Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta‐analysis

Abstract

BackgroundFood allergy is a common cause of anaphylaxis, but the incidence of fatal food anaphylaxis is not known. The aim of this study was to estimate the incidence of fatal food anaphylaxis for people with food allergy and relate this to other mortality risks in the general population.MethodsWe undertook a systematic review and meta-analysis, using the generic inverse variance method. Two authors selected studies by consensus, independently extracted data and assessed the quality of included studies using the Newcastle-Ottawa assessment scale. We searched Medline, Embase, PsychInfo, CINAHL, Web of Science, LILACS or AMED, between January 1946 and September 2012, and recent conference abstracts. We included registries, databases or cohort studies which described the number of fatal food anaphylaxis cases in a defined population and time period and applied an assumed population prevalence rate of food allergy.ResultsWe included data from 13 studies describing 240 fatal food anaphylaxis episodes over an estimated 165 million food-allergic person-years. Study quality was mixed, and there was high heterogeneity between study results, possibly due to variation in food allergy prevalence and data collection methods. In food-allergic people, fatal food anaphylaxis has an incidence rate of 1.81 per million person-years (95%CI 0.94, 3.45; range 0.63, 6.68). In sensitivity analysis with different estimated food allergy prevalence, the incidence varied from 1.35 to 2.71 per million person-years. At age 0–19, the incidence rate is 3.25 (1.73, 6.10; range 0.94, 15.75; sensitivity analysis 1.18–6.13). The incidence of fatal food anaphylaxis in food-allergic people is lower than accidental death in the general European population.ConclusionFatal food anaphylaxis for a food-allergic person is rarer than accidental death in the general population.

Risk Factors for Severe Reactions during Double-Blind Placebo-Controlled Food Challenges

“…First, our severity classification had 3 levels, as does the EAACI scale. Grade 3 covered the full spectrum of severity, from severe symptoms that would improve with some treatment [35] to near-fatal symptoms [36]. Among severe symptoms, distinguishing between extremely severe and severe symptoms requires comparing detailed symptoms.…”

Emerging therapies for food allergy

“…Reported rates of reaction due to accidental exposure vary widely, from 5% per year to 58% per five years for peanut (2,3) and up to 80% per year for milk (4). Although mortality from food-related anaphylaxis is rare, estimated to be approximately 1.8 per million person-years among foodallergic subjects (5), fear of accidental reactions and social effects of avoidance diets contribute to significantly impaired quality of life for food-allergic children and their caregivers (6). Moreover, avoidance diets can leave food-allergic children at nutritional risk (7).…”

Health-related quality of life in food allergy

“…Food allergy is major public health concern affecting nearly 15 million Americans and 80 million Europeans, including 8 % of children, with high costs to public health services [1,2]. Reactions can occur on initial exposure, from minimal quantities, and range from mild to life-threatening.…”