Epidemiology of severe anaphylaxis: can we use population-based data to understand anaphylaxis?

Turner, Paul J.; Campbell, Dianne E.

doi:10.1097/aci.0000000000000305

Cited by 57 publications

(31 citation statements)

References 58 publications

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“…Due to the limitations of ICD-10 codes, food related anaphylaxis is often coded as anaphylactic shock, despite shock being a rare occurrence in food anaphylaxis. 2 4 16 Therefore, no conclusions can be drawn as to the severity of anaphylaxis when analysing hospital admissions, unless other considerations are taken into account (such as admission to intensive care or fatal outcomes). The introduction of ICD-11 will hopefully address many of the current limitations of ICD-10, 18 although a proposal to include a classification of anaphylaxis by clinical severity was rejected.…”

Section: Discussionmentioning

confidence: 99%

Food anaphylaxis in the United Kingdom: analysis of national data, 1998-2018

Conrado

Ierodiakonou

Gowland

et al. 2021

BMJ

134

113

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Objective To describe time trends for hospital admissions due to food anaphylaxis in the United Kingdom over the past 20 years. Design Analysis of national data, 1998-2018. Setting Data relating to hospital admissions for anaphylaxis and deaths, and prescription data for adrenaline autoinjector devices. Participants UK population as a whole and devolved nations (England, Scotland, Wales, and Northern Ireland). Main outcome measures Time trends, age, and sex distributions for hospital admissions for anaphylaxis due to food and non-food triggers, and how these admission rates compare with the case fatality rate (number of fatalities as a proportion of hospital admissions). Results Between 1998 and 2018, 101 891 people were admitted to hospital for anaphylaxis. Of these admissions, 30 700 (30.1%) were coded as due to a food trigger. Food anaphylaxis admissions increased from 1.23 to 4.04 per 100 000 population per year (from 1998 to 2018), an annual increase of 5.7% (95% confidence interval 5.5% to 5.9%, P<0.001). The largest increase in hospital admissions was observed in children younger than 15 years, with an increase from 2.1 to 9.2 admissions per 100 000 population per year (an annual increase of 6.6%, 95% confidence interval 6.3% to 7.0%). For comparison, the annual increase was 5.9% (5.6% to 6.2%) in people aged 15-59 years and 2.1% (1.8% to 3.1%) in those aged 60 years and older. 152 deaths were identified where the fatal event was probably caused by food induced anaphylaxis. The case fatality rate decreased from 0.7% to 0.19% for confirmed fatal food anaphylaxis (rate ratio 0.931, 95% confidence interval 0.904 to 0.959, P<0.001) and to 0.30% for suspected fatal food anaphylaxis (0.970, 0.945 to 0.996, P=0.024). At least 46% (86 of 187, which also includes 35 deaths in 1992-98) of deaths were triggered by peanut or tree nut. Cow’s milk was responsible for 17 of 66 (26%) deaths in school aged children. Over the same time period, prescriptions for adrenaline autoinjectors increased by 336% (estimated rate ratio 1.113, 95% confidence interval 1.112 to 1.113; an increase of 11% per year). Conclusions Hospital admissions for food induced anaphylaxis have increased from 1998 to 2018, however the case fatality rate has decreased. In school aged children, cow’s milk is now the most common single cause of fatal anaphylaxis.

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Section: Discussionmentioning

confidence: 99%

Food anaphylaxis in the United Kingdom: analysis of national data, 1998-2018

Conrado

Ierodiakonou

Gowland

et al. 2021

BMJ

134

113

View full text Add to dashboard Cite

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“… 11 , 14 Most fatal food anaphylaxis is associated with severe respiratory symptoms, with cardiovascular compromise thought to be secondary to respiratory failure. 18 For example, acute dyspnea was noted in 64% of cases in one study. 11 It therefore seems sensible to optimize asthma management in individuals at risk of food anaphylaxis.…”

Section: Fatal Food Anaphylaxismentioning

confidence: 90%

“… 6 A significant increase was also noted in an Australian ICD-10-based report, between 1997 and 2005, 7 and an overall rate of increase of 5.6% per year over the period 1997-2013. 18 In contrast, an increase has not been reported in the United Kingdom, according to data from a national fatal anaphylaxis registry. 14 Problems with current ICD-10-based anaphylaxis mortality coding have been recently detailed.…”

Section: Fatal Drug Anaphylaxismentioning

confidence: 98%

“… 36 Although nonsteroidal anti-inflammatory drugs are frequently associated with anaphylaxis, they do not appear to be a common trigger of fatal anaphylaxis. 18 …”

Section: Fatal Drug Anaphylaxismentioning

confidence: 99%

“…Despite consistent reports of increased incidence in nonfatal food anaphylaxis over recent decades, a parallel increase in fatalities has not, in general, been reported, 2 , 6 , 11 , 12 , 14 with the exception of one recent Australian study. 18 Recent epidemiological data are summarized in Table II . There are unexplained regional variations, with United Kingdom and Australia reporting almost double the rate of fatal, food-related anaphylaxis to that in the United States.…”

Section: Fatal Food Anaphylaxismentioning

confidence: 99%

See 2 more Smart Citations

Fatal Anaphylaxis: Mortality Rate and Risk Factors

Turner

Jerschow

Umasunthar

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

Self Cite

412

269

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Up to 5% of the US population has suffered anaphylaxis. Fatal outcome is rare, such that even for people with known venom or food allergy, fatal anaphylaxis constitutes less than 1% of total mortality risk. The incidence of fatal anaphylaxis has not increased in line with hospital admissions for anaphylaxis. Fatal drug anaphylaxis may be increasing, but rates of fatal anaphylaxis to venom and food are stable. Risk factors for fatal anaphylaxis vary according to cause. For fatal drug anaphylaxis, previous cardiovascular morbidity and older age are risk factors, with beta-lactam antibiotics, general anesthetic agents, and radiocontrast injections the commonest triggers. Fatal food anaphylaxis most commonly occurs during the second and third decades. Delayed epinephrine administration is a risk factor; common triggers are nuts, seafood, and in children, milk. For fatal venom anaphylaxis, risk factors include middle age, male sex, white race, cardiovascular disease, and possibly mastocytosis; insect triggers vary by region. Upright posture is a feature of fatal anaphylaxis to both food and venom. The rarity of fatal anaphylaxis and the significant quality of life impact of allergic conditions suggest that quality of life impairment should be a key consideration when making treatment decisions in patients at risk for anaphylaxis.

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Implementing Primary Prevention for Peanut Allergy at a Population Level

Turner

Campbell

2017

JAMA

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Peanut allergy is increasingly common, with an estimated prevalence in children of 2% to 3% in the United States, 1 the United Kingdom, 2 and Australia. 3 Decades of well-intentioned advice from specialist organizations to avoid introducing peanuts (and other nuts) into the diet of infants and young children may have contributed but is unlikely to have been the only reason for this increase. Evidence from a randomized clinical trial (RCT), the Learning Early About Peanut Allergy (LEAP) study, suggested that the introduction of peanut into the diets of infants at high risk of peanut allergy between 4 and 11 months decreases the risk of a clinical peanut allergy at the age of 5 years, 4 with persistence of the protective effect at 6 years demonstrated by the follow-up study. 5 The Enquiring About Tolerance (EAT) study examined early introduction of multiple foods, including peanut, from 4 months of age in a population not selected for atopic risk. 2 This study failed to show a protective effect for peanut introduction by intention-to-treat analysis, although a per-protocol analysis suggested a potential benefit.In January 2017, the National Institute of Allergy and Infectious Diseases (NIAID) released a guideline for the prevention of peanut allergy in the United States, 6 a document designed to apply primary VIEWPOINT

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Epidemiology of severe anaphylaxis: can we use population-based data to understand anaphylaxis?

Cited by 57 publications

References 58 publications

Food anaphylaxis in the United Kingdom: analysis of national data, 1998-2018

Food anaphylaxis in the United Kingdom: analysis of national data, 1998-2018

Fatal Anaphylaxis: Mortality Rate and Risk Factors

Implementing Primary Prevention for Peanut Allergy at a Population Level

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