Increases in anaphylaxis fatalities in Australia 1997 to 2013

Abstract

Background

Recent epidemiological studies indicate increases in Australian, UK and US hospital anaphylaxis admission rates.

Objectives

The aim of the study was to determine whether Australian anaphylaxis fatalities are increasing in parallel and to examine the characteristics of fatalities recorded in the National Coronial Information System (NCIS).

Methods

Time trends in Australian anaphylaxis fatalities were examined using data derived from the Australian Bureau of Statistics (ABS) 1997-2013 and the NCIS 2000-2013, the latter providing additional information to verify cause and identify risk factors.

Results

The ABS recorded 324 anaphylaxis fatalities by cause: unspecified (n=205); medication (n=52); insect stings/tick bites (n=41); food (n=23); blood products (n=3). From 1997-2013, all-cause fatal anaphylaxis rates increased by 6·2%/year (95% CI: 3·8 to 8·6%, p<0·0001) or from 0·054 to 0·099/10⁵ population). Fatal food anaphylaxis increased by 9·7%/year (95% CI: 0·25 to 20%, p=0·04) and unspecified anaphylaxis deaths by 7·8% (95%CI: 4·6 to 11·0, p<0·0001). There was an insignificant change in medication–related fatalities, (5·6% increase/year; 95% CI: 0·3% decrease to 11·8% increase, p=0·06) and sting/bite fatalities remained unchanged. Hospital anaphylaxis admission rates for all-cause, food, unspecified and medication anaphylaxis increased at rates of 8%, 10%, 4·4% and 6·8%/year, respectively. 147 verified NCIS deaths were examined in detail: Medication and sting/bite-related fatalities occurred predominantly in older individuals with multiple co-morbidities. Upright posture after anaphylaxis was associated with risk of sudden death (all causes). Seafood (not nuts) was the most common trigger for food-related anaphylaxis deaths.

Conclusions

Australian anaphylaxis fatality rates (most causes) have increased over the last 16 years, contrasting with UK and USA-based studies that describe overall lower and static overall anaphylaxis fatality rates (0·047-0·069/10⁵ population).

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