Original Article
Systemic Allergic Disorders
Rate of recurrent anaphylaxis and associated risk factors among Olmsted County, Minnesota, residents: A population-based study

https://doi.org/10.1016/j.anai.2016.09.444Get rights and content

Abstract

Background

The rate and risk factors for recurrence of anaphylaxis are not well known.

Objective

To measure the rate and risk factors for recurrent anaphylaxis in a population-based cohort in Olmsted County, Minnesota.

Methods

We conducted a population-based cohort study using the Rochester Epidemiology Project, a comprehensive medical records linkage system, to obtain records of patients who presented to medical centers within the Olmsted County area with anaphylaxis from January 1, 2001, through December 31, 2010. We evaluated the rate and associations of risk factors with anaphylaxis recurrence.

Results

Among the 611 patients with anaphylaxis, 50 (8%) experienced a total of 60 recurrences within the 10-year period, resulting in a recurrence rate of 2.6 per 100 person-years. A history of atopic dermatitis (hazard ratio [HR], 5.6; 95% confidence interval [CI], 2.0–16.1; P = .001), presenting symptoms of cough (HR, 4.7; 95% CI, 2.1–10.7; P < .001) oral pruritus (HR, 9.9; 95% CI, 4.3–23.2; P < .001), and receiving corticosteroids (HR, 5.2; 95% CI, 2.3–11.7; P < .001) were associated with an increased risk of recurrence. The cardiovascular symptom of chest pain (HR, 0.24; 95% CI, 0.07–0.79; P = .02) was associated with a decreased risk of recurrence.

Conclusion

In this epidemiologic study, the rate of recurrence was 8% during the 10-year study period (recurrence rate of 2.6 per 100 person-years). Those with atopic dermatitis and mucocutaneous or respiratory symptoms were more likely to have a recurrent anaphylactic event. Our findings underscore the importance of early patient access to self-injectable epinephrine and referral to an allergist/immunologist for additional testing and education.

Introduction

Anaphylaxis is a systemic allergic reaction that can be fatal.1 Several studies in different populations have reported increasing incidence rates of anaphylaxis over time.[2], [3], [4], [5] Clinical criteria for the diagnosis of anaphylaxis were poorly defined until 2006 when the National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network (NIAID/FAAN) diagnostic criteria for anaphylaxis were established.1 One of the most feared aspects of anaphylaxis is its recurrence. Previous studies report frequent recurrence of anaphylaxis, particularly in patients with multiple triggers.6 Identification of those at greatest risk for recurrent anaphylaxis may enable patients to be more vigilant and prepared to mitigate the risk. Despite the dangers of recurrent anaphylactic reactions, few studies have examined the incidence of and risk factors for recurrence, and there have been no population-based studies.[6], [7], [8] This study was designed to measure the rate and risk factors for recurrent anaphylactic reactions in the population of Olmsted County, Minnesota, from 2001 to 2010.

Section snippets

Study Design and Setting

We conducted a population-based observational cohort study among residents of Olmsted County between 2001 and 2010. We identified patients with anaphylaxis from the Rochester Epidemiology Project, a medical record linkage system connecting the records of all health care workers in Olmsted County, Minnesota.[9], [10], [11], [12], [13] Every patient's diagnosis was coded with either the codes of the Hospital Adaptation of the International Classification of Diseases, Second Edition (HICDA-2), or

Interobserver Agreement

Twenty medical records were reviewed by a trained medical assistant (C.B.) and the principal investigator (S.L.), and interrater agreement was very good, with an overall agreement of 95% and a κ of 0.88 (95% CI, 0.64–1.00).

Participants

Using the resources of the Rochester Epidemiology Project, we identified 631 patients who had at least one anaphylactic reaction that met the NIAID/FAAN criteria (Fig 1) in Olmsted County from January 1, 2001, through December 31, 2010. One patient did not have research

Main Findings

In this population-based, epidemiologic study, we found that recurrent anaphylaxis occurred in 8% of the patients during the 10-year study period (2.6 per 100 patient-years). The median time to recurrence was 0.6 years. We found an association between recurrence and a history of atopic dermatitis and the presenting symptoms of cough, oral pruritus, and receiving steroid therapy for the index reaction, whereas the cardiovascular symptom of chest pain was significantly associated with a decreased

Acknowledgments

We appreciate Waqas Gilani, MD, and Dante Lucas Souza from Mayo Clinic for assistance in medical record review.

References (20)

There are more references available in the full text version of this article.

Cited by (11)

  • Anaphylaxis

    2022, Comprehensive Pharmacology
  • Community Use of Epinephrine for the Treatment of Anaphylaxis: A Review and Meta-Analysis

    2021, Journal of Allergy and Clinical Immunology: In Practice
    Citation Excerpt :

    The trigger of anaphylaxis was not specified in 2 articles (3.8%). Epinephrine use in the pre–hospital setting was reported as ranging from 0.0% to 74.7%.5,10-61 Among the 53 articles, 20 specified epinephrine use pre–emergency medical services (EMS; ie, self-administration or administration by a parent or other bystander).

  • Risk factors for recurrent anaphylaxis-related emergency department visits in the United States

    2018, Annals of Allergy, Asthma and Immunology
    Citation Excerpt :

    Third, our study was limited to persons with private insurance and those with Medicare Advantage. Those without health insurance or with Medicaid were not part of the data source and may explain why our sample population (median age, 42 years) was slightly older than previous studies by Lee et al11 (median age, 31 years) and Mullins2 (median age, 27.4 years). Fourth, most of our cohort was white, and nearly half the patients were from the South.

View all citing articles on Scopus

Disclosures: The contents are solely the responsibility of the authors and do not necessarily represent the official view of National Institutes of Health.

Funding Sources: This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under award R01AG034676, and by Clinical and Translational Science Award grant UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health.

View full text