Fatal Anaphylaxis: Mortality Rate and Risk Factors

Abstract

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.

Current perspectives on peanut allergy

“…A very high rate of challenge‐proven food allergy was described with 10.4% of participating children allergic to egg, peanut or sesame . Although rates of anaphylaxis to foods are increasing, those of fatal anaphylaxis appear to be stable in most countries . However, Australia reported a significant increase, of 9.7% per year, in fatal food anaphylaxis between 1997 and 2013 .…”

“…Food‐induced anaphylaxis occurs most commonly in young children, with peanut being the commonest cause worldwide, along with tree nuts, cow's milk and egg . Fatal food anaphylaxis is reported to account for 0.03–0.3 deaths per million inhabitants yearly worldwide, with peanut being the leading causative allergen, peanut, along with tree nuts, account for 55–87% cases of fatal food anaphylaxis . Most fatal food‐induced reactions occur in adolescents and young adults most likely due to increased risk taking behaviours in this age group, although a possible physiological predisposition to more severe reactions in this age group cannot be excluded .…”

“…Fatal food anaphylaxis is reported to account for 0.03–0.3 deaths per million inhabitants yearly worldwide, with peanut being the leading causative allergen, peanut, along with tree nuts, account for 55–87% cases of fatal food anaphylaxis . Most fatal food‐induced reactions occur in adolescents and young adults most likely due to increased risk taking behaviours in this age group, although a possible physiological predisposition to more severe reactions in this age group cannot be excluded . Other risk factors for fatal outcome include asthma and delayed administration of adrenaline …”

“…Most fatal food‐induced reactions occur in adolescents and young adults most likely due to increased risk taking behaviours in this age group, although a possible physiological predisposition to more severe reactions in this age group cannot be excluded . Other risk factors for fatal outcome include asthma and delayed administration of adrenaline …”

Risk factors and indicators of severe systemic insect sting reactions

“…Pre‐existing pulmonary disease including asthma was identified as a risk factor for hypoxemic reactions and delayed deterioration of anaphylaxis in general, and to specifically impair the outcome of food‐induced anaphylaxis . Some authors accordingly observed an increased incidence of respiratory symptoms during sting‐induced anaphylactic reactions in a subgroup of atopic patients which was likely to contain a significant proportion of individuals with concurrent asthma .…”