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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Available from: Anne Denise Moneret-Vautrin
    • "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.
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