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Anaphylaxis and pregnancy: a systematic review and call for public health actions

Published: August 05, 2021

Although rare, anaphylaxis during pregnancy carries a risk to both a woman and her fetus. This systematic review published in The Journal of Allergy and Clinical Immunology: In Practice was performed by Carra et al. with the aim of identifying key issues in the diagnosis and management of this condition in order to support prevention strategies and decrease the risk of death related to anaphylaxis during pregnancy. The authors searched MEDLINE, Cochrane, Lilacs, Scielo and Science Direct databases for manuscripts with the terms “anaphylaxis during pregnancy” without language restrictions. Studies were screened and the data were extracted and assessed for risk of bias.

A total of 12 manuscripts were identified. Frequency of anaphylaxis during pregnancy is estimated between 1.5 to 3.8 per 100 000. Only 1 study provided anaphylaxis mortality data in pregnant women, and the rate of anaphylaxis-related maternal mortality is estimated at 0.05 per 100 000 live births. No standard definition of anaphylaxis severity has been utilized. Forty-nine percent to 74% of anaphylaxis cases were described during caesarean sections. Beta-lactam antibiotics (58%), latex (25%) and anaesthetic agents (17%) were the main culprits. In 17% of papers, causative agents were proven by allergy testing. Seventy two percent of articles proposed the same management and treatment for a clinical episode of anaphylaxis during pregnancy as in non-pregnant patients. All of the articles with management guidelines recommended epinephrine for anaphylaxis management in pregnancy. Risk factors for anaphylaxis during pregnancy were identified, such as a history of multiple cesarean sections/procedures,a personal history of anaphylaxis, and/or allergic reactions to medication without allergy work-up.

Identification of patients at-risk and collaboration among different specialists involved in the care of pregnant women should be established in order to support preventive strategies.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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