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Anaphylaxie en réanimation médicale : expérience d’un centre de référence tunisien

Anaphylaxis in a medical intensive care unit: Experience of a Tunisian reference center

  • Article Original / Original Article
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Médecine Intensive Réanimation

Résumé

Contexte

L’anaphylaxie est la manifestation la plus grave des réactions d’hypersensibilité immédiate. L’absence de données épidémiologiques en Tunisie nous a incités à mener ce travail. L’objectif principal était de dresser le profil épidémioclinique des accidents anaphylactiques admis dans un centre de référence tunisien.

Méthode

Étude rétrospective menée sur dix ans (janvier 2005–décembre 2014) incluant les accidents d’anaphylaxie hospitalisés en réanimation médicale dans un centre de référence à Tunis.

Résultats

Cent trois cas ont été étudiés (âge moyen : 40 ± 16 ans). L’allergène était un médicament chez 58 patients, un aliment chez 32 et une rupture spontanée d’un kyste hydatique du foie chez trois patients. Chez les dix autres patients, l’allergène était soit une piqûre d’hyménoptère, soit inconnu. La présentation clinique était dominée par les signes cutanés (95,2 %). Un état de choc était présent dans 52,4 % des cas, des signes respiratoires dans 50,5 % et des signes digestifs dans 34,9 %. Le traitement était un remplißsage vasculaire chez 84 patients, de l’adrénaline chez 54, des corticoïdes chez 97, des antihistaminiques chez 60 et des β-2-mimétiques chez 35 patients. La durée moyenne d’hospitalisation était de 1,6 ± 2,7 jours. La mortalité globale était de 3,9 % (quatre décès). Deux signes cliniques indépendants liés à l’origine médicamenteuse de l’anaphylaxie ont été identifiés : la dyspnée (odds ratio [OR] = 1,44 ; intervalle de confiance à 95 % [IC 95 %] : 1,06–1,95) et le vertige (OR = 1,65 ; IC 95 % : 1,39–1,97). Deux facteurs indépendants prédictifs de choc ont également été individualisés : la sensation de malaise (OR = 3,5 ; IC 95 % : 1,47–8,36) et un flush (OR = 1,36 ; IC 95 % : 1,36–1,85).

Conclusion

Le profil épidémioclinique des accidents anaphylactiques admis dans un centre de référence tunisien est comparable aux données de la littérature médicale.

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 druginduced 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.

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Ben Ghezala, H., Kouraichi, N., Brahmi, N. et al. Anaphylaxie en réanimation médicale : expérience d’un centre de référence tunisien. Méd. Intensive Réa 25 (Suppl 5), 228–234 (2016). https://doi.org/10.1007/s13546-016-1221-4

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  • DOI: https://doi.org/10.1007/s13546-016-1221-4

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