Critical view of anaphylaxis epidemiology: open questions and new perspectives

Abstract

In contrast to the majority of allergic or hypersensitivity conditions, worldwide anaphylaxis epidemiological data remain sparse with low accuracy, which hampers comparable morbidity statistics. Data can differ widely depending on a number of variables. In the current document we reviewed the forms on which anaphylaxis has been defined and classified; and how it can affect epidemiological data. With regards to the methods used to capture morbidity statistics, we observed the impact of the anaphylaxis coding utilizing the World Health Organization’s International Classification of Diseases. As an outcome and depending on the anaphylaxis definition, we extracted the cumulative incidence, which may not reflect the real number of new cases. The new ICD-11 anaphylaxis subsection developments and critical view of morbidity statistics data are discussed in order to reach new perspectives on anaphylaxis epidemiology.

Food‐induced fatal anaphylaxis: From epidemiological data to general prevention strategies

“…However, this estimate is likely to be lower than the true rate of fatal anaphylaxis, due to under-diagnosis and under-notification. [7][8][9] In the majority of countries, the most common causes for fatal anaphylaxis are medication/iatrogenic triggers and foods; foods are the most common elicitors in children and young adults. Fatal foodinduced anaphylaxis rates range from 0.03 to 0.3 deaths per million inhabitants per year, 5,[8][9][10][11][12][13] (Table 1).…”

“…Estimates can differ widely depending on a number of variables. 5,[7][8][9] Anaphylaxis is an uncommon cause of death, [10][11][12] particularly for food, and is difficult to study because it is typically a community event, occurring outside the hospital environment. 2,3 Hospitalizations due to anaphylaxis are also increasing in many countries, [4][5][6] in particular in young children; these increases are noted particularly for medication and food triggers.…”

“…5,6 These reported increases probably reflect a true increase in the prevalence of allergic disease, but are also confounded by cumulative incidence of anaphylaxis, better awareness and recognition of anaphylaxis, and changes in anaphylaxis coding, in part due to modifications in the international classification of diseases. 5,[7][8][9] Anaphylaxis is an uncommon cause of death, [10][11][12] particularly for food, and is difficult to study because it is typically a community event, occurring outside the hospital environment. Severe anaphylaxis is unpredictable, which contributes to the high adverse impact of the diagnosis on health-related quality of life of individuals at risk of anaphylaxis.…”

Idiopathic anaphylaxis

“…Idiopathic anaphylaxis has been classified according to clinical parameters (IA‐generalized, IA‐angio‐oedema), frequency of episodes (frequent, infrequent) and severity in terms of response to steroid treatment (corticosteroid‐dependent, malignant). This classification, in particular IA‐angio‐oedema, could be challenged in the context of the diagnostic criteria for anaphylaxis, as some cases with mucocutaneous involvement only would clearly not meet the criteria for anaphylaxis. Thus, it is plausible that incidence rates of IA published prior to 2011 may be inaccurate and potentially be an overestimation.…”

Improving adrenaline autoinjector adherence: A psychologically informed training for healthcare professionals

“…1(p.835) International prevalence rates show increasing numbers of children, adolescents, and adults in Europe and the United States are being diagnosed with anaphylaxis. [2][3][4][5][6][7][8][9][10] However, diagnosis is difficult and anaphylaxis fatalities are probably underreported. 11 United Kingdom hospital admission data show a population prevalence of 7 per 100 000, a 615% increase from 1992-2012.…”