Seasonal and regional variations in the causes of anaphylaxis in Korean adults

Yeon-Kyung Lee; Mi Kyeong Kim; Hye-Ryun Kang; Tae-Bum Kim; Seong-Wook Sohn; Hye-Kyung Park; Young-Il Koh; Gwang Cheon Jang; Cheol-Woo Kim; Young-Koo Jee; Gyu-Young Hur; Joo-Hee Kim; Sang-Heon Kim; Gil-Soon Choi; Soo-Keol Lee; Hae-Sim Park; Young-Min Ye

doi:10.4168/aard.2015.3.3.187

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Lee, Kim, Kang, Kim, Sohn, Park, Koh, Jang, Kim, Jee, Hur, Kim, Kim, Choi, Lee, Park, Ye, and Korean Academy of Asthma, Allergy and Clinical Immunology Work Group on Urticaria/Angioedema/Anaphylaxis: Seasonal and regional variations in the causes of anaphylaxis in Korean adults

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(3): 187-193.

Published online: 29 May 2015

DOI: https://doi.org/10.4168/aard.2015.3.3.187

Seasonal and regional variations in the causes of anaphylaxis in Korean adults

Yeon-Kyung Lee¹, Mi Kyeong Kim², Hye-Ryun Kang³, Tae-Bum Kim⁴, Seong-Wook Sohn⁵, Hye-Kyung Park⁶, Young-Il Koh⁷, Gwang Cheon Jang⁸, Cheol-Woo Kim⁹, Young-Koo Jee¹⁰, Gyu-Young Hur¹¹, Joo-Hee Kim¹², Sang-Heon Kim¹³, Gil-Soon Choi¹⁴, Soo-Keol Lee¹⁵, Hae-Sim Park¹

, Young-Min Ye¹

; Korean Academy of Asthma, Allergy and Clinical Immunology Work Group on Urticaria/Angioedema/Anaphylaxis

¹Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.

²Division of Internal Medicine, Chungbuk National University, Cheongju, Korea.

³Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

⁴Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁵Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.

⁶Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.

⁷Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.

⁸Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.

⁹Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.

¹⁰Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.

¹¹Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.

¹²Division of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.

¹³Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

¹⁴Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.

¹⁵Department of Internal Medicine, Dong-A University, College of Medicine, Busan, Korea.

Correspondence to: Young-Min Ye. Department of Allergy & Clinical Immunology, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 443-721, Korea. Tel: +82-31-219-4262, Fax: +82-31-219-4265, ye9007@ajou.ac.kr

Received 16 February 2015 Revised 9 April 2015 Accepted 16 April 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

To investigate whether causes of anaphylaxis vary according to regions and seasons in Korean adults.

Methods

Based on previous retrospective studies of anaphylaxis between 2007 and 2011 at the 15 university hospitals. Regions were classified into 4 groups: region I, Seoul; region II, Gyeonggi; region III, Chungcheong; and region IV, Chonnam and Busan. The cases induced by 5 major allergens including drugs, food, bee sting, radiocontrast media, and exercise, were analyzed in the present study.

Results

Among a total of 1,661 cases reported (53% male, 45.9±16.0 years), 367 (22.2%), 706 (42.5%), 319 (19.2%), and 269 cases (16.2%) were enrolled in regions I, II, III, and IV, respectively. Of the 5 major allergens, drugs (37.3%) were the most frequently reported, followed by food (25.7%), bee sting (17.9%), radiocontrast media (12.9%), and exercise (6.2%). There was no significant difference in the total occurrence of anaphylaxis in 4 seasons (374 in spring, 460 in summer, 460 in autumn, and 367 in winter). Multiple logistic regression analysis revealed that drug-induced anaphylaxis was significantly associated with the winter season (odds ratio [OR] 1.0 vs. OR 0.597, P<0.05 for spring; OR 1.0 vs. OR 0.481, P<0.01 for summer; OR 1.0 vs. OR 0.653, P<0.05 for autumn). Food-associated anaphylaxis was mainly reported in region I, whereas the frequency of insect sting was relatively higher in regions II, III, and IV than in region I. Older age and female gender were significantly associated with drug-induced anaphylaxis.

Conclusion

Specific causative allergens of anaphylaxis in adults may vary according to age, gender, region, and season in Korea.

Keywords: Anaphylaxis, Adult, Etiology, Seasons, Geographic locations

Figures and Tables

Fig. 1

Seasonal variations in the proportion of 5 common causes of anaphylaxis. RCM, radiocontrast media.

Fig. 2

Classification of regions and reported numbers of anaphylaxis cases according to the regions. SN, Seoul National University Hospital; AS, Asan Medical Center; KK, Korea University Guro Hospital; HY, Hanyang University Medical Center; AJ, Ajou University Hospital; DG, Dongguk University Ilsan Hospital; IH, Inha University Hospital; IS, National Health Insurance Service Ilsan Hospital; HL, Hallym University Sacred Heart Hospital; CB, Chungbuk National University Hospital; DK, Dankook University Hospital; PS, Pusan National University Hospital; CN, Chonnam National University Hospital; KS, Kosin University Gospel Hospital; DA, Dong-A University Hospital.

Table 1

Clinical characteristics of study population

Characteristic	Region I (n = 367)	Region II (n = 706)	Region III (n = 319)	Region IV (n = 269)	P-value	Total (n = 1,661)
Male sex	201 (54.8)	388 (55.0)	155 (48.6)	136 (50.6)	0.197	880 (53.0)
Age (yr)	48.3 ± 16.9	45.4 ± 15.5	43.8 ± 15.4	46.7 ± 16.6	0.002^*	45.9 ± 16.0
Allergic diseases	67/201 (33.3)	214/493 (43.4)	150/316 (47.5)	91/269 (33.8)	0.001	522/1,279 (40.8)
Causes
Drugs	124 (33.8)	219 (31.0)	184 (57.7)	93 (34.6)	< 0.001	620 (37.3)
NSAIDs	28	80	109	30		247
Antibiotics	45	67	40	29		181
Food	118 (32.2)	179 (25.4)	67 (21.0)	63 (23.4)	0.006	427 (25.7)
Wheat	44	76	14	14		148
Seafood	33	59	21	29		142
Bee sting	20 (5.4)	187 (26.5)	37 (11.6)	53 (19.7)	< 0.001	297 (17.9)
RCM	77 (21.0)	68 (9.6)	22 (6.9)	47 (17.5)	< 0.001	214 (12.9)
Exercise	28 (7.6)	53 (7.5)	9 (2.8)	13 (4.8)	0.015	103 (6.2)
FDEIA	23	42	2	6		73

Values are presented as number (%) or mean± standard deviation.

NSAID, nonsteroid anti-inflammatory drug; RCM, radiocontrast media; FDEIA, food-dependent exercise-induced anaphylaxis.

^*Analysis of variance and other P-values were obtained by chi-square test.

Table 2

Multiple logistic regression analysis for the specific causalities of anaphylaxis

Variable	Drug (n = 620)	RCM (n = 214)	Food (n = 427)	Exercise (n = 103)	Bee venom (n = 297)
Age	1.008 (1.001-1.014)^*	1.036 (1.026-1.046)^†	0.977 (0.970-0.984)^†	0.942 (0.928-0.957)^†	1.013 (1.005-1.022)^*
Gender	1.938 (1.582-2.374)^†	1.369 (1.016-1.843)^*	0.839 (0.671-1.048)	0.282 (0.173-0.462)^†	0.401 (0.302-0.534)^†
Region
I	1	1	1	1	1
II	0.903 (0.688-1.184)	0.442 (0.308-0.636)^†	0.675 (0.510-0.893)^*	0.875 (0.530-1.445)	7.077 (4.309-11.623)^†
III	2.472 (1.818-3.361)^†	0.294 (0.176-0.489)^†	0.492 (0.346-0.698)^†	0.286 (0.130-0.629)^*	2.219 (1.242-3.967)^*
IV	1.069 (0.766-1.492)	0.827 (0.547-1.249)	0.634 (0.442-0.909)^*	0.583 (0.289-1.177)	4.267 (2.443-7.452)^†
Season
Winter	1	1	1	1	1
Spring	0.597 (0.443-0.804)^*	1.690 (1.105-2.586)^*	0.851 (0.619-1.171)	1.405 (0.782-2.523)	2.374 (1.298-4.3426)^*
Summer	0.481 (0.360-0.643)^†	1.015 (0.656-1.571)	0.573 (0.417-0.788)^*	0.765 (0.415-1.411)	9.890 (5.781-16.919)^†
Autumn	0.653 (0.492-0.866)^*	1.036 (0.507-1.259)	0.822 (0.604-1.117)	1.018 (0.559-1.851)	5.537 (3.206-9.564)^†

RCM, radiocontrast media.

^*P< 0.05. ^†P< 0.01.

Notes

This work was supported by the Korean Academy of Asthma, Allergy and Clinical Immunology.

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ORCID iDs

Hae-Sim Park
https://orcid.org/http://orcid.org/0000-0003-2614-0303

Young-Min Ye
https://orcid.org/http://orcid.org/0000-0002-7517-1715

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