Medications are the leading
cause of allergy-related sudden deaths in the U.S., according to an analysis of
death certificates from 1999 to 2010, conducted by researchers at Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva
University. The study, published online today in the Journal of
Allergy and Clinical Immunology, also found that the risk of fatal
drug-induced allergic reactions was particularly high among older people and
African-Americans and that such deaths increased significantly in the U.S. in
recent years.
Anaphylaxis is the term used for a severe, potentially
life-threatening allergic reaction that can occur within seconds or minutes
following exposure to an allergen. Until now, data on trends in anaphylactic
deaths—or even the number of yearly deaths from anaphylactic shock—has not been
well-defined. One reason: unlike countries such as the UK, the U.S. doesn't
maintain a national registry for anaphylaxis deaths.
"Anaphylaxis-related deaths in the U.S. have not been
well understood in recent years," said Elina Jerschow ,
M.D., M.Sc. director, Drug Allergy Center, Allergy and Immunology Division of
Medicine, Montefiore Medical Center, and assistant professor of medicine,
Albert Einstein College, the lead author of the study. "We hope these findings
will help in identifying specific risk factors and allow physicians to
formulate preventative approaches."
Dr. Jerschow and colleagues analyzed death certificates from
the U.S. National Mortality Database and found that medication-related anaphylaxis
was the most common cause of death (58.8 percent). Additional causes identified
included unspecified anaphylaxis (19.3 percent), venom (15.2 percent) and food
(6.7 percent). Further analyses revealed fatal anaphylaxis due to medications,
food and unspecified allergens was significantly associated with African
American race and older age; and fatal anaphylaxis rates due to venom was more
common in white, older men.
Of the 2,458 deaths identified between 1999-2010, culprit
drugs were not specified in most of the cases (approximately 74 percent).
However, among those with an identified culprit drug, nearly half were
antibiotics, followed by radiocontrast agents used during diagnostic imaging
procedures and chemotherapeutics that are used in treatment of cancer.
During the years studied, there was a significant increase
in fatal drug anaphylaxis, from 0.27 per million in 1999-2001 to 0.51 per
million in 2008-2010. The increase in medication-related anaphylaxis deaths
likely relates to increased medication and radiocontrast use, enhanced
diagnosis and coding changes.
"Anaphylaxis has been dubbed 'the latest allergy
epidemic,'" said Dr. Jerschow. "The U.S. and Australia have some of
the highest rates of severe anaphylaxis among developed countries. We hope
these results bring increased awareness of the need for a better understanding
of anaphylaxis deaths."
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