Dying from allergies: fatal anaphylaxis in the United States

Published Online: September 30, 2014

Hospital admissions for anaphylaxis in the United States are on the rise. This trend has also been observed among other westernized countries. However, it is not clear whether the rise in admissions for anaphylaxis is accompanied by higher rates of deaths due to anaphylaxis. In a recent issue of the The Journal of Allergy and Clinical Immunology, E. Jerschow and colleagues present temporal trends of fatal anaphylaxis in the United States from 1999 through 2010 and the associations of fatal anaphylaxis with age, gender, race and geographical distribution.

Utilizing the Multiple Cause of Death Database of the National Center for Health Statistics’ (NCHS), Jerschow, et al. investigated fatal anaphylaxis among all deaths in the US during a period of twelve years. Deaths due to anaphylaxis were identified by using ICD-10 codes for anaphylaxis as well as by a previously published algorithm (L. Harduar-Morano et al., JACI 2010).

2,458 deaths due to anaphylaxis and additional 593 deaths due to fatal allergic reactions were identified over the twelve-year period, for a combined prevalence of 0.86 deaths due to anaphylaxis per million people in the United States. These results indicate that the US has one of the highest prevalences of fatal anaphylaxis in the world. A few other interesting findings emerged from this analysis:

  • Similar to the reports from UK, Australia, and New Zealand, medications were the most common cause of fatal anaphylaxis in the US. While most (~74%) of the drug anaphylaxis deaths in the study by Jerschow et al. had no identified culprit drug, among those with an identified culprit drug, nearly half were antibiotics, followed by radiocontrast agents, and chemotherapeutics.
  • Fatal anaphylaxis to medications increased overtime. At the same time, unspecified anaphylaxis decreased. It is possible that such change was due to the new coding practices, greater use of medications, and/or a better recognition of drug anaphylaxis by physicians.
  • The rates of the fatal anaphylaxis to foods tripled among African-American men.
  • Higher fatal anaphylaxis rates were observed in adults across all anaphylaxis categories. Although food allergy is commonly regarded as a childhood ailment, adults are more likely to die from anaphylaxis to foods.
  • There were some regional differences in fatal anaphylaxis prevalence: while Northeast had significantly lower rates of fatal anaphylaxis to medications, the rates of unspecified anaphylaxis were lower in the West. Higher anaphylaxis rates to venom were observed in the South.

This study was based on the entire US population during the study period and provides important insights into the patterns of anaphylaxis-related mortality in the US. There is a possibility of under- and mis-reporting of anaphylaxis fatalities on death certificates. Such limitations could be lessened if a dedicated national registry for fatal anaphylaxis were established. Further data clarification would be promoted by creation of ICD-10 anaphylaxis codes related to venom, specific foods and medications.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.


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