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Diagnostic Utility of Two Case Definitions for Anaphylaxis

A Comparison Using a Retrospective Case Notes Analysis in the UK

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Abstract

Background: Anaphylaxis is a clinical diagnosis with no gold-standard test. Recent case definitions have attempted to provide objective criteria for diagnosis.

Objective: The aim of this study was to compare the diagnostic concordance of the Brighton Collaboration case definition (the ‘Brighton’ case definition) to the consensus case definition from the Second Symposium on the Definition and Management of Anaphylaxis (the ‘Symposium’ definition).

Method: The study setting was a hospital-based emergency department in the UK. We identified cases of anaphylaxis by physicians’ discharge diagnoses over a 2-year period from 2005 to 2006, and used randomly selected cases of allergic reaction, asthma and urticaria as a control group. Data was extracted by clinicians (who were unaware of the content of either case definition), and the two case definitions were applied by Boolean operators in a Microsoft® Excel spreadsheet. Concordance between the case definitions was measured using Cohen’s kappa (κ) statistic.

Results: We reviewed 128 sets of notes, with 47 cases of anaphylaxis. Brighton and Symposium definitions had sensitivities of 0.681 and 0.671, respectively, and specificities of 0.790 and 0.704, respectively. A discordant result was found in 36/128 cases (28.1%; κ = 0.414 [95% CI 0.253, 0.574]), which represents a moderate level of agreement between case definitions.

Conclusions: The Brighton case definition has a similar diagnostic concordance to the Symposium case definition. It does not seem to over-or underestimate cases and is sufficiently unique that the identification of an allergic trigger does not have to form part of the case definition. This will be important in the recognition of anaphylaxis resulting from the administration of drug and vaccines, where causality should be examined separately from case ascertainment.

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References

  1. Johansson SG, Hourihane JO, Bousquet J, et al. A revised nomenclature for allergy: an EAACI position statement from the EAACI Nomenclature Task Force. Allergy 2001; 56(9): 813–24

    Article  PubMed  CAS  Google Scholar 

  2. Simons FE. Anaphylaxis. J Allergy Clin Immunol 2008; 121 (2 Suppl.): S402–7

    Article  PubMed  CAS  Google Scholar 

  3. Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second Symposium on the Definition and Management of Anaphylaxis: summary report. Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium. J Allergy Clin Immunol 2006; 117(2): 391–7

    Article  PubMed  Google Scholar 

  4. Ruggeberg JU, Gold MS, Bayas JM, et al. Anaphylaxis: case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2007; 25(31): 5675–84

    Article  PubMed  Google Scholar 

  5. Erlewyn-Lajeunesse M, Bonhoeffer J, Ruggeberg JU, et al. Anaphylaxis as an adverse event following immunisation. J Clin Pathol 2007; 60(7): 737–9

    Article  PubMed  Google Scholar 

  6. Advanced Life Support Group. Paediatric advanced life support: provider manual. Manchester: Advanced Life Support Group, 2007

    Google Scholar 

  7. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33(1): 159–74

    Article  PubMed  CAS  Google Scholar 

  8. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 1998; 17(8): 857–72

    Article  PubMed  CAS  Google Scholar 

  9. Brown SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol 2004; 114(2): 371–6

    Article  PubMed  Google Scholar 

  10. Simons FE, Frew AJ, Ansotegui IJ, et al. Risk assessment in anaphylaxis: current and future approaches. J Allergy Clin Immunol 2007; 120 (1 Suppl.): S2–24

    Article  PubMed  CAS  Google Scholar 

  11. West SL, D’Aloisio AA, Ringel-Kulka T, et al. Population-based drug-related anaphylaxis in children and adolescents captured by South Carolina Emergency Room Hospital Discharge Database (SCERHDD) [2000–2002]. Pharmaco-epidemiol Drug Saf 2007; 16(12): 1255–67

    Article  Google Scholar 

  12. Ross MP, Ferguson M, Street D, et al. Analysis of food-allergic and anaphylactic events in the National Electronic Injury Surveillance System. J Allergy Clin Immunol 2008; 121(1): 166–71

    Article  PubMed  Google Scholar 

  13. Gaeta TJ, Clark S, Pelletier AJ, et al. National study of US emergency department visits for acute allergic reactions, 1993 to 2004. Ann Allergy Asthma Immunol 2007; 98(4): 360–5

    Article  PubMed  Google Scholar 

  14. Lieberman P. Anaphylactic reactions during surgical and medical procedures. J Allergy Clin Immunol 2002; 110 (2 Suppl.): S64–9

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Tina Bennett and Gary White for their administrative assistance.

The Peel Medical Research Trust funded this study. They were not involved in the design and conduct of the study nor in the analysis of data or preparation of this manuscript.

Michel Erlewyn-Lajeunesse is a member of the Brighton Collaboration working party for the anaphylaxis following immunization case definition used in this study. All other authors have no conflicts of interest to declare that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Paediatric Allergy, Immunology and Infectious Diseases, Southampton University Hospitals NHS Trust, Tremona Road, Southampton, SO16 6YD, UK

    Michel Erlewyn-Lajeunesse

  2. Clinical Sciences at South Bristol, University of Bristol, Bristol, UK

    Sandra Dymond

  3. Institute of Cancer Research, University of London, London, UK

    Ingrid Slade

  4. Emergency Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK

    Helen L. Mansfield, Rosie Fish, Owen Jones & Jonathan R. Benger

  5. Faculty of Health and Life Sciences, University of the West of England, Bristol, UK

    Jonathan R. Benger

Authors
  1. Michel Erlewyn-Lajeunesse
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  2. Sandra Dymond
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  3. Ingrid Slade
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  4. Helen L. Mansfield
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  5. Rosie Fish
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  6. Owen Jones
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  7. Jonathan R. Benger
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Correspondence to Michel Erlewyn-Lajeunesse.

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Erlewyn-Lajeunesse, M., Dymond, S., Slade, I. et al. Diagnostic Utility of Two Case Definitions for Anaphylaxis. Drug-Safety 33, 57–64 (2010). https://doi.org/10.2165/11318970-000000000-00000

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