title: Anaphylaxis-related deaths in Ontario: a retrospective review of cases from 1986 to 2011.
abstract: BACKGROUND
  Examining deaths caused by anaphylaxis may help identify factors that may decrease the risk of these unfortunate events. However, information on fatal anaphylaxis is limited. The objectives of our study were to examine all cases of fatal anaphylaxis in Ontario to determine cause of death, associated features, co factors and trends in mortality. The identification of these factors is important for developing effective strategies to overcome gaps in monitoring and treatment of patients with food allergies and risk for anaphylaxis.
  
  
  METHODS
  This was a retrospective case-series analysis of all causes of anaphylaxis-related deaths using data from the Ontario Coroner's database between 1986 and 2011. Quantitative data (e.g. demographic) were analyzed using descriptive statistics and frequency analysis using SPSS. Qualitative data were analyzed using content analysis of grounded theory methodology.
  
  
  RESULTS
  We found 92 deaths in the last 26 years related to anaphylaxis. Causes of death, in order of decreasing frequency, included food (40 cases), insect venom (30 cases), iatrogenic (16 cases), and idiopathic (6 cases). Overall, there appears to be a decline in the frequency of food related deaths, but an increase in iatrogenic causes of fatalities. We found factors associated with fatal anaphylaxis included: delayed epinephrine administration, asthma, allergy to peanut, food ingestion outside the home, and teenagers with food allergies.
  
  
  CONCLUSIONS
  Our findings indicate the need to improve epinephrine auto-injector use in acute reactions, particularly for teens and asthmatics with food allergies. In addition, education can be improved among food service workers and food industry in order to help food allergic patients avoid potentially fatal allergens. The increasing trend in iatrogenic related anaphylaxis is concerning, and requires monitoring and more investigation.
authors: Department of Allergy & Immunology, McMaster University, Hamilton, ON L8N 4 K1, Canada.
authors: Ya Sophia
authors: YS
authors: Xu
authors: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON M5B 1 W8, Canada.
authors: Monika
authors: M
authors: Kastner
authors: Anaphylaxis Canada, Toronto, ON M2J 5B4, Canada.
authors: Laurie
authors: L
authors: Harada
authors: Department of Physiology and Pharmacology, Western University, London, ON N6A 5C1, Canada.
authors: Anna
authors: A
authors: Xu
authors: Independent MD, Toronto, Canada.
authors: Jane
authors: J
authors: Salter
authors: Department of Medicine, McMaster University, Hamilton, ON L8S 4 K1, Canada.
authors: Susan
authors: S
authors: Waserman
keywords: Adverse drug reaction; Anaphylaxis; Anaphylaxis mortality; Food allergy; Iatrogenic anaphylaxis; Insect sting allergy; Medication allergy; Severe allergic reaction; Venom allergy