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International audience; Purpose of review: This systematic review evaluates published data related to the economic burden of drug-induced anaphylaxis (DIA) to understand preventive cost saving measures that could reduce the burden of these conditions.Recent findings: Although DIA has a relevant societal impact, there are limited and heterogenous available data related to its cost. Direct costs related to the management of acute phase of DIA was estimated by $529.6 to $3 125, depending on the number of emergency room visits/hospitalizations, emergency kits and transports in ambulance. Direct costs of investigations of DIA varied from $288 to $2 292.95 and the desensitization was estimated by $6 796. Main variables for this were: personnel, allergy screening procedures, medical consumables and space cost. The mean indirect cost was based on a mean absenteeism of 3 days per DIA corresponding to $381.2.Summary: More than reviewing the published data, we were able to identify variables that, if correctly managed, can reduce the economic burden of DIA, such as adjusting the timing of referral and etiological diagnosis, identification of potential risk and/or co-factors, correct written recommendations to patients. The evidence presented highlights the need of optimization of healthcare patients to patients suffering from DIA.

International audience; Purpose of review: To identify patterns and key issues though a systematic review in order to support prevention strategies and reduce avoidable deaths related to drug-induced anaphylaxis (DAF).Recent findings: DAF rate has been estimated by 0.13-0.53/106 population/year. General global trends of DAF are increasing over time, mostly occurring at healthcare settings (62%) with a similar gender distribution and an average age of 53 years. Antibiotics, anaesthetics, radio-contrast media and NSAIDs were the most frequently implicated agents. Main comorbidities were personal history of drug allergy, cardiovascular diseases and asthma. Main manifestations were cardiovascular and respiratory commitments. Use of adrenaline is mentioned in only 29% of the articles.Summary: DAF is increasing worldwide and most cases are iatrogenic. This first systematic review of DAF identified key gaps and served as a wake-up call to prevent avoidable deaths. Phenotype at risk for DAF was represented by patients aged more than 54 years, with personal history of drug allergy/hypersensitivity with no or incomplete allergological work-up, cardiovascular disease and/or asthma with need of hospitalization and/or frequent healthcare assistance. Additional risk for those who need frequent use of intravenous antibiotics and/or undergoing surgery or image investigation with radiocontrast media.

Anaphylaxis is a systemic and severe allergic reaction, which can be fatal. The first-line treatment of choice, according to international guidelines, is intramuscular adrenaline. However, different studies show that the performance of health professionals managing anaphylaxis is often inadequate.To assess the current resources available in Latin American countries for the diagnosis and treatment of anaphylaxis.Online survey promoted by the Latin American Society of Allergy and Immunology to representatives of the national allergy societies of Latin American countries.Responses were received from 10 countries out of the 14 countries invited to participate. Only five of the countries have clinical practice guidelines in anaphylaxis. Adrenaline autoinjectors are available only in two countries, Argentina and Brazil, but are not subsidized by public health systems. In all countries, adrenaline is available in ampoules, which is the presentation usually prescribed to patients for self-administration. The use of adrenaline was estimated to be less than 50 % of cases in five countries, while antihistamines and corticosteroids are almost always used. The determination of serum tryptase is possible in some health centers, often private, in five of the countries surveyed.It is necessary to improve resources related to the diagnosis and management of anaphylaxis in Latin American countries.Antecedentes: La anafilaxia es una reacción alérgica sistémica y grave que puede resultar fatal. El tratamiento de elección de primera línea, según las guías internacionales, es la adrenalina intramuscular. No obstante, diferentes estudios muestran que las acciones de los profesionales sanitarios ante un cuadro de anafilaxia frecuentemente son inadecuadas. Objetivo: Analizar los recursos actuales disponibles en los países de América Latina para el diagnóstico y tratamiento de la anafilaxia. Métodos: Encuesta en línea promovida por la Sociedad Latinoamericana de Alergia e Inmunología y realizada a representantes de las sociedades nacionales de alergia de los países de América Latina. Resultados: Se recibieron respuestas de 10 países de los 14 a los que se invitó. Solo en 5 se disponía de guías de práctica clínica en anafilaxia y en 2, Argentina y Brasil, de autoinyectores de adrenalina, no subvencionados por el sistema público de atención a la salud. En todos los países se dispone de adrenalina en ampolletas, que suele prescribirse a los pacientes para autoadministración. Se estimó que la utilización de adrenalina se emplea en menos de 50 % de los casos en 5 países, mientras que los antihistamínicos y los corticoides se utilizan casi siempre. En 5 países, la determinación de triptasa sérica fue posible en algunos centros sanitarios, muchas veces privados. Conclusión: Es necesario mejorar los recursos relacionados con el diagnóstico y tratamiento de la anafilaxia en los países latinoamericanos.