Epidemiology of Anaphylaxis

  • David J. Chinn
  • Aziz Sheikh
Part of the Allergy Frontiers book series (ALLERGY, volume 1)

Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems [1]. Epidemiological measures of interest for anaphylaxis include the incidence, incidence rate, lifetime prevalence of its occurrence and case fatality rate (Box 1). Other aspects of interest concern features of persons who experience it, temporal relationships, and the factors that lead to its development and recurrence. Anaphylaxis is a potentially life-threatening hypersensitivity reaction to a substance or set of factors to which the affected person is sensitive and people who experience an anaphylactic reaction remain at risk of further reactions. Accordingly, a description of its epidemiology is important to inform the development and evaluation of strategies to reduce its frequency of occurrence.

Anaphylaxis affects children and adults alike, but estimates of its incidence and lifetime prevalence vary across populations, with time in the same population, and with the data sources used to estimate them. One important reason for this imprecision relates to the great variability in clinical symptoms experienced [2]. An anaphylactic reaction can present with cutaneous, respiratory, cardiovascular or gastrointestinal symptoms that can be misinterpreted for other disorders [3]. The variety of physiological responses experienced by patients and the failure to identify specific biomarkers present during all attacks contributes to the uncertainty of diagnosis [4]. Accordingly, agreement on a case definition has proved elusive and this has contributed to difficulties of conducting research into its epidemiology [5, 6].


Food Allergy Allergy Clin Immunol Lifetime Prevalence Anaphylactic Reaction Case Fatality Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Last JM (2001) A dictionary of epidemiology, 4th edn. Oxford University Press, New York.Google Scholar
  2. 2.
    Ewan PA (1998) ABC of allergies. Anaphylaxis. BMJ 316:1442–1445.Google Scholar
  3. 3.
    Kumar A, Teuber SS, Gershwin ME (2005) Why do people die of anaphylaxis? A clinical review. Clin Develop Immunol 12:281–287.CrossRefGoogle Scholar
  4. 4.
    Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF, Bock A, Branum A, Brown SGA, Camargo CA, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O'Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons ER, Thomas S, Wood JP, Decker WW (2006) Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 117:391–397.PubMedCrossRefGoogle Scholar
  5. 5.
    Neugut AI, Ghatak AT, Miller RL (2001) Anaphylaxis in the United States. An investigation into its epidemiology. Arch Intern Med 161:15–21.PubMedCrossRefGoogle Scholar
  6. 6.
    Lieberman P, Camargo CA, Bohlke K, Jick H, Miller RL, Sheikh A, Simons FER (2006) Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy, Asthma Immunol 97:596–602.Google Scholar
  7. 7.
    American Academy of Pediatrics, Committee on School Health (1990) Guidelines for urgent care in school. Pediatrics 86:999–1000Google Scholar
  8. 8.
    International Collaborative Study of Severe Anaphylaxis (1998) An epidemiologic study of severe anaphylactic and anaphylactoid reactions among hospital patients: methods and overall risks. Epidemiology 9:141–146.CrossRefGoogle Scholar
  9. 9.
    Australasian Society of Clinical Immunology and Allergy Inc. (ASCIA) (2004) Guidelines for EpiPen prescription. ASCIA Anaphylaxis Working Party. Accessed 21st June 2007.
  10. 10.
    Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; and Joint Council of Allergy, Asthma, and Immunology (2005) The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol 115(3 suppl):S483–S523.Google Scholar
  11. 11.
    Pumphrey RSH (2000) Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exper Allergy 30:1144–1150.CrossRefGoogle Scholar
  12. 12.
    Peng MM, Jick H (2004) A population-based study of the incidence, cause and severity of anaphylaxis in the United Kingdom. Arch Intern Med 164:317–19.PubMedCrossRefGoogle Scholar
  13. 13.
    Mullins RJ (2003) Anaphylaxis: risk factors for recurrence. Clin Exp Allergy 33:1033–1040.PubMedCrossRefGoogle Scholar
  14. 14.
    Klein JS, Yocum MW (1995) Underreporting of anaphylaxis in a community emergency room. J Allergy Clin Immunol 95:637–638.PubMedCrossRefGoogle Scholar
  15. 15.
    Bohlke K, Davis RL, DeStefano F, Marcy SM, Braun MM, Thompson RS (2004) Epidemiology of anaphylaxis among children and adolescents enrolled in a health maintenance organization. J Allergy Clin Immunol 113:536–542.PubMedCrossRefGoogle Scholar
  16. 16.
    Sørensen HT, Nielsen B, Nielson-Østergaard J (1989) Anaphylactic shock occurring outside hospitals. Allergy 44:288–290.PubMedCrossRefGoogle Scholar
  17. 17.
    Pumphrey RSH, Davis S (1999) Under-reporting of antibiotic anaphylaxis may put patients at risk. Lancet 353:1157–1158.PubMedCrossRefGoogle Scholar
  18. 18.
    Lieberman PL (2003) Anaphylaxis and anaphylactoid reactions. In: Adkinson NF Jr, Busse WW, Yunginger JW, et al (eds). Middleton's allergy principles and practice, 6th edn. Elsevier, St Louis, MO.Google Scholar
  19. 19.
    Boros CA, Kay D, Gold MS (2000) Parent reported allergy and anaphylaxis in 4173 South Australian children. J Paediatr Child Health 36:36–40.PubMedCrossRefGoogle Scholar
  20. 20.
    Rankin KE, Sheikh A (2006) Serious shortcomings in the management of children with ana-phylaxis in Scottish schools. PLoS Med 3(8):e326. doi: 10.1371/journal.pmed.0030326PubMedCrossRefGoogle Scholar
  21. 21.
    Yocum MW, Butterfield JH, Klein JS, Volcheck GW, Schroeder DR, Silverstein MD (1999) Epidemiology of anaphylaxis in Olmstead County, a population-based study. J Allergy Clin Immunol 104:452–456.PubMedCrossRefGoogle Scholar
  22. 22.
    Gupta R, Sheikh A, Strachan D, Anderson HR (2004) Burden of allergic disease in the UK: secondary analyses of national databases. Clin Exp Allergy 34:520–26.PubMedCrossRefGoogle Scholar
  23. 23.
    Helbling A, Hurni T, Mueller UR, Pichler WJ (2004) Incidence of anaphylaxis with circulatory symptoms: a study over a 3-year period comprising 940,000 inhabitants of the Swiss Canton Bern. Clin Exp Allergy 34:285–290.PubMedCrossRefGoogle Scholar
  24. 24.
    Sheikh A, Hippisley-Cox J, Newton J, Fenty J (2008). Trends in national incidence, lifetime prevalence and adrenaline prescribing for anaphylaxis in England. J Roy Soc Med 101: 139–143.CrossRefPubMedGoogle Scholar
  25. 25.
    Mulla ZD, Simon MR (2007) Hospitalizations for anaphylaxis in Florida: epidemiologic analysis of a population-based dataset. Int Arch Allergy Immunol 144:128–136.PubMedCrossRefGoogle Scholar
  26. 26.
    Amornmarn L, Bernard L, Kumar N, et al (1992) Anaphylaxis admissions to a university hospital [abstract]. J Allergy Clin Immunol 89(suppl):349.Google Scholar
  27. 27.
    Stewart AG, Ewan PW (1996) The incidence, aetiology and management of anaphylaxis presenting to an accident and emergency department. Q J Med 89:859–864Google Scholar
  28. 28.
    Sheikh A, Alves B (2001) Age, sex, geographical and socioeconomic variations in admissions for anaphylaxis: analysis of four years of English hospital data. Clin Exp Allergy 31: 1571–76.PubMedCrossRefGoogle Scholar
  29. 29.
    Pastorello EA, Rivolta F, Bianchi M, Mauro M, Pravettoni V (2001) Incidence of anaphylaxis in the emergency department of a general hospital in Milan. J Chromatogr B Biomed Sci Appl 756:11–17.PubMedCrossRefGoogle Scholar
  30. 30.
    Brown AF, McKinnon D, Chu K (2001) Emergency department anaphylaxis: a review of 142 patients in a single year. J Allergy Clin Immunol 108:861–866PubMedCrossRefGoogle Scholar
  31. 31.
    Smit De V, Cameron PA, Rainer TH (2005) Anaphylaxis presentations to an emergency department in Hong Kong: incidence and predictors of biphasic reactions. J Emer Med 28:381–388.CrossRefGoogle Scholar
  32. 32.
    Braganza SC, Acworth JP, McKinnon DRL, Peake JE, Brown AFT (2006) Paediatric emergency department anaphylaxis: different patterns from adults. Arch Dis Child 91:159–163.PubMedCrossRefGoogle Scholar
  33. 33.
    Poachanukoon O, Paopairochanakorn C (2006) Incidence of anaphylaxis in the emergency department: a 1-year study in a university hospital. Asian Pacific J Allergy Immunol 24:111–116.Google Scholar
  34. 34.
    Gupta R, Sheikh A, Strachan D, Anderson HR (2007) Time trends in allergic disorders in the UK. Thorax 62:91–96.PubMedCrossRefGoogle Scholar
  35. 35.
    Simons FER, Peterson S, Black CD (2002) Epinephrine dispensing patterns for an out-of-hospital population; a novel approach to studying the epidemiology of anaphylaxis. J Allergy Clin Immunol 110:647–651PubMedCrossRefGoogle Scholar
  36. 36.
    Sicherer SH, Simons ERS (2005) Quandries in prescribing an emergency action plan and self-injectable epinephrine for first-aid management of anaphylaxis in the community. J Allergy Clin Immunol 115:578–583.Google Scholar
  37. 37.
    Simons FER, Peterson S, Black CD (2001) Epinephrine dispensing for the out-of-hospital treatment of anaphylaxis in infants and children: a population-based study. Ann Allergy Asthma Immunol 86:622–626.PubMedGoogle Scholar
  38. 38.
    Bock SA, Muñoz-Furlong A, Sampson HA (2001) Fatalities due to anaphylactic reactions to food. J Allergy Clin Immunol 107:191–193.PubMedCrossRefGoogle Scholar
  39. 39.
    Bock SA, Muñoz-Furlong A, Sampson HA (2007) Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol 118:1016–1018.CrossRefGoogle Scholar
  40. 40.
    Moneret-Vautrin DA, Morisset M, Flabbee J, Beaudouin E, Kanny G (2005) Epidemiology of life-threatening and lethal anaphylaxis: a review. Allergy 60:443–451.CrossRefGoogle Scholar
  41. 41.
    Population UK. = 6. Accessed 6 Jun 2007.
  42. 42.
    National Patient Safety Agency (2007) Safety in doses: improving the use of medicines in the NHS. London.Google Scholar
  43. 43.
    Pumphrey RSH (2004) Fatal anaphylaxis in the UK, 1992–2001. 2004 anaphylaxis. Wiley (Novartis Foundation Symposium 257), Chichester, pp 116–132Google Scholar
  44. 44.
    Pumphrey R (2004) Anaphylaxis: can we tell who is at risk of a fatal reaction? Curr Opin Allergy Clin Immunol 4:285–290PubMedCrossRefGoogle Scholar
  45. 45.
    Pumphrey RSH, Gowland MH (2007) Further fatal allergic reactions to food in the United Kingdom, 1999–2006. J Allergy Clin Immunol 119:1018–1019.PubMedCrossRefGoogle Scholar
  46. 46.
    Bernstein DI, Wanner M, Borish L, Liss GM, and the Immunotherapy committee of the American Academy of Allergy, Asthma and Immunology (2004) Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990–2001. J Allergy Clin Immunol 113:1129–1136.PubMedCrossRefGoogle Scholar
  47. 47.
    Gupta R, Sheikh A, Strachan D, Anderson HR (2003) Increasing hospital admission for systematic allergic disorders in England: analysis of national admission data. BMJ 327:1142–1143PubMedCrossRefGoogle Scholar
  48. 48.
    Alves B, Sheikh A (2001) Age-specific aetiology of anaphylaxis: a study of routine hospital admission data in England. Arch Dis Child 85:349.CrossRefGoogle Scholar
  49. 49.
    Black CD, Peterson S, Simons FER (2001) Epinephrine for outpatient treatment of anaphylaxis: a population-based study. J Allergy Clin Immunol 107:S59Google Scholar
  50. 50.
    Pumphrey RSH, Stanworth SJ (1996) The clinical spectrum of anaphylaxis in north-west England. Clin Exp Allergy 26:1364–1370.PubMedCrossRefGoogle Scholar
  51. 51.
    Slater JE (1993) Latex allergy. Ann Allergy 70:1–2.PubMedGoogle Scholar
  52. 52.
    Kemp SF, Lockey RF, Wolf BL, Lieberman P (1996) Anaphylaxis: a review of 266 cases. Arch Int Med 155:1749–1754CrossRefGoogle Scholar
  53. 53.
    Quiralte J, Sanchez-Garcia F, Torres MJ, Blanco C, Castillo R, Ortega N, de Castro FR, Perez-Aciego P, Carillo T (1999) Association of HLA-DR11 with the anaphylactoid reaction caused by nonsteroidal anti-inflammatory drugs. J Allergy Clin Immunol 103:685–689PubMedCrossRefGoogle Scholar
  54. 54.
    Brown RH, Hamilton RG, Mintz M, Jedlicka AE, Scott AL, Kleeberger SR (2005) Genetic predisposition to latex allergy: role of interleukin 13 and interleukin 18. Anesthesiology 102:496–502.PubMedCrossRefGoogle Scholar
  55. 55.
    Ewan PW, Clark AT. Long-term prospective observational study of the outcome of a management plan in patients with peanut and nut allergy referred to a regional allergy centre. Lancet 2001; 357:111–115.PubMedCrossRefGoogle Scholar
  56. 56.
    Cianferoni A, Novembre E, Pucci N, Lombardi E, Bernardini R, Vierucci A (2004) Anaphylaxis: a 7-year follow-up survey of 46 children. Ann Allergy Asthma Immunol 92:464–468.PubMedCrossRefGoogle Scholar
  57. 57.
    Yocum MW, Khan DA (1994) Assessment of patients who have experienced anaphylaxis: a 3-year survey. Mayo Clin Proc 69:16–23.PubMedGoogle Scholar
  58. 58.
    Sheikh A, Alves B (2000) Hospital admission for acute anaphylaxis: time trend study. BMJ 320:1441–1444.PubMedCrossRefGoogle Scholar
  59. 59.
    Brown SGA (2004) Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol 114:371–376.PubMedCrossRefGoogle Scholar
  60. 60.
    Sicherer SH, Munoz-Furlong A, Burks AW, Sampson HA (1999) Prevalence of peanut and tree nut allergy in the US determined by a random digit dial telephone survey. J Allergy Clin Immunol 103:559–562.PubMedCrossRefGoogle Scholar
  61. 61.
    Altman DR, Chiaramonte LT (1996) Public perception of food allergy. J Allergy Clin Immunol 97:1247–1251.PubMedCrossRefGoogle Scholar
  62. 62.
    Pereira B, Venter C, Grundy J, Clayton CB, Arshad SH (2005) Prevalence of sensitisation to food allergens, reported adverse reaction to foods, food avoidance, and food hypersensitivity among teenagers. J Allergy Clin Immunol 116:884–892PubMedCrossRefGoogle Scholar
  63. 63.
    Venter C, Pereira B, Grundy J, Clayton CB, Roberts G, Higgins B, Dean T (2006) Incidence of parentally reported and clinically diagnosed food hypersensitivity in the first year of life. J Allergy Clin Immunol 117:1118–1124.PubMedCrossRefGoogle Scholar
  64. 64.
    SNOMED International, a division of the College of American Pathologists. www.snomed. org. Accessed 14 Jun 2007.
  65. 65.
    Choo K, Sheikh A (2007) Action plans for the long-term management of anaphylaxis:systematic review of effectiveness. Clin Exp Allergy 37:1090–1094PubMedCrossRefGoogle Scholar
  66. 66.
    Fernando B, Savelyich BSP, Avery AJ, Sheikh A, Bainbridge M, Horsfield P, Teasdale S (2004) Prescribing safety features of general practice computer systems: evaluation using simulated test cases. BMJ 328:1171–1172.PubMedCrossRefGoogle Scholar
  67. 67.
    Akeson N, Worth A, Sheikh A (2007) The psychosocial impact of anaphylaxis on young people and their parents. Clin Exp Allergy 37:1213–1220.PubMedCrossRefGoogle Scholar
  68. 68.
    Anandan C, Simpson CR, Fischbacher C, Sheikh A (2006) Exploiting the potential of routine data to better understand the disease burden posed by allergic disorders. Clin Exp Allergy 36:866–871.PubMedCrossRefGoogle Scholar
  69. 69.
    Clark S, Camargo CA (2007) Epidemiology of anaphylaxis. Immunol Allergy Clin N Am 27:145–163CrossRefGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • David J. Chinn
    • 1
  • Aziz Sheikh
    • 1
  1. 1.Division of Community Health Sciences: GP SectionUniversity of EdinburghEdinburgh

Personalised recommendations