Drug-Induced Fatal Anaphylaxis: The Most Common Culprits
the MPR take:
The United States has one of the highest rates of severe anaphylaxis among developed countries, but research has not examined changes in mortality rates for anaphylaxis and differences among race/ethnicity, age, and sex. With mortality data from the Vital Statistics Database of the National Center for Health Statistics’ Multiple Cause of Death Data, mortality data from 1999-2010 was assessed using ICD-10 codes for specific anaphylaxis (food, drug, serum, and unspecified) and causality codes (eg medications and venom.). There were 2,458 anaphylaxis-related deaths from 1999-2010, with medication being the most common cause (58.8%), followed by “unspecified” (19.3%), venom (15.2%), and food (6.7%). Rates of drug-induced fatal anaphylaxis increased over the time frame, from 0.27 per million in 1999–2001 to 0.51 per million in 2008–2010; from the deaths in which a culprit drug class was identified, 40.5% were due to antibiotics, most commonly penicillins, followed by radiocontrast agents, antineoplastic drugs, serum, opiates, antihypertensive agents, nonsteroidal anti-inflammatory drugs (NSAIDs), and anesthetic agents. Fatal anaphylaxis from venom was significantly associated with older age, white race, and male sex but no changes were seen in these rates over time, nor for food-induced anaphylaxis. African-American race was a significant risk factor for all causes except venom, and older age was also linked regardless of cause. Particularly with the increase in drug-related fatal anaphylaxis, physicians should be aware of the risk factors and the medications most commonly associated.
Anaphylaxis-related deaths in the United States have not been well characterized in recent years.