title: Drug-Induced Anaphylaxis in Latin American Countries.
abstract: BACKGROUND
  Information regarding the clinical features and management of drug-induced anaphylaxis (DIA) in Latin America is lacking.
  
  
  OBJECTIVE
  The objective of this study was to assess implicated medications, demographics, and treatments received for DIA in Latin American patients referred to national specialty centers for evaluation.
  
  
  METHODS
  A database previously used to compile information on drug-induced allergic reactions in 11 Latin American countries was used to identify and characterize patients presenting specifically with a clinical diagnosis of DIA. Information regarding clinical presentation, causative agent(s), diagnostic studies performed, treatment, and contributing factors associated with increased reaction severity was analyzed.
  
  
  RESULTS
  There were 1005 patients evaluated for possible drug hypersensitivity reactions during the study interval, and 264 (26.3%) met criteria for DIA. DIA was more frequent in adults and in elderly females (N = 129 [76.6%] and N = 30 [75%], respectively) compared with children and/or adolescents (N = 21 [42.9%], P < .01). Severe DIA was less frequent with underlying asthma (N = 22 vs 35 [38.6% vs 61.4%], P < .05) or atopy (N = 62 vs 71 [43% vs 59% ], P < .01). Nonsteroidal anti-inflammatory drugs (NSAIDs) (N = 178 [57.8%]), beta-lactam antibiotics (N = 44 [14.3%]), and other antibiotics (N = 16 [5.2%]) were the most frequently implicated drug classes. Anaphylaxis was rated as severe in N = 133 (50.4%) and anaphylactic shock (AS) was present in N = 90 (34.1%). Epinephrine was only used in N = 73 (27.6%) overall, but in N = 70 (77.8%) of patients with AS.
  
  
  CONCLUSIONS
  In Latin American patients referred for evaluation of DIA, NSAIDs and antibiotics were implicated in approximately 80% of cases. Most of these reactions were treated in the emergency department. Epinephrine was administered in only 27.6% of all cases, although more frequently for anaphylactic shock. Dissemination of anaphylaxis guidelines among emergency department physicians should be encouraged to improve management of DIA.
authors.affiliation: Allergy Unit, CMP S.A., Libra Foundation, Buenos Aires, Argentina. Electronic address: edgardo.jares@gmail.com.
authors.forename: Edgardo José
authors.initials: EJ
authors.lastname: Jares
authors.affiliation: Centro de Investigación en Medicina Respiratoria, Faculty of Medicine, Catholic University of Cordoba, Cordoba, Argentina.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Baena-Cagnani
authors.affiliation: Allergy and Clinical Immunology Department, Centro Médico-Docente La Trinidad, Caracas, Venezuela.
authors.forename: Mario
authors.initials: M
authors.lastname: Sánchez-Borges
authors.affiliation: Allergy, Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Luis Felipe C
authors.initials: LF
authors.lastname: Ensina
authors.affiliation: Centro Regional de Alergia e Inmunología Clínica, Hospital Universitario, Monterrey, Mexico.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Arias-Cruz
authors.affiliation: Allergy and Asthma Unit, Hospital San Bernardo, Salta, Argentina.
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Gómez
authors.affiliation: Allergy and Immunology Department, Consultorios San Juan, San Juan, Argentina.
authors.forename: Mabel Noemi
authors.initials: MN
authors.lastname: Cuello
authors.affiliation: Allergy, Hospital Mocel, Mexico City, Mexico.
authors.forename: Blanca María
authors.initials: BM
authors.lastname: Morfin-Maciel
authors.affiliation: Allergy and Clinical Immunology, Universidad Nacional de La Plata, La Plata, Argentina.
authors.forename: Alicia
authors.initials: A
authors.lastname: De Falco
authors.affiliation: Allergy and Immunology, Nuevo Hospital San Roque, Córdoba, Argentina.
authors.forename: Susana
authors.initials: S
authors.lastname: Barayazarra
authors.affiliation: Department of Internal Medicine and Division of Immunology/Allergy Section, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Bernstein
authors.affiliation: Allergy Unit, Fundación Valle del Lili, Cali, Colombia.
authors.forename: Carlos
authors.initials: C
authors.lastname: Serrano
authors.affiliation: Allergy Unit, CMP S.A., Libra Foundation, Buenos Aires, Argentina.
authors.forename: Silvana
authors.initials: S
authors.lastname: Monsell
authors.affiliation: Allergy Unit, Hospital Britanico, Montevideo, Uruguay.
authors.forename: Juan
authors.initials: J
authors.lastname: Schuhl
authors.affiliation: Universidad de Antiquia, Medellin, Colombia.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cardona-Villa
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000485:Allergens / Q000276:immunology*; D000707:Anaphylaxis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000276:immunology*; D002648:Child; D003430:Cross-Sectional Studies; D004342:Drug Hypersensitivity / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007843:Latin America; D008297:Male; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012737:Sex Factors; D047090:beta-Lactams / Q000276:immunology*
chemical_list: D000485:Allergens; D000894:Anti-Inflammatory Agents, Non-Steroidal; D047090:beta-Lactams; D004837:Epinephrine
keywords: Anaphylaxis; Drug allergy; Epidemiology; Epinephrine; Latin America