forename: Oliver
authors.initials: O
authors.lastname: Eckermann
authors.forename: Sabine
authors.initials: S
authors.lastname: Dölle
authors.forename: Werner
authors.initials: W
authors.lastname: Aberer
authors.forename: Kirsten
authors.initials: K
authors.lastname: Beyer
authors.forename: Thomas
authors.initials: T
authors.lastname: Hawranek
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hompes
authors.forename: Alice
authors.initials: A
authors.lastname: Koehli
authors.forename: Vera
authors.initials: V
authors.lastname: Mahler
authors.forename: Katja
authors.initials: K
authors.lastname: Nemat
authors.forename: Bodo
authors.initials: B
authors.lastname: Niggemann
authors.forename: Claudia
authors.initials: C
authors.lastname: Pföhler
authors.forename: Uta
authors.initials: U
authors.lastname: Rabe
authors.forename: Angelika
authors.initials: A
authors.lastname: Reissig
authors.forename: Ernst
authors.initials: E
authors.lastname: Rietschel
authors.forename: Kathrin
authors.initials: K
authors.lastname: Scherer
authors.forename: Regina
authors.initials: R
authors.lastname: Treudler
authors.forename: Franziska
authors.initials: F
authors.lastname: Ruëff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000188:drug therapy* / Q000401:mortality*; D001317:Austria / Q000453:epidemiology; D001733:Bites and Stings / Q000188:drug therapy / Q000401:mortality*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004342:Drug Hypersensitivity / Q000188:drug therapy / Q000401:mortality*; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D005512:Food Hypersensitivity / Q000188:drug therapy / Q000401:mortality*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D055815:Young Adult
chemical_list: D004837:Epinephrine