Surveillance of anaphylaxis in pregnancy

Summary

Anaphylaxis is severe and potentially fatal systemic hypersensitivity reaction. It is characterised by a combination of life-threatening airway, breathing or circulatory problems with skin or mucosal changes. There is always rapid onset and progression of symptoms. Current estimates of incidence suggest that maternal anaphylaxis occurs in approximately 1 in 30,000 pregnancies, although this is based on limited evidence. There is currently no published information relating to the incidence of anaphylaxis during pregnancy available for the UK and although this condition is rare, the importance of studying it is highlighted by a number of case studies showing that anaphylaxis during pregnancy can be associated with significant adverse outcomes for both mother and infant. Anaphylaxis can be caused by a wide variety of agents and it is unclear as to whether the risk factors for anaphylaxis in the general population such as age, concomitant co-morbidities and previously documented hypersensitivity can accurately predict risk of anaphylaxis in pregnancy. The recent proposed and actual policy changes with regard to antibiotic administration in pregnancy, including the use of prophylactic antibiotics up to one hour prior to delivery by caesarean section and the use of prophylactic antibiotics for maternal group B streptococcal carriage in labour have the potential to impact on the incidence and/or outcomes of anaphylaxis during pregnancy, making this study very timely. Beyond adhering to the best practice algorithm for management of anaphylaxis in an adult, there is little known about how anaphylactic shock in pregnancy should be managed in order to optimise the outcome for both mother and baby. This study collected information about the incidence, management and outcomes of anaphylaxis in pregnancy in the UK. Data analysis is currently underway.