Incidence of Fatal Anaphylaxis: A Systematic Review of Observational Studies

Abstract

Background: Fatal anaphylaxis is very rare, with an incidence ranging from 0.5 to 1 deaths per million person-years. Objective: Based on a systematic review, we aimed to explain differences in the reported incidence of fatal anaphylaxis based on the methodological and demographic factors addressed in the various studies. Methods: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for relevant retrospective and prospective cohort studies and registry studies that had assessed the anaphylaxis death rate for the population of a country or for an administrative region. The research strategy was based on combining “anaphylaxis” with “death”, “study design”, and “main outcomes” (incidence). Results: A total of 46 studies met the study criteria and included 16,541 deaths. The range of the anaphylaxis mortality rate for all causes of anaphylaxis was 0.002-2.51 deaths per million person-years. Fatal anaphylaxis due to food (range 0.002-0.29) was rarer than deaths due to drugs (range 0.004-0.56) or Hymenoptera venom (range 0.02-0.61). The frequency of deaths due to anaphylaxis by drugs increased during the study period (IRR per year, 1.02, 95%CI 1.00-1.04). We detected considerable heterogeneity in almost all of the meta-analyses carried out. Conclusion: The incidence of fatal anaphylaxis is very low and differs according to the various subgroups analyzed. The studies were very heterogeneous. Fatal anaphylaxis due to food seems to be less common than fatal anaphylaxis due to drugs or Hymenoptera venom.

Anaphylaxis mortality in the perioperative setting: Epidemiology, elicitors, risk factors and knowledge gaps

“…PA can be life‐threatening, and data on PA mortality are scarce at any age. The mortality in PA is higher than from other causes of anaphylaxis, including foods and Hymenoptera 1 …”

“…36,40 Decreased PAF-AH F I G U R E 1 Epidemiology of perioperative anaphylaxis compared to food anaphylaxis. 1,65,66 F I G U R E 2 Potential modulators of perioperative anaphylaxis and risk factors for severity. ASA, American Society of Anaesthesiologists; PAF, platelet activating factor.…”

“…The mortality in PA is higher than from other causes of anaphylaxis, including foods and Hymenoptera. 1 Epidemiological studies have demonstrated the variability of PA triggers. However, published data mention neuromuscular blocking agents (NMBAs) and antibiotics, mainly penicillin and cefazolin, as the main causes.…”

Fatal and near‐fatal anaphylaxis: The Allergy‐Vigilance® Network data (2002–2020)

“…Although the number of hospital admissions for anaphylaxis via the emergency or intensive care units is increasing in many countries, anaphylaxis deaths remain rare. The anaphylaxis mortality rate varies from 0.5 to 1 case/million inhabitants/year and is 10‐fold lower in children, although these data are subject to debate given the heterogeneity of the collection methods, coding and analysis 1–3 . For food‐induced anaphylaxis, this rate is even lower than 1 case per million inhabitants per year, and the rate varies from 0.2 to 0.5 cases for anaphylaxis related to drugs or insect venom 2 .…”

“…The anaphylaxis mortality rate varies from 0.5 to 1 case/million inhabitants/year and is 10-fold lower in children, although these data are subject to debate given the heterogeneity of the collection methods, coding and analysis. [1][2][3] For foodinduced anaphylaxis, this rate is even lower than 1 case per million inhabitants per year, and the rate varies from 0.2 to 0.5 cases for anaphylaxis related to drugs or insect venom. 2 Descriptive data on anaphylaxis deaths are sparse and do not shed any light on the risk factors for severe allergic reactions.…”