ASSESSMENT OF PATIENTS WHO HAVE EXPERIENCED ANAPHYLAXIS - A 3-YEAR SURVEY

Design: A quality-control retrospective review of medical records was conducted for cases of anaphylaxis encountered at Mayo Clinic Rocheste r during a 3 1/2-year period. Patients: For inclusion in the study, al l patients had to manifest general symptoms of mediator release such a s generalized pruritus, urticaria, angioedema, and flushing. Of the 17 9 patients with anaphylaxis (mean age, 36 years), 66% were female, 49% had atopy, and 37% had a previous history of immediate reactions to a llergens. Of these study patients, 11 were receiving medications capab le of exacerbating anaphylaxis (beta-blockers in 7 of them). Results: Consultation with an allergist was obtained in 142 cases, and a probab le diagnosis was made after review of the medical records. Causes of a naphylaxis included foods in 59 patients, idiopathic in 34, Hymenopter a in 25, medications in 23, and exercise in 12; false-positive diagnos es were recorded in 18. Allergy prick tests were done in 104 patients, 71 of whom had positive results; allergen-specific IgE tests were don e in 44 patients, 23 of whom had positive results. In 19 patients, onl y allergen-specific IgE testing was done, and results were positive in 12. Normal test results included C1 esterase inhibitor in 33 patients , metabisulfite challenge in 15, and dye or preservative challenge in 10. Food skin tests were graded on a relative value scale and revealed 15 highly allergic, 24 moderately allergic, and 39 weakly allergic fo od groups. Conclusion: A standard protocol should be used for assessme nt of patients with anaphylaxis, and fresh food extracts should be use d for prick skin testing. A national incidence study of anaphylaxis is needed. The public and school personnel should be educated about food anaphylaxis, and emergency treatment for anaphylaxis should be readil y available for patients.