title: Epidemiology of anaphylaxis at a tertiary care center: A report of 730 cases.
abstract: Recent data reveal that the rate of anaphylaxis is increasing and suggest that idiopathic anaphylaxis may account for most of these cases.
  
  
  
  To determine the pattern of anaphylaxis at a tertiary care referral center.
  
  
  
  A retrospective electronic medical record review spanning 12 years (2002-2013) identified patients with anaphylaxis.
  
  
  
  Of the 4,777 records reviewed, 730 patients met our anaphylaxis definition. Median age was 34.0 years; 72.7% were adults, 58.6% were female, and 86.8% were white. Median time to evaluation by an allergist was 8.8 months. Foods were the most common cause (29.9%), followed by Hymenoptera venom (24.6%), idiopathic anaphylaxis (13.7%), and medications (13.3%). The most common foods were peanuts (23.9%), tree nuts (21.6%), shellfish (16.1%), and egg and milk (both 10.1%). The most common cause of anaphylaxis in adults was Hymenoptera venom. The most frequent symptoms were urticaria and/or angioedema, reported in 84.7% of cases. Atopy was present in 43.8%. In 15.4% of cases, anaphylaxis was not the chief reason for the office visit.
  
  
  
  We found food allergy was the most common overall cause of anaphylaxis, with peanut the most frequent food trigger. Idiopathic anaphylaxis was not the most common cause but accounted for 13.7% of all cases. Approximately 1 in 6 cases of anaphylaxis may be missed if a comprehensive evaluation is not performed.
authors.affiliation: Department of Allergy and Immunology, Cleveland Clinic, Cleveland, Ohio. Electronic address: gonzalez.alexei@gmail.com.
authors.forename: Alexei
authors.initials: A
authors.lastname: Gonzalez-Estrada
authors.affiliation: Allergy Partners of North Texas, Dallas, Texas.
authors.forename: Stacy K
authors.initials: SK
authors.lastname: Silvers
authors.affiliation: ACPNY, Brooklyn, New York.
authors.forename: Asaf
authors.initials: A
authors.lastname: Klein
authors.affiliation: Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Katrina
authors.initials: K
authors.lastname: Zell
authors.affiliation: Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Wang
authors.affiliation: Department of Allergy and Immunology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: David M
authors.initials: DM
authors.lastname: Lang
mesh_terms: D000328:Adult; D000485:Allergens / Q000145:classification / Q000276:immunology; D000707:Anaphylaxis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D000818:Animals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000485:Allergens