Epidemiology of life-threatening and lethal anaphylaxis: A review

Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, Nancy Cedex, France.
Allergy (Impact Factor: 6.03). 05/2005; 60(4):443-51. DOI: 10.1111/j.1398-9995.2005.00785.x
Source: PubMed


Severe anaphylaxis is a systemic reaction affecting two or more organs or systems and is due to the release of active mediators from mast cells and basophils. A four-grade classification routinely places 'severe' anaphylaxis in grades 3 and 4 (death could be graded as grade 5). Studies are underway to determine the prevalence of severe and lethal anaphylaxis in different populations and the relative frequencies of food, drug, latex and Hymenoptera anaphylaxis. These studies will also analyse the risk arising from the lack of preventive measures applied in schools (personalized management protocols) and from the insufficient use of self-injected adrenalin. Allergy-related conditions may account for 0.2-1% of emergency consultations. Severe anaphylaxis affects 1-3 per 10 000 people, but for the United States and Australia figures are even higher. It is estimated to cause death in 0.65-2% of patients, i.e. 1-3 per million people. An increased prevalence has been revealed by monitoring hospitalized populations by reference to the international classification of disease (ICD) codes. The relative frequency of aetiological factors of allergy (food, drugs, insects and latex) varies in different studies. Food, drug and Hymenoptera allergies are potentially lethal. The risk of food-mediated anaphylaxis can be assessed from the number of personalized management protocols in French schools: 0.065%. Another means of assessment may be the rate of adrenalin prescriptions. However, an overestimation of the anaphylaxis risk may result from this method (0.95% of Canadian children). Data from the literature leads to several possibilities. First, a definition of severe anaphylaxis should be agreed. Secondly, prospective, multicentre enquiries, using ICD codes, should be implemented. Moreover, the high number of anaphylaxis cases for which the aetiology is not identified, and the variation in aetiology in the published series, indicate that a closer cooperation between emergency specialists and allergists is essential.

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    • "Du fait d'une grande hétérogénéité des méthodologies utilisées dans les études épidémiologiques, il existe une importante disparité des incidences retrouvées. En France, le réseau d'Allergo-vigilance, créé en 2002, permet un recensement déclaratif des réactions graves [5]. Le Groupe d'études des réactions anaphylactiques peranesthésiques (GERAP) collige les réactions peranesthésiques [6]. "
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    ABSTRACT: L’anaphylaxie est une réaction d’hypersensibilité sévère, potentiellement fatale, de mécanisme IgE-dépendant ou non. Sa prévalence est estimée à 0,3 % en Europe. Les auteurs exposent les bases physiopathogéniques de la réaction anaphylactique, ses aspects cliniques et les facteurs de risque, rappelant que le pronostic dépend de la rapidité du diagnostic et du traitement. Comme le soulignent les recommandations internationales, l’administration rapide d’adrénaline est essentielle. La littérature fait état d’une sous-utilisation de ce médicament. Les auteurs proposent un algorithme de prise en charge de l’anaphylaxie en fonction du grade de sévérité basée sur la classification de Ring et Messmer. À la sortie de l’hôpital, la prescription d’une trousse d’urgence contenant 2 stylos auto-injecteurs d’adrénaline avec éducation à leur utilisation est essentielle. Un document exposant la réaction clinique, ses circonstances de survenue et son traitement doit être remis au patient. Au décours d’une réaction anaphylactique, une consultation allergologique est indispensable dans l’objectif d’identifier l’allergène responsable et mettre en œuvre une stratégie préventive secondaire pour prévenir la récidive. Il convient de recommander au patient et à son entourage de conserver les aliments et médicaments pour faciliter l’enquête étiologique réalisée par l’allergologue.
    Journal Europeen des Urgences et de Reanimation 05/2015; 27(2). DOI:10.1016/j.jeurea.2015.03.009
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    • "Nevertheless, admissions in English NHS hospitals for (all cause) anaphylaxis (severe allergic reactions) rose steadily from 2821 in 2004-05 to 3595 in 2008-09 [2]. Anaphylaxis is responsible for the death of approximately 1 to 3 individuals per million population [3]. "
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    ABSTRACT: Allergy is a serious and apparently increasing public health problem yet relatively little is known about the types of allergy seen in routine tertiary practice, including their spatial distribution, co-occurrence or referral patterns. This study reviewed referrals over an eleven year period to a regional allergy clinic that had a well defined geographical boundary. For those patients confirmed as having an allergy we explored: (i) differences over time and by demographics, (ii) types of allergy, (iii) co-occurrence, and (iv) spatial distributions. Data were extracted from consultant letters to GPs, from September 1998 to September 2009, for patients confirmed as having an allergy. Other data included referral statistics and population data by postcode. Simple descriptive analysis was used to describe types of allergy. We calculated 11 year standardised morbidity ratios for postcode districts and checked for spatial clustering. We present maps showing 11 year rates by postcode, and 'difference' maps which try to separate referral effect from possible environmental effect. Of 5778 referrals, 961 patients were diagnosed with an allergy. These were referred by a total of 672 different GPs. There were marked differences in referral patterns between GP practices and also individual GPs. The mean age of patients was 35 and there were considerably more females (65%) than males. Airborne allergies were the most frequent (623), and there were very high rates of co-occurrence of pollen, house dust mite, and animal hair allergies. Less than half (410) patients had a food allergy, with nuts, fruit, and seafood being the most common allergens. Fifteen percent (142) had both a food and a non-food allergy. Certain food allergies were more likely to co-occur, for example, patients allergic to dairy products were more likely to be allergic to egg.There were age differences by types of allergy; people referred with food allergies were on average 5 years younger than those with other allergies, and those allergic to nuts were much younger (26 Vs 38) than those with other food allergies.There was clear evidence for spatial clustering with marked clustering around the referral hospital. However, the geographical distribution varied between allergies; airborne (particularly pollen allergies) clustered in North Dartmoor and Exmoor, food allergies (particularly nut allergies) in the South Hams, and on small numbers, some indication of seafood allergy in the far south west of Cornwall and in the Padstow area. This study shows marked geographical differences in allergy referrals which are likely to reflect a combination of environmental factors and GP referral patterns. The data suggest that GPs may benefit from education and ongoing decision support and be supported by public education on the nature of allergy. It suggests further research into what happens to patients with allergy where there has been low use of tertiary services and further research into cross-reactivity and co-occurrence, and spatial distribution of allergy.
    BMC Public Health 12/2010; 10(1):790. DOI:10.1186/1471-2458-10-790 · 2.26 Impact Factor
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    • "However, consumption of fruits may also impose adverse effects in individuals with fruit allergy [2]. Epidemiological data estimate the prevalence of food allergies to be 1.4 – 2.4% worldwide with an increasing progression [3] and children and young adults being particularly affected [4] [5]. "
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    ABSTRACT: IgE-reactive proteins in raspberry (Rubus ideaus L.) were identified using PCR, RT-PCR, 2-DE and MS/MS peptide sequencing. Specific polyclonal antibodies and patient sera were used in Western blotting to identify crossreactive epitopes. Initially, two potential allergens Rub i 1 and Rub i 3 were detected using PCR, showing high sequence identity to proteins in Rosaceous species like Mal d 1 and Mal d 3 from apple, Pru av 1 and Pru av 3 from cherry and Pru p 1 and Pru p 3 from peach. Furthermore, de novo identified peptides of a protein band at about 30 kDa reacting with most of the patient sera tested (> 80%) revealed a high sequence homology with class III chitinases. Raspberry chitinase, when subjected to glycoproteomic analysis, showed typical complex plant-type N-glycans with a core alpha1,3 fucose and a beta1,2 xylose at least at one position, indicating the presence of crossreacting carbohydrate determinants (CCDs). Finally, MS/MS analysis revealed an IgE-reactive raspberry cyclophilin, homologous to Bet v 7. Results obtained suggest that the consumption of raspberries might be responsible for adverse reactions in sensitised individuals.
    Molecular Nutrition & Food Research 12/2008; 52(12):1497-506. DOI:10.1002/mnfr.200700518 · 4.60 Impact Factor
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