Anaphylaxis in a Medical Intensive Care Unit: Experience of a Tunisian Reference Center

Abstract

Background : Anaphylaxis is the most severe immediate hypersensitivity reaction. However, it is underreported in Tunisia. We decided to perform this study in order to describe the clinical and epidemiological features of anaphylactic reactions recorded in a Tunisian reference center.

Methods : It was a retrospective study over ten years (January 2005–December 2014). In this study, we included all patients admitted for severe anaphylactic reactions to the intensive care unit of a reference center in Tunis.

Results : We analyzed 103 patients admitted to our unit with a mean age of 40 ± 16 years. Most cases were with drug-induced anaphylaxis (N = 58; 56%). Food-induced anaphylaxis was present in 32 cases (31%). Three patients had a ruptured hydatid cyst. In another ten patients, the origin of anaphylaxis was hymenoptera sting or the cause remained unknown. Skin and mucosal signs were found in almost all cases (95.2%). Cardiovascular collapse was present in 52.4% of them. Respiratory signs were noted in 50.5% of the cases and disturbances in the digestive system in 34.9%. Management of anaphylaxis consisted of a fluid challenge, epinephrine administration in 54 patients, corticosteroids in 97, and antihistamine drugs in 60. The mean length of stay in the intensive care unit was 1.6 ± 2.7 days. Recurrence of the anaphylactic accident was observed in six patients. The mortality rate was 3.9% (N = 4). Multiple factor analysis revealed two signs associated with drug anaphylaxis: dyspnea (OR = 1.43; CI 95%: 1.06–1.95) and dizziness (OR = 1.65; CI 95%: 1.39–1.97). We identified two independent factors of shock: malaise (OR = 3.50; CI 95%: 1.47–8.36) and hot flush (OR = 1.36; CI 95%: 1.36–1.85).

Conclusions : The epidemiologic profile of anaphylaxis in our Tunisian reference center is similar to the one found in literature. We report, however, a Tunisian-specific cause, that is, a ruptured hydatid cyst.