Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul;55(7):532-540.
doi: 10.1111/cea.70089. Epub 2025 May 29.

Risk Factors for Fatal and Near-Fatal Food Anaphylaxis: Analysis of the Allergy-Vigilance Network Database

Guillaume Pouessel  1   2   3   4 , Claire Egea  1   2 , Amandine Divaret-Chauveau  4   5 , Pascale Beaumont  4   6 , Eléna Bradatan  4   7 , Pascale Dumond  4   5 , Rémy Diesnis  8 , Sélina Tscheiller  4 , Xavier Van der Brempt  9 , Camille Braun  4   10   11 , Dominique Sabouraud-Leclerc  4   12
Affiliations

Risk Factors for Fatal and Near-Fatal Food Anaphylaxis: Analysis of the Allergy-Vigilance Network Database

Guillaume Pouessel et al. Clin Exp Allergy. 2025 Jul.

Abstract

Background: Gaining a better understanding of the risk factors for severe anaphylaxis represents a crucial challenge for physicians. This survey aimed to analyse cases of severe food anaphylaxis and assess potential risk factors for severity.

Methods: We retrospectively analysed food anaphylaxis cases recorded by the French-speaking Allergy-Vigilance Network (2002-2021) and compared the main characteristics of grade 3 (Ring classification) and grade 4 cases using univariate and multivariate statistical analyses.

Results: Of the 2621 food anaphylaxis cases reported, 731 (27.9%) were considered severe (grade 3, n = 687 [94%] and grade 4, n = 44 [6%]; 19 deaths). Overall, 56.1% of cases were adults (mean age: 28.3 years) and 53.7% were male. The most frequent triggers were peanut (13.9%), wheat (9.4%), cashew (5.8%), shrimp (5.3%), and cow's milk (4.6%). More grade 4 anaphylaxis cases occurred in children than in adults (26 vs. 18; p = 0.01). In univariate analysis, individuals with grade 4 anaphylaxis were more likely to have a history of allergy to the culprit food (71.1% vs. 42.1%; p < 0.001), asthma diagnosis (59.5% vs. 30.4%; p < 0.001), and peanut as the culprit food (34.1% vs. 12.6%; p < 0.001). In multivariate analysis, factors predictive of grade 4 anaphylaxis were asthma diagnosis (OR [95% CI]: 3.41 [1.56-7.44]; p = 0.002) and peanut as the culprit trigger (OR [95% CI]: 3.46 [1.28-9.34]; p = 0.014).

Conclusions: Our data highlight the risk factors for severe food anaphylaxis, notably a history of asthma and peanut as the culprit food. These individuals should benefit from personalised management strategies.

Keywords: adrenaline; anaphylaxis; asthma; fatal; food allergy; risk factors.

PubMed Disclaimer

References

    1. P. J. Turner, E. Jerschow, T. Umasunthar, R. Lin, D. E. Campbell, and R. J. Boyle, “Fatal Anaphylaxis: Mortality Rate and Risk Factors,” Journal of Allergy and Clinical Immunology. In Practice 5, no. 5 (2017): 1169–1178.
    1. G. Pouessel, C. Tacquard, L. K. Tanno, P. M. Mertes, and G. Lezmi, “Anaphylaxis Mortality in the Perioperative Setting: Epidemiology, Elicitors, Risk Factors and Knowledge Gaps,” Clinical and Experimental Allergy 54, no. 1 (2024): 11–20.
    1. V. Höfer, S. Dölle‐Bierke, W. Francuzik, et al., “Fatal and Near‐Fatal Anaphylaxis: Data From the European Anaphylaxis Registry and National Health Statistics,” Journal of Allergy and Clinical Immunology. In Practice 12, no. 1 (2024): 96–105.e8.
    1. M. C. Carter, J. Park, P. Vadas, and M. Worm, “Extrinsic and Intrinsic Modulators of Anaphylaxis,” Journal of Allergy and Clinical Immunology. In Practice 11, no. 7 (2023): 1998–2006.
    1. P. J. Turner, S. Arasi, B. Ballmer‐Weber, et al., “Global Allergy, Asthma European Network (GA2LEN) Food Allergy Guideline Group. Risk Factors for Severe Reactions in Food Allergy: Rapid Evidence Review With Meta‐Analysis,” Allergy 77, no. 9 (2022): 2634–2652.

MeSH terms

LinkOut - more resources