• 1. Simons FE, Ardusso LR, Bilo MB, et al. World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis. World Allergy Organ J 2011;4:1337.

    • Search Google Scholar
    • Export Citation
  • 2. Shmuel DL, Cortes Y. Anaphylaxis in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2013;23:377394.

  • 3. Peters LJ, Kovacic JP. Histamine: metabolism, physiology, and pathophysiology with applications in veterinary medicine. J Vet Emerg Crit Care (San Antonio) 2009;19:311328.

    • Search Google Scholar
    • Export Citation
  • 4. Kitoh K, Katoh H, Kitagawa H, et al. Role of histamine in heartworm extract-induced shock in dogs. Am J Vet Res 2001;62:770774.

  • 5. Kitoh K, Mikami C, Kitagawa H, et al. Hemodynamic alterations in dogs with shock induced by intravenous injection of heartworm extract. J Vet Med Sci 2001;63:179182.

    • Search Google Scholar
    • Export Citation
  • 6. Dean HR, Webb RA. The morbid anatomy and histology of anaphylaxis in the dog. J Pathol Bacteriol 1924;27:5764.

  • 7. Rostaher A, Hofer-Inteeworn N, Kümmerle-Fraune C, et al. Triggers, risk factors, and clinico-pathological features of urticaria in dogs – a prospective observational study of 24 cases. Vet Dermatol 2017;28:38e9.

    • Search Google Scholar
    • Export Citation
  • 8. Turner PJ, Jerschow E, Umasunthar T, et al. Fatal anaphylaxis: mortality rate and risk factors. J Allergy Clin Immunol Pract 2017;5:11691178.

    • Search Google Scholar
    • Export Citation
  • 9. Ma L, Danoff TM, Borish L. Case fatality and population mortality associated with anaphylaxis in the United States. J Allergy Clin Immunol 2014;133:10751083.

    • Search Google Scholar
    • Export Citation
  • 10. Brown SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol 2004;114:371376.

  • 11. Worm M, Eckermann O, Dölle S, et al. Triggers and treatment of anaphylaxis. Dtsch Arztebl Int 2014;111:367375.

  • 12. Saager L, Turan A, Egan C, et al. Incidence of intraoperative hypersensitivity reactions: a registry analysis. Anesthesiology 2015;122:551559.

    • Search Google Scholar
    • Export Citation
  • 13. Harper NJ, Cook TM, Garcez T, et al. Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6). Br J Anaesth 2018;121:159171.

    • Search Google Scholar
    • Export Citation
  • 14. Lee SY, Lee SC, Shin SD, et al. Epidemiology and outcomes of anaphylaxis-associated out-of-hospital cardiac arrest. PLoS One 2018;13:e0194921.

    • Search Google Scholar
    • Export Citation
  • 15. Tanno LK, Simons FE, Annesi-Maesano I, et al. Fatal anaphylaxis registries data support changes in the WHO anaphylaxis mortality coding rules. Orphanet J Rare Dis 2017;12:8.

    • Search Google Scholar
    • Export Citation
  • 16. Hume-Smith KM, Groth AD, Rishniw M, et al. Anaphylactic events observed within 4 h of ocular application of an antibiotic-containing ophthalmic preparation: 61 cats (1993–2010). J Feline Med Surg 2011;13:744751.

    • Search Google Scholar
    • Export Citation
  • 17. Walters AM, O'Brien MA, Selmic LE, et al. Comparison of clinical findings between dogs with suspected anaphylaxis and dogs with confirmed sepsis. J Am Vet Med Assoc 2017;251:681688.

    • Search Google Scholar
    • Export Citation
  • 18. Sasaki K, Mutoh T, Shiga T, et al. Unsuccessful resuscitation with epinephrine in a dog with suspected severe perioperative anaphylaxis. Vet Rec Case Rep 2017;5:e000440.

    • Search Google Scholar
    • Export Citation
  • 19. Waddell LS, Drobatz KJ. Massive envenomation by Vespula spp. in two dogs. J Vet Emerg Crit Care 1999;9:6771.

  • 20. Schaer M, Ginn PE, Hanel RM. A case of fatal anaphylaxis in a dog associated with a dexamethasone suppression test. J Vet Emerg Crit Care 2005;15:213216.

    • Search Google Scholar
    • Export Citation
  • 21. Webster CRL, Cooper JC. Diagnostic approach to hepatobiliary disease. In: Bonagura J, Twedt D, eds. Kirk's current veterinary therapy. 15th ed. St Louis: Elsevier, 2014;569575.

    • Search Google Scholar
    • Export Citation
  • 22. Quantz JE, Miles MS, Reed AL, et al. Elevation of alanine transaminase and gallbladder wall abnormalities as biomarkers of anaphylaxis in canine hypersensitivity patients. J Vet Emerg Crit Care (San Antonio) 2009;19:536544.

    • Search Google Scholar
    • Export Citation
  • 23. Makabe-Kobayashi Y, Hori Y, Adachi T, et al. The control effect of histamine on body temperature and respiratory function in IgE-dependent systemic anaphylaxis. J Allergy Clin Immunol 2002;110:298303.

    • Search Google Scholar
    • Export Citation
  • 24. Dunayer EK, Gwaltney-Brant SM. Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs. J Am Vet Med Assoc 2006;229:11131117.

    • Search Google Scholar
    • Export Citation
  • 25. Schmidt LE, Dalhoff K. Serum phosphate is an early predictor of outcome in severe acetaminophen-induced hepatotoxicity. Hepatology 2002;36:659665.

    • Search Google Scholar
    • Export Citation
  • 26. Shakil AO. Predicting the outcome of fulminant hepatic failure. Liver Transpl 2005;11:10281030.

  • 27. Sarwar S, Khan AA, Alam A, et al. Predictors of fatal outcome in fulminant hepatic failure. J Coll Physicians Surg Pak 2006;16:112116.

    • Search Google Scholar
    • Export Citation
  • 28. Haider DG, Lindner G, Wolzt M, et al. Hyperphosphatemia is an independent risk factor for mortality in critically ill patients: Results from a cross-sectional study. PLoS One 2015;10:e0133426.

    • Search Google Scholar
    • Export Citation
  • 29. Omar AS. Anaphylaxis and rhabdomyolysis. Any early relationship? Crit Care Shock 2012;15:8894.

  • 30. Perret D, Mahul P, Rochette Y, et al. Rhabdomyolysis associated with an anaphylactic shock from suxamethonium. Ann Fr Anesth Reanim 1996;15:11931195.

    • Search Google Scholar
    • Export Citation
  • 31. Carter JE, Chanoit G, Kata C. Anaphylactoid reaction in a heartworm-infected dog undergoing lung lobectomy. J Am Vet Med Assoc 2011;238:13011304.

    • Search Google Scholar
    • Export Citation
  • 32. Thomas E, Mandell DC, Waddell LS. Survival after anaphylaxis induced by a bumblebee sting in a dog. J Am Anim Hosp Assoc 2013;49:210215.

    • Search Google Scholar
    • Export Citation
  • 33. Caldwell DJ, Petras KE, Mattison BL, et al. Spontaneous hemoperitoneum and anaphylactic shock associated with Hymenoptera envenomation in a dog. J Vet Emerg Crit Care (San Antonio) 2018;28:476482.

    • Search Google Scholar
    • Export Citation
  • 34. Guilarte M, Sala-Cunill A, Labrador-Horrillo M, et al. The mast cell, contact, and coagulation system connection in anaphylaxis. Front Immunol 2017;8:846.

    • Search Google Scholar
    • Export Citation
  • 35. Borahay MA, Harirah HM, Olson G, et al. Disseminated intravascular coagulation, hemoperitoneum, and reversible ischemic neurological deficit complicating anaphylaxis to prophylactic antibiotics during cesarean delivery: a case report and review of literature. AJP Rep 2011;1:1520.

    • Search Google Scholar
    • Export Citation
  • 36. Iqbal A, Morton C, Kong KL. Fibrinolysis during anaphylaxis and its spontaneous resolution as demonstrated by thromboelastography. Br J Anaesth 2010;105:168171.

    • Search Google Scholar
    • Export Citation
  • 37. Parashchanka A, Wyffels PA, Van Limmen JG, et al. Anaphylactic shock and hyperfibrinolysis measured with thromboelastography. Acta Anaesthesiol Belg 2011;62:207211.

    • Search Google Scholar
    • Export Citation
  • 38. Koami H, Sakamoto Y, Furukawa T, et al. Utility of rotational thromboelastometry for the diagnosis of asymptomatic hyperfibrinolysis secondary to anaphylaxis. Blood Coagul Fibrinolysis 2016;27:450453.

    • Search Google Scholar
    • Export Citation
  • 39. Smith PL, Kagey-Sobotka A, Bleeker ER, et al. Physiologic manifestations of human anaphylaxis. J Clin Invest 1980;66:10721080.

  • 40. Kavanagh C, Shaw S, Webster C. Coagulation in hepatobiliary disease. J Vet Emerg Crit Care (San Antonio) 2011;21:589604.

  • 41. Drobatz KJ, Macintire DK. Heat-induced illness in dogs: 42 cases (1976–1993). J Am Vet Med Assoc 1996;209:18941899.

  • 42. Dhar HL, Sanyal RK, West GB. The relationship of the blood sugar level to the severity of anaphylactic shock. Br J Pharmacol Chemother 1967;31:351355.

    • Search Google Scholar
    • Export Citation
  • 43. Greenway CV, Oshiro G. Effects of histamine on hepatic volume (outflow block) in anaesthetized dogs. Br J Pharmacol 1973;47:282290.

    • Search Google Scholar
    • Export Citation
  • 44. Richardson PD, Withrington PG. Responses of the simultaneously-perfused hepatic arterial and portal venous vascular beds of the dog to histamine and 5-hydroxytryptamine. Br J Pharmacol 1978;64:581588.

    • Search Google Scholar
    • Export Citation

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Mortality rate and prognostic factors for dogs with severe anaphylaxis: 67 cases (2016–2018)

M. Ryan Smith DVM1, Virginie A. Wurlod MS, Dr Med Vet1, Alan G. Ralph DVM2, Erin R. Daniels DVM2, and Mark Mitchell DVM, PhD1
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  • 1 1Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803.
  • | 2 2MedVet Medical and Cancer Centers for Pets, Mandeville, LA 70448.

Abstract

OBJECTIVE

To determine mortality rates for dogs with severe anaphylaxis and identify potential prognostic factors.

ANIMALS

67 dogs with suspected anaphylaxis graded as severe.

PROCEDURES

Dogs were classified on the basis of outcome as survivors and nonsurvivors. Medical records were reviewed, and data were extracted including signalment, examination findings, time to hospital admission from onset of clinical signs, CBC results, serum biochemical analysis results, coagulation testing results, and findings on abdominal ultrasonography. Initial treatment within the first 6 hours after hospital admission was recorded for analysis, specifically including the use of epinephrine, diphenhydramine, corticosteroids, antimicrobials, fresh-frozen plasma, and supplemental dextrose.

RESULTS

The overall mortality rate was 14.9% (10/67) for dogs with anaphylaxis graded as severe. Serum phosphorus concentration and prothrombin time (PT) were significantly higher in nonsurvivors, compared with survivors. Nonsurvivors had lower presenting body temperatures than survivors. Serum phosphorus concentration ≥ 12.0 mmol/L, hypoglycemia within 6 hours after hospital admission, high PT value, concurrently high PT and partial thromboplastin time (PTT) values > 50% above the reference range limit, and the need for supplemental dextrose were associated with death. The incidences of coagulopathy and peritoneal effusion were unexpectedly high (85.2% and 65.5% of dogs, respectively) but were not indicative of survival.

CONCLUSIONS AND CLINICAL RELEVANCE

Despite the poor presenting clinical condition seen in dogs with severe anaphylaxis, the rate of survival with treatment was fairly high. Coagulopathy and the presence of peritoneal effusion were common findings in dogs with severe anaphylaxis. Serum phosphorus concentration ≥ 12.0 mmol/L, high PT value, concurrent increases of PT and PTT values > 50% above reference range limits, hypoglycemia within 6 hours after hospital admission, and the need for supplemental dextrose were associated with death.

Abstract

OBJECTIVE

To determine mortality rates for dogs with severe anaphylaxis and identify potential prognostic factors.

ANIMALS

67 dogs with suspected anaphylaxis graded as severe.

PROCEDURES

Dogs were classified on the basis of outcome as survivors and nonsurvivors. Medical records were reviewed, and data were extracted including signalment, examination findings, time to hospital admission from onset of clinical signs, CBC results, serum biochemical analysis results, coagulation testing results, and findings on abdominal ultrasonography. Initial treatment within the first 6 hours after hospital admission was recorded for analysis, specifically including the use of epinephrine, diphenhydramine, corticosteroids, antimicrobials, fresh-frozen plasma, and supplemental dextrose.

RESULTS

The overall mortality rate was 14.9% (10/67) for dogs with anaphylaxis graded as severe. Serum phosphorus concentration and prothrombin time (PT) were significantly higher in nonsurvivors, compared with survivors. Nonsurvivors had lower presenting body temperatures than survivors. Serum phosphorus concentration ≥ 12.0 mmol/L, hypoglycemia within 6 hours after hospital admission, high PT value, concurrently high PT and partial thromboplastin time (PTT) values > 50% above the reference range limit, and the need for supplemental dextrose were associated with death. The incidences of coagulopathy and peritoneal effusion were unexpectedly high (85.2% and 65.5% of dogs, respectively) but were not indicative of survival.

CONCLUSIONS AND CLINICAL RELEVANCE

Despite the poor presenting clinical condition seen in dogs with severe anaphylaxis, the rate of survival with treatment was fairly high. Coagulopathy and the presence of peritoneal effusion were common findings in dogs with severe anaphylaxis. Serum phosphorus concentration ≥ 12.0 mmol/L, high PT value, concurrent increases of PT and PTT values > 50% above reference range limits, hypoglycemia within 6 hours after hospital admission, and the need for supplemental dextrose were associated with death.

Contributor Notes

Address correspondence to Dr. Smith (smith1@lsu.edu).