Introduction
Causes of fatal anaphylaxis
Study | Nationality/Database | Analysis | N° subjects/Mean age | Causes of death (%) | Study period |
---|---|---|---|---|---|
Liew et al [9] (2009) | Australia/National database | Retrospective case review based on ICD-10 codes on death certificates | 112/Not reported | Probable drugs (38), drugs (20), insect (18), food (6), undetermined (13) | 8 years (1997–2005) |
Tanno et al [14] (2012) | Brazil/Brazilian Mortality Information System | Population-based epidemiologic study using ICD codes on death certificates | 498/Not reported | Drugs (42), insect (35), unspecified (21), food (2) | 3 years (2008–2010) |
Jerschow et al [18] (2014) | USA/United States Vital Statistic Data | Population-based epidemiologic study using ICD CM diagnostic codes on death certificates | 2,458 / > 50 years (cause -reported) | Drugs (58.8), unspecified (19.3), venom (15.2), food (6.7) | 11 years (1999–2010) |
Turner et al [16] (2015) | UK /UK Office on National Statistics database | Hospital admission and fatalities caused by anaphylaxis. Data on anaphylaxis cross-checked against a prospective fatal anaphylaxis registry based on ICD-9 and ICD-10 | 480/The mean age of fatal food-induced cases ofanaphylaxis was 25 years; The mean age of fatal cases of anaphylaxis due to iatrogenic causes was 58 years; The mean age of fatal cases by sting-induced anaphylaxis was 59 years | Drugs (54.8), food (25.8), insect (19.3) | 20 years (1992–2012) |
Bilò et al [17] (2020) | Italy/National Register of Causes of Death database, managed by the Italian National Institute of Statistics | Descriptive study An analytical method was developed to identify all the ICD-10 codes related to anaphylaxis deaths, which were divided into two classes: "definite anaphylaxis deaths” and “possible anaphylaxis deaths” | 392 definite anaphylaxis deaths and 220 possible anaphylaxis deaths were recorded/ Not reported | Drugs (73.7), unspecified causes (20.7), Hymenoptera stings (5.6) | 14 years (2004–2016) |
Xu et al [19] (2014) | Canada/Data from the Ontario Coroner’s database | Retrospective case-series analysis of all causes of anaphylaxis-related deaths using data from the Ontario Coroner’s database | 92 / Mean age 46.5 years [age range 9 to 86 years] | Food (43), insect (33), drugs (17), unclear (7) | 26 years (1986–2011) |
Poussels et al [20] (2023) | France/Allergy-Vigilance® Network | Retrospective analysis | 25 / Not reported | Food (76), drugs (14), Hymenoptera (12) | 19 years (2002–2020) |
Incidence of food-induced fatal anaphylaxis
Study | Nationality/Database | Analysis | Time period | Total deaths | Rate of fatal food (per million/year) | Age | Causal foods | Risk factors |
---|---|---|---|---|---|---|---|---|
Mullins et al [22] (2016) | Australia/Data collected from the Australian Bureau of Statistics (ABS) 1997–2013 and the National Coronial Information System (NCIS) 2000- 2013 | Retrospective | 1997–2013 2000–2013 | 324 anaphylaxis fatalities in the period 1997–2013, food (n = 23) | 1997:0 2014:0.09 | Median age 28 (range 4–66) | Seafood 50%, nuts 32% | Known food allergy 91%, asthma 68%, alcohol or recreational drugs 27%, upright posture 68%, delayed use of epinephrine |
Xu et al [19] (2014) | Canada/Data from the Ontario Coroner’s database | Retrospective | 1986- 2011 | 92 total, food in 40(43%) | 1986:0.32 2011:0.08 | Mean age 32 (range 9–78) | Peanuts, tree nuts (55%) | Known food allergy, delayed use of epinephrine |
Turner et al [16] (2015) | UK/Data from national databases recording hospital admissions and fatalities caused by anaphylaxis in England and Wales | Retrospective | 1992–2012 | 480 total, food 124(26%) | 1992:0–10 2012:0–12 | Mean age 25, median age 20. Range (4–85) | Peanuts or tree nuts (73%) | Known food allergy, asthma 78%, change in posture |
Risk factors of food-induced fatal anaphylaxis
Food fatal anaphylaxis in children
AA | Source/Period | Total N° of Fatal Food | Causal Food |
---|---|---|---|
Sampson [28] (1992) USA | - | 6 | 5 peanuts/tree nuts 1 milk/ egg |
MacDougal [29] (2002) UK | 1990–2000 | 8 | 4 milk 2 peanut 1 egg 1 mixed food |
Calvani [30] (2006) Italy | Ministerial data/2000–2002 | 1 | Not specified |
Bock [31] (2007) USA | Registry kept by members of the American Academy of Allergy, Asthma & Immunology/2001–2006 | 17 | 12 peanuts/tree nuts 4 milk 1 not specified |
Levi [32] (2012) Israel | All medical and media data reported 2004–2011 | 3 | 3 milk |
Poussel [33] (2023) France | France/Allergy-Vigilance® Network | 13 | Not specified |
Name | Age | Year/Location/City | Allergen Certain (C) / Suspected (S) | Suspected food | Injectable Adrenaline available | Autopsy | Other |
---|---|---|---|---|---|---|---|
DP (M) | 16 years | 2010 / Restaurant / San Giovanni Rotondo (FG) | Wheat allergy (S), other unspecified food allergies, celiac disease | Ice cream with cereals biscuit | Yes Late and improper injection | YES Not available | Restaurant staff informed of allergies |
CW (M) | 7 years | 2015 / Restaurant/ Ravello (Sa) | Milk (C) | Homemade (with milk) spaghetti with tomato sauce | Yes EpiPen injected by the mother (nurse) | Yes Anaphylactic shock confirmed | Death in Santobono hospital after 3 days |
AB (M) | 17 years | 2015 / Friend’s house / Gaiole in Chianti (Si)/ | Milk (C) | Pasta with tomato and cheese | No | Yes Anaphylactic shock confirmed | Previous anaphylactic shock at 11 years |
BS (F) | 16 years | 2018 / Home (Cosenza) | Milk (C) | Licorice candy | No | No | Dyspnea, hypotension, urticaria |
MVS (F) | 12 years | 2019 / Pizzeria / Villorba (Treviso) | Milk (C) | Pizza | No Adrenaline injected by parents | Yes Anaphylactic shock confirmed | Restaurant staff aware of her allergy |
FS (F) | 16 years | 2019 / Bar / Roma | Milk (S) Other unspecified allergies | Cocktail (rum, whisky, fruit cream, coconut milk) | Not reported | Yes Not available | Not available |
AA (M) | 17 years | 2020 / Friend’s home / Taggia (Imperia) news/shock-anafilattico-muore-ragazzo-di-17-anni-a-taggia-1.38523834 | Milk (C) | Salami sandwich | No | Coroner confirmed cause of death | Similar episode 1 years before |
MQ (F) | 13 years | 2022/Birthday party with friends (Fondi-Latina) | Milk (C) | Salami sandwich | Yes Not sure if used right away back at home | Yes (glottis oedema) | Restaurant staff informed of allergy |
CP (F) | 16 years | 2021/School (Enna) | Milk (C) | Pasta with ragu sauce | Not reported | Yes Not available | First symptoms at school. Died while waiting for the bus |