D1.79 - Cardiovascular symptoms during anaphylaxis: An analysis from the European Anaphylaxis Registry

Cardiovascular involvement occurs in 50–60% of moderate to severe anaphylaxis and even myocardial injury has been reported in up to 7.3% of anaphylaxis patients. In this analysis we aimed to better understand the spectrum of cardiovascular symptoms in anaphylaxis and the impact of age and comorbidities in this patient group.

We selected data from the European Anaphylaxis Registry (status until April 2024) for anaphylaxis cases with cardiovascular involvement. 

10,588 cases of anaphylaxis with cardiovascular involvement were identified. 16.4% (n=1,733) were children and adolescents and 83.6% (n=8,825) were adults. The median age was 46 years and 51.3% were females (n=5,421). The majority of cases were grade II (57.3%, n=6,052), followed by grade III (39.2%, n=4,144) and grade IV (3.4%, n=362) according to Ring and Messmer. Dizziness was the most frequent reported symptom (49.3%, n=5,203), followed by hypotension/collapse (44.9%, n=4,745). Loss of consciousness was reported in 26.9% (n=2,835), while tachycardia was noted in 20.7% (n=2,189). Reduction of alertness occurred in 17.7% (n=1,864), and palpitations or arrhythmia were documented in 5.9% (n=626). Severe cardiovascular manifestations included cardiac arrest (2.6%, n=274), chest pain/angina (1.9%, n=205) and bradycardia (0.2%, n=22). Cardiac symptoms were age dependent: among children and adolescents, reduction of alertness (36.4%, n=631) and dizziness (36.2%, n=627) were frequent and in adults, dizziness (51.9%, n=4,576) and hypotension or collapse (47.5%, n=4,191). Of 496 cases with severe cardiovascular symptoms, 57.1% (n=283) were male and adults (92.3%, n=458) and cardiovascular comorbidities were present in 36.1% (n=179) of those cases. Individuals with ongoing cardiovascular disease were 2.5 times more likely to experience cardiovascular symptoms in anaphylaxis (OR = 2.537, 95% CI: 2.298 - 2.801). Age > 18 years was associated with an increased likelihood (OR = 5.12, 95% CI: 4.76-5.50) and mastocytosis was strongly associated (OR = 11.72, 95% CI: 6.56-20.94) with cardiovascular symptoms in anaphylaxis.

Cardiovascular symptoms affect individuals across all age groups, but show age dependent differences. Ongoing cardiovascular disease and mastocytosis were strongly associated with cardiovascular symptoms, indicating the need to alert emergency physicians about the differential diagnosis of anaphylaxis in such patients presenting with cardiac symptoms.