Original ArticleSystemic Allergic DisordersRate of recurrent anaphylaxis and associated risk factors among Olmsted County, Minnesota, residents: A population-based study
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.
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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.