Global Trends in Anaphylaxis Epidemiology and Clinical Implications

Abstract

The true global scale of anaphylaxis remains elusive, because many episodes occur in the community without presentation to health care facilities, and most regions have not yet developed reliable systems with which to monitor severe allergic events. The most robust data sets currently available are based largely on hospital admissions, which are limited by inherent issues of misdiagnosis, misclassification, and generalizability. Despite this, there is convincing evidence of a global increase in rates of all-cause anaphylaxis, driven largely by medication- and food-related anaphylaxis. There is no evidence of parallel increases in global all-cause anaphylaxis mortality, with surprisingly similar estimates for case-fatality rates at approximately 0.5% to 1% of fatal outcomes for hospitalizations due to anaphylaxis across several regions. Studying regional patterns of anaphylaxis to certain triggers have provided valuable insights into susceptibility and sensitizing events: for example, the link between the mAb cetuximab and allergy to mammalian meat. Likewise, data from published fatality registers can identify potentially modifiable risk factors that can be used to inform clinical practice, such as prevention of delayed epinephrine administration, correct posturing during anaphylaxis, special attention to populations at risk (such as the elderly on multiple medications), and use of venom immunotherapy in individuals at risk of insect-related anaphylaxis.

Keywords: Anaphylaxis; Biphasic; Epidemiology; Food allergy; Time trends.

Figure 1

Time trends in hospital admissions (A) and fatalities (B) for all-cause anaphylaxis. Data from Motosue et al include all patients admitted to either an observation unit or a hospital ward. UK data relating to admissions after 2012 are previously unpublished but are obtained using identical methodology to that before 2012.

Figure 2

Time trends in hospital admissions (A, adults and children; B, children only) and fatalities (C) for food-induced anaphylaxis. Data from Motosue et al include all patients admitted to either an observation unit or a hospital ward. UK data relating to admissions after 2012 are previously unpublished but are obtained using identical methodology to that before 2012.

Figure 3

Time trends in hospital admissions (A) and fatalities (B) for anaphylaxis due to nonfood triggers, by agent (venom, medication, and “unspecified”). Data from Motosue et al include all patients admitted to either an observation unit or a hospital ward.

Figure 4

Incidence of fatal anaphylaxis expressed as a proportion of hospital admissions, for all cause (A) and due to food (B). Data for United States relating to case-fatality rate for food anaphylaxis estimated using data from Motosue et al and Jerschow et al.