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

Abstract

Background Having a better understanding of the risk factors of severe anaphylaxis is a crucial challenge for physicians. Methods To 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. Results Among 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%). Conclusions Severe 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.

Anaphylaxis mortality in the perioperative setting: Epidemiology, elicitors, risk factors and knowledge gaps

“…A study conducted in the same country with anaphylaxis records in intensive care units (ICU) identified nine out of ten fatal PA cases that evolved to death related to drugs used in perioperative settings 29,30 . One out of 25 fatal anaphylaxis cases reported by the French Allergy‐Vigilance® network (2002–2022) was related to suxamethonium 31 . Similarly, NMBAs appear to be the leading culprit drugs in anaphylaxis‐related maternal death (five maternal deaths between 2001 and 2012 in France, all related or highly suspected to be related NMBAs) 30 .…”

“…29,30 One out of 25 fatal anaphylaxis cases reported by the French Allergy-Vigilance® network (2002-2022) was related to suxamethonium. 31 Similarly, NMBAs appear to be the leading culprit drugs in anaphylaxis-related maternal death (five maternal deaths between 2001 and 2012 in France, all related or highly suspected to be related NMBAs). 30 In general, there are still difficulties in accessing the elicitor of fatal PA due to the lack of allergy investigation.…”

Lead Optimization of Butyrolactone I as an Orally Bioavailable Antiallergic Agent Targeting FcγRIIB

“…Antihistamines, steroids and nonsteroids, and epinephrine are the three main medications used to alleviate FA. 13,14 However, these medications have several limitations, including being unsuitable for children under 2 years old, having numerous side effects, and potentially fatal if misused. Therefore, improving therapeutic options has become vital for food allergy research.…”

Biologicals in IgE-mediated food allergy

“…Food allergy is an important issue due to its increasing frequency and high severity [4]. It remains one of the main anaphylaxis cause in children, and an accidental exposure can even be fatal [5]. The possibility for this devastating outcome has resulted in increased awareness of food allergy and fear for those who are affected [1], impacting on the nutritional health of patients and the quality of life of the entire family.…”