Food, drug, insect sting allergy, and anaphylaxis
Increase in anaphylaxis-related hospitalizations but no increase in fatalities: An analysis of United Kingdom national anaphylaxis data, 1992-2012

https://doi.org/10.1016/j.jaci.2014.10.021Get rights and content
Under a Creative Commons license
open access

Background

The incidence of anaphylaxis might be increasing. Data for fatal anaphylaxis are limited because of the rarity of this outcome.

Objective

We sought to document trends in anaphylaxis admissions and fatalities by age, sex, and cause in England and Wales over a 20-year period.

Methods

We extracted data from national databases that record hospital admissions and fatalities caused by anaphylaxis in England and Wales (1992-2012) and crosschecked fatalities against a prospective fatal anaphylaxis registry. We examined time trends and age distribution for fatal anaphylaxis caused by food, drugs, and insect stings.

Results

Hospital admissions from all-cause anaphylaxis increased by 615% over the time period studied, but annual fatality rates remained stable at 0.047 cases (95% CI, 0.042-0.052 cases) per 100,000 population. Admission and fatality rates for drug- and insect sting–induced anaphylaxis were highest in the group aged 60 years and older. In contrast, admissions because of food-triggered anaphylaxis were most common in young people, with a marked peak in the incidence of fatal food reactions during the second and third decades of life. These findings are not explained by age-related differences in rates of hospitalization.

Conclusions

Hospitalizations for anaphylaxis increased between 1992 and 2012, but the incidence of fatal anaphylaxis did not. This might be due to increasing awareness of the diagnosis, shifting patterns of behavior in patients and health care providers, or both. The age distribution of fatal anaphylaxis varies significantly according to the nature of the eliciting agent, which suggests a specific vulnerability to severe outcomes from food-induced allergic reactions in the second and third decades.

Key words

Anaphylaxis
drug allergy
epidemiology
food allergy
hospitalization
insect sting allergy

Abbreviations used

ASR
Age-standardized rate
ICD
International Classification of Diseases
ONS
Office for National Statistics
UK
United Kingdom

Cited by (0)

P.J.T. has received a Clinician Scientist award from the UK Medical Research Council (grant no. MR/K010468/1). R.J.B. and P.J.T. are supported by the National Institute for Health Research (NIHR)'s Imperial Biomedical Research Centre, and the MRC–Asthma UK Centre in Allergic Mechanisms of Asthma.

Disclosure of potential conflict of interest: P. J. Turner has received research support from the UK Medical Research Council and the NHS National Institute for Health Research. M. H. Gowland has consultant arrangements through Allergy Action with the Anaphylaxis Campaign and the Laboratory of the Government Chemist and has provided training through Allergy Action in partnership with Hygiene Audit Systems, Allergy and Hygiene Solutions, the Royal Environmental Health Institute of Scotland, the Royal Borough of Kensington and Chelsea, the Royal Society of Public Health, and the Wolverhampton City Council; has provided expert testimony for Her Majesty's Coroners and Police; has received research support from the Food Standards Agency; has received royalties and payment for development of educational presentations through Allergy Action Training from Hygiene Audit Systems; has received payments for delivering presentations from the University Caterers Organisation, the Chartered Institute of Environmental Health, the Trading Standards Institute, and their members; and has received travel support from the Food Standards Agency, the Allergy Academy in London, the European Academy of Allergy and Clinical Immunology, the French Cercle d'Investigations Cliniques et Biologiques en Allergologie Alimentaire, and the Universities of Cambridge, Southampton, Bath, Surrey, and Portsmouth. V. Sharma has received research support from ALK-Abelló, Meda, and Emmerade; has received travel support from ALK-Abelló, Meda, and Stallergenes; and is a member of the North West Paediatric Allergy Network, which has received grants from ALK-Abelló, Meda, Stallergenes, Nutricia, and Mead Johnson Nutrition toward organization of their annual educational event. N. Harper is employed by Central Manchester University Hospitals NHS Foundation Trust, has received research support from Manchester Allied Health Sciences Centre, and has received royalties from Nerve Stimulator. R. Pumphrey has received consulting fees and travel support from Her Majesty's Coroners; has received payment for lectures from NHS hospitals; has received travel support from ALK-Abelló, Meda, iMed Systems, and Lincoln Medical; has provided a device review for Meda; and is a medical advisor to the Anaphylaxis Campaign, UK. R. J. Boyle has received research support from Lincoln Medical and has received travel support from Meda Pharmaceuticals. The rest of the authors declare that they have no relevant conflicts of interest.