Should β-blockers be given to patients with heart disease and peanut-induced anaphylaxis? A decision analysis - 24/08/11
Boston, Mass, and Denver, Colo
Abstract |
Background |
β-Blocker therapy postmyocardial infarction is generally recommended because it reduces mortality. However, β-blockers may increase anaphylaxis mortality in the growing population of patients with peanut-induced anaphylaxis.
Objective |
We sought to assess the risks and benefits of β-blocker therapy among patients with peanut allergy and heart disease.
Methods |
We created a Markov model for patients with heart disease at risk for peanut-induced anaphylaxis to compare life expectancy with the following strategies: (1) β-blocker and (2) no β-blocker. Meta-analysis and a literature review were used to estimate model parameters. We performed sensitivity analysis to explore parameter uncertainty.
Results |
For peanut-allergic patients who are postmyocardial infarction or who have congestive heart failure, the heart disease benefit of β-blockers outweighs the increased likelihood of dying from anaphylaxis, increasing life expectancy by 9.4 and 17.4 months, respectively. β-Blocker was preferred unless (1) the annual rate of moderate to severe anaphylaxis exceeded 6.0% for postmyocardial infarction and 15% for congestive heart failure patients; (2) β-blocker therapy increased the incidence of moderate to severe anaphylaxis >2.5-fold for postmyocardial infarction and >5.8-fold for congestive heart failure patients; (3) anaphylaxis case fatality exceeded 6.5% postmyocardial infarction; or (4) β-blocker therapy increased anaphylaxis case fatality >25-fold postmyocardial infarction.
Conclusion |
Our results suggest that for patients postmyocardial infarction or with congestive heart failure who are at risk for peanut-induced anaphylaxis, β-blocker use should still improve survival. However, the epidemiology of anaphylaxis and effects of β-blocker therapy on anaphylaxis incidence and mortality require further study.
Le texte complet de cet article est disponible en PDF.Keywords : Anaphylaxis, peanut allergy, coronary artery disease, congestive heart failure, β-adrenergic receptor antagonists
Abbreviations : CHF, MI
Plan
The authors report no conflicts of interest, but for full disclosure, Dr Wong was a coinvestigator in the Patient Outcome Research Team grant for Ischemic Heart Disease from the then Agency for Health Care Policy and Research from 1990 to 1995 and is currently the content editor for Coronary Artery Disease for the nonprofit Foundation for Informed Medical Decision Making. In both of these cases, he has complete independence from the funding source in study design, interpretation of data, report writing, and publication regardless of results. |
Vol 113 - N° 5
P. 977-982 - mai 2004 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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