title: Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012.
abstract: BACKGROUND
  The incidence of anaphylaxis might be increasing. Data for fatal anaphylaxis are limited because of the rarity of this outcome.
  
  
  OBJECTIVE
  We sought to document trends in anaphylaxis admissions and fatalities by age, sex, and cause in England and Wales over a 20-year period.
  
  
  METHODS
  We extracted data from national databases that record hospital admissions and fatalities caused by anaphylaxis in England and Wales (1992-2012) and crosschecked fatalities against a prospective fatal anaphylaxis registry. We examined time trends and age distribution for fatal anaphylaxis caused by food, drugs, and insect stings.
  
  
  RESULTS
  Hospital admissions from all-cause anaphylaxis increased by 615% over the time period studied, but annual fatality rates remained stable at 0.047 cases (95% CI, 0.042-0.052 cases) per 100,000 population. Admission and fatality rates for drug- and insect sting-induced anaphylaxis were highest in the group aged 60 years and older. In contrast, admissions because of food-triggered anaphylaxis were most common in young people, with a marked peak in the incidence of fatal food reactions during the second and third decades of life. These findings are not explained by age-related differences in rates of hospitalization.
  
  
  CONCLUSIONS
  Hospitalizations for anaphylaxis increased between 1992 and 2012, but the incidence of fatal anaphylaxis did not. This might be due to increasing awareness of the diagnosis, shifting patterns of behavior in patients and health care providers, or both. The age distribution of fatal anaphylaxis varies significantly according to the nature of the eliciting agent, which suggests a specific vulnerability to severe outcomes from food-induced allergic reactions in the second and third decades.
authors.affiliation: Section of Paediatrics (Allergy & Immunology) and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom; Division of Paediatrics and Child Health, University of Sydney, Sydney, Australia. Electronic address: paulyt@doctors.org.uk.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Turner
authors.affiliation: Allergy Action & Anaphylaxis Campaign UK, Farnborough, United Kingdom.
authors.forename: M Hazel
authors.initials: MH
authors.lastname: Gowland
authors.affiliation: Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Vibha
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Section of Paediatrics (Allergy & Immunology) and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom.
authors.forename: Despo
authors.initials: D
authors.lastname: Ierodiakonou
authors.affiliation: Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Nigel
authors.initials: N
authors.lastname: Harper
authors.affiliation: Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Tomaz
authors.initials: T
authors.lastname: Garcez
authors.affiliation: Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Pumphrey
authors.affiliation: Section of Paediatrics (Allergy & Immunology) and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Boyle
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000453:epidemiology* / Q000209:etiology / Q000266:history / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005512:Food Hypersensitivity / Q000453:epidemiology / Q000276:immunology; D049673:History, 20th Century; D049674:History, 21st Century; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D007231:Infant, Newborn; D007299:Insect Bites and Stings; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010343:Patient Admission; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D004837:Epinephrine
keywords: Anaphylaxis; drug allergy; epidemiology; food allergy; hospitalization; insect sting allergy