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Incidence of Fatal Anaphylaxis: A Systematic Review of Observational Studies

Perez-Codesido S1,2, Rosado-Ingelmo A1, Privitera-Torres M1, Pérez Fernández E3, Nieto-Nieto A1, Gonzalez-Moreno A1, Grifol-Clar E4, Alberti-Masgrau N5, Tejedor-Alonso MA1,6

1Allergy Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
2International Doctoral School, Facultad Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón (Madrid), Spain
3Clinical Research Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
4Medical Library, Hospital Universitario Fundación Alcorcón, Madrid, Spain
5Pathology Department. Hospital Universitario 12 de Octubre, Madrid, Spain
6Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain

J Investig Allergol Clin Immunol 2022; Vol 32(4) : 245-260
doi: 10.18176/jiaci.0693

Background: Fatal anaphylaxis is very rare, with an incidence ranging from 0.5 to 1 deaths per million person-years.
Objective: Based on a systematic review, we aimed to explain differences in the reported incidence of fatal anaphylaxis based on the methodological and demographic factors addressed in the various studies.
Methods: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for relevant retrospective and prospective cohort studies and registry studies that had assessed the anaphylaxis mortality rate for the population of a country or for an administrative region. The research strategy was based on combining the term “anaphylaxis” with “death”, “study design”, and “main outcomes” (incidence).
Results: A total of 46 studies met the study criteria and included 16,541 deaths. The range of the anaphylaxis mortality rate for all causes of anaphylaxis was 0.002-2.51 deaths per million person-years. Fatal anaphylaxis due to food (range 0.002-0.29) was rarer than deaths due to drugs (range 0.004-0.56) or Hymenoptera venom (range 0.02-0.61). The frequency of deaths due to anaphylaxis by drugs increased during the study period (IRR per year, 1.02; 95%CI, 1.00-1.04). We detected considerable heterogeneity in almost all of the meta-analyses carried out.
Conclusion: The incidence of fatal anaphylaxis is very low and differs according to the various subgroups analyzed. The studies were very heterogeneous. Fatal anaphylaxis due to food seems to be less common than fatal anaphylaxis due to drugs or Hymenoptera venom.

Key words: Anaphylaxis, Drugs, Food, Hymenoptera, Systematic review, Death, Incidence