Fatal and near‐fatal anaphylaxis: The Allergy‐Vigilance® Network data (2002–2020)

Author:

Pouessel Guillaume12ORCID,Alonzo Sabrina1,Divaret‐Chauveau Amandine3ORCID,Dumond Pascale3,Bradatan Eléna4,Liabeuf Valérie5,Beaumont Pascale6,Tscheiller Sélina7,Diesnis Rémy8,Renaudin Jean‐Marie9,Sabouraud‐Leclerc Dominique10,

Affiliation:

1. Department of Paediatrics CH Roubaix Roubaix France

2. Paediatric Pneumology and Allergology Unit CHRU Lille France

3. Paediatric Allergology, Children's Medicine CHRU Vandoeuvre‐les‐Nancy France

4. Department of Paediatrics CHRU Namur Belgium

5. Department of Dermatology CHRU La Timone Marseille France

6. Medical Practice Paris France

7. Allergy‐Vigilance Network Vandoeuvre Les Nancy France

8. Adult Emergency – SMUR and Clinical Research Unit Victor Provo Hospital, CH Roubaix Roubaix France

9. Allergology Department CH Durkheim Epinal France

10. General and Specialized Pediatrics Department American Hospital, Reims University Hospital Reims France

Abstract

AbstractBackgroundHaving a better understanding of the risk factors of severe anaphylaxis is a crucial challenge for physicians.MethodsTo retrospectively analyse fatal/near‐fatal anaphylaxis cases recorded by the Allergy‐Vigilance® Network (2002–2020) and evaluate the characteristics associated with survival, age and allergens.ResultsAmong the 3510 anaphylaxis cases documented in the network, 70 (2%) patients (males: 57%; mean age: 35.4 y) presented grade 4 (Ring‐Messmer) anaphylaxis and 25 died (19 food‐related); 33% had a history of asthma. The main allergens were food (60%; peanut, 20%; milks, 11%) involved in 25/26 cases in children and in 17/44 (39%) cases in adults. Non‐food anaphylaxis was related to drugs/latex (24%; neuromuscular blocking agents, 10%; betalactamins, 6%), Hymenoptera (16%). Three food‐related cases (one death) occurred during oral food challenge in children. Patients with a food allergy were younger (22.2 years vs. 55 years, p < .001), had more likely a history of asthma (50% vs. 7%; p < .001), a pre‐existing allergy (62% vs. 18%; p < .001) compared with other allergies. A cofactor was identified in 35 cases (50%) but predominantly in adults as opposed to children (64% vs. 27%; p = .01). The patients who died were younger (25.6 vs. 40.8 years; p = .01) than the survivors and mostly presented bronchospasm (56% vs. 29%; p = .05). Gaps in the prevention and management of anaphylaxis were noted in 15 cases (21%).ConclusionsSevere food anaphylaxis has specific features compared with other causes such as young age, asthma history and exercise. Food is also involved in severe anaphylaxis in adults that should not be underestimated.

Publisher

Wiley

Subject

Immunology,Immunology and Allergy

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