Epidemiology, anaphylaxis

Published data on the epidemiology of anaphylaxis has been continuously increasing worldwide within the last 2 years. One reason is that anaphylaxis has been more recognized by allergists but also the common commimity due to the onset of deaths even in small children. 

In principal, data on the epidemiology of anaphylaxis will help to identify causes, risk factors and circumstances of the reaction. It will support the medical commimity to develop measures for the protection of affected patients. A true incidence of anaphylaxis has not been established, reasons are diverse study designs and the fact that there has been no universal consensus as to the definition of anaphylaxis [ 1 ]. 

Table 1. Data regarding the epidemiology of anaphylaxis [according to 47-51]... 

The data on the epidemiology of anaphylaxis are widely varying estimates on the frequency of this condition. The findings are based on diverse study designs and are often not comparable. A clear conclusion from the data published so far is difficult. One major reason is that there is no universal consensus regarding the definition of anaphylaxis. The International Classification Codes (ICD) recording anaphylaxis are imprecise and do not properly reflect the epidemiological needs. 

BohlkeK, Davis RL,DeStefanoF,etal Epidemiology 24 of anaphylaxis among children and adolescents enrolled in a health maintenance organization. J Allergy Clin Immunol 2004 113 536-542. 25... 

Clark S, Camargo CA Jr Epidemiology of anaphylaxis. Immunol Allergy Clin North Am 2007 27 145- 26... 

Peng MM. Jick H A population-based study of the incidence, cause, and severity of anaphylaxis in the United Kingdom. Arch Intern Med 2004 164 317-319. Bohlke K, Davis RL, DeStefano F. et al Vaccine Safety Datalink Team. Epidemiology of anaphylaxis among children and adolescents enrolled in a health maintenance organization. J Allergy Clin Immunol 2004 113 536-542. 

Yang MS, Lee SH, Kim TW, et al Epidemiologic and clinical features of anaphylaxis in Korea. Ann Allergy Asthma Immunol 2008 100 31-36. 

Simon MR, Mulla ZD A population-based epidemiologic analysis of deaths from anaphylaxis in Florida. Allergy 2008 63 1077-1083. 

Simons FE, Peterson S, Black CD Epinephrine dispensing patterns for an out-of-hospital population a novel approach to studying the epidemiology of anaphylaxis. J Allergy Clin Immunol 2002 10 647-651. 

Rangaraj S, Tuthill D, Burr M. Alfaham M Childhood epidemiology of anaphylaxis and epinephrine in Wales 1994-1999. J Allergy Clin Immunol 2000 109 S75. 

Moneret-Vautrin DA, Morisset M, Flabbee J, Beau-douin E, Karmy G Epidemiology of hfe-threatening and lethal anaphylaxis a review. Allergy 2005 60 443-451. 

Decker WW, Campbell RL, Manivannan V, Luke A, St Sauver JL, Weaver A, Belloho MF, Bergstralh EJ, Stead LG, Li JT Etiology and incidence of anaphylaxis in Rochester, Minnesota a report from the Rochester Epidemiology Project. J Allergy Chn Immunol 2008 122 1161-1165. 

Opioids. Reactions to morphine, codeine phosphate, meperidine, fentanyl and its derivatives are uncommon. Because of their direct histamine-releasing properties, especially regarding morphine and codeine, distinction between anaphylaxis and non-immune-mediated histamine release is not always easy. Only 12 cases were recorded in the last 2 years epidemiologic survey in France, 9 of them being related to morphine administration [9]. 

The current evidence base for the injection of epinephrine in the initial acute treatment of anaphylaxis includes clinical experience during nearly a century of use, observational studies, epidemiological studies, fatality studies, and randomized controlled trials in people at risk for anaphylaxis although not actually experiencing it at the time of the study. Moreover, the pharmacology of epinephrine has been... 

Tanaka, S. (1994). An epidemiological survey of food-dependent exercise-induced anaphylaxis in kindergartners, schoolchildren and junior high school students. Asia Pac. ]. Public Health 7,26-30. 

Neuqut Al, Ghatak AT, Miller RL. Anaphylaxis in the United States An investigation into its epidemiology. Ann Intern Med 2001 161 15-21. 

Many medical textbooks recommend the use of parenteral HI and H2 antagonists in anaphylaxis, particularly in those hypotensive patients who are resistant to adrenaline [53 ]. However, a systematic review did not identify any studies to support antihistamine administration as a first-line therapy for anaphylaxis [54 ]. In this regard, an epidemiological study of 490 patients with anaphylaxis reported in a substudy that three patients with anaphylaxis who were treated with promethazine 25 mg intravenously subsequently developed hypotension [55 ]. All were then successfully treated with adrenalin. Although the authors accept that these observations do not prove causality, they do demonstrate the potential risk of using parenteral antihistamines in patients with anaphylaxis. 

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