Anaphylaxis fatalities and admissions in Australia

doi:10.1016/j.jaci.2008.10.049

Journal of Allergy and Clinical Immunology

Volume 123, Issue 2, February 2009, Pages 434-442

https://doi.org/10.1016/j.jaci.2008.10.049 Get rights and content

Background

Detailed data on fatal anaphylaxis are limited, with national anaphylaxis fatality data for the United Kingdom and food-induced anaphylaxis fatality data for the United States. Time trends for anaphylaxis fatalities are not available.

Objective

We examined causes, demographics, and time trends for anaphylaxis fatalities in Australia between January 1997 and December 2005 and compared these with findings for anaphylaxis admissions.

Methods

Data on anaphylaxis deaths and hospital admissions were extracted from a national database. Death certificate codes were analyzed to determine the likely cause and associated comorbidities.

Results

There were 112 anaphylaxis fatalities in Australia over 9 years. Causes were as follows: food, 7 (6%); drugs, 22 (20%); probable drugs, 42 (38%); insect stings, 20 (18%); undetermined, 15 (13%); and other, 6 (5%). All food-induced anaphylaxis fatalities occurred between 8 and 35 years of age with female preponderance, despite the majority of food-induced anaphylaxis admissions occurring in children less than 5 years of age. Most insect sting–induced anaphylaxis deaths occurred between 35 and 84 years almost exclusively in male subjects, although bee sting–induced admissions peak between 5 and 9 years of age with a male/female ratio of 2.7. However, most drug-induced anaphylaxis deaths occurred between 55 and 85 years with equal sex distribution similar to drug-induced anaphylaxis admissions. There was no evidence of an increase in death rates for food-induced anaphylaxis, despite food-induced anaphylaxis admissions increasing approximately 350%. In contrast, drug-induced anaphylaxis deaths increased approximately 300% compared with an approximately 150% increase in drug-induced anaphylaxis admissions.

Conclusion

The demographics for anaphylaxis deaths are different to those for anaphylaxis presentations. Anaphylaxis mortality rates remain low and stable, despite increasing anaphylaxis prevalence, with the exception of drug-induced anaphylaxis deaths, which have increased.

Section snippets

Methods

The cause or causes of death in Australia are recorded on death certificates by medical practitioners or in coroners' reports and collated by each state. Causes of death are amalgamated, validated, and coded by the Australian Bureau of Statistics and then entered into a National Mortality Database maintained by the Australian Institute of Health and Welfare (AIHW).

Data were extracted from the AIHW database from January 1997 through December 2005, and the following International Classification

Results

There were 112 anaphylaxis fatalities in Australia during the 9-year study period. Based on the Australian 2001 population census, this equates to 0.64 anaphylaxis deaths per million population per year.

Of these 112 fatalities, 7 (6.3%) were attributed to food anaphylaxis (T78.0), 22 (19.6%) to drug anaphylaxis (T88.6), and 83 to unspecified anaphylaxis (T78.2). Detailed examination of the death codes for the latter group enabled us to deduce the allergen cause in the majority of cases. Of the

Anaphylaxis deaths: Causes and demographics

This is the first detailed analysis of national statistics for anaphylaxis fatalities from all causes in Australia. The only other detailed analysis of national data for fatal anaphylaxis is the UK series reported by Pumphrey.⁴ Our data estimate the rate of anaphylaxis fatality in Australia to be 0.64 deaths per million population per year, which is higher than the UK series estimate of 0.33 anaphylactic deaths per million population per year.⁴ Our data indicates that the relative number of

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Around 25% to 50% of food-induced allergic reactions in adults cause anaphylaxis, and epidemiologic evidence suggests that food is the most common cause of anaphylaxis. Reaction severity is unpredictable, and patients will often experience reactions of variable severity, even to an identical exposure (both dose and allergen). A common explanation for this phenomenon has been the impact of “cofactors”—factors that might contribute to reaction severity independent of the allergen exposure. Cofactors can influence reaction severity in 2 ways: either by reducing the reaction threshold (ie, the dose needed to trigger any symptoms) so that patients have no symptoms in the absence of the cofactor and only react with the cofactor present, or by increasing reaction severity such that individuals have only mild symptoms in the absence of the cofactor, but a more severe reaction when the cofactor is present. Indeed, the same patient may have reactions with different cofactors or even need more than one cofactor to develop a severe reaction. Cofactors reportedly play a role in approximately 30% of anaphylaxis reactions in adults. Exercise, nonsteroidal, anti-inflammatory drugs, alcohol, and sleep deprivation are the most frequent cofactors reported. Routine evaluation of the possible involvement of cofactors is essential in managing patients with food anaphylaxis: in patients with a suggestive history but a negative oral food challenge, cofactors should be taken into account to provide appropriate advice to reduce the risk of future anaphylaxis.
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: Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

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Food, drug, insect sting allergy, and anaphylaxisAnaphylaxis fatalities and admissions in Australia

Background

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Anaphylaxis deaths: Causes and demographics

J Allergy Clin Immunol

Pathology

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Paediatr Child Health

Toxicon

Lessons for management of anaphylaxis from a study of fatal reactions

Clin Exp Allergy

Fatal anaphylaxis in the UK, 1992-2001

Novartis Found Symp

Food, drug, insect sting allergy, and anaphylaxis
Anaphylaxis fatalities and admissions in Australia