Medications Are the Leading Cause of Allergy-Related Sudden Deaths

A new study indicates that medications produce far more fatal cases of anaphylaxis than either venom or food. Researchers from Albert Einstein College of Medicine and Weill-Cornell Medical College identified 2,458 anaphylaxis-related deaths that took place between 1999 and 2010 from diagnostic codes on death certificates from the US National Mortality Database.

Their paper, which appeared in the Journal of Allergy and Clinical Immunology, reports that medications were identified as the trigger in 1,446 (58.8%) of those deaths and, most likely, deserve the blame in many of the 475 fatalities (19.3%) triggered by “unspecified” allergens.

Many of the 1,446 death certificates that indicated medical triggers failed to name individual medications, but among those that did the most common culprits were antibiotics, which caused 149 deaths.

Radiocontrast agents used in diagnostic imaging got the blame for another 100 fatalities, while chemotherapy was named in a further 46 cases. Less common triggers included serum, opiates, antihypertensives, nonsteroidal anti-inflammatory drugs, and anesthetics.

Further analysis of the figures revealed a significant increase in fatal drug-induced anaphylaxis over the study period, from 0.27 (95% confidence interval [CI], 0.23-0.30) per million in 1999 to 2001 to 0.51 (95% CI, 0.47-0.56) per million in 2008 to 2010 (P < .001).

The study authors cited several possible explanations for the rise.

“The increase in medication-related deaths caused by anaphylaxis likely relates to increased medication and radiocontrast use, enhanced diagnosis, and coding changes,” they wrote in a statement that accompanied publication of the study results.

The second biggest cause of fatal anaphylaxis over the study period was venom, but it trailed far behind medication. It only appeared as the likely trigger in 15.2% of all the death certificates.

Food was even further behind. Just 6.7% of the death certificates named any sort of food as the most probable catalyst for the eventual attack.

In addition to tallying the causes for each fatality, the research team also analyzed victims by age, sex race and other demographic factors — an effort that uncovered many significant associations.

Older age was associated with greater risk of fatal anaphylaxis from all causes (P < .001).

Women did not face a greater risk from any trigger, but they faced a relatively lower risk than men of suffering fatal anaphylaxis triggered by venom. People who lived in the southern United States, on the other hand, faced a greater risk of suffering fatal anaphylaxis triggered by venom.

African-Americans faced greater risk of fatal anaphylaxis from medications, food and unspecified allergens (P < .001), while whites faced a greater risk of fatal anaphylaxis from venom (P < .001).

“There are strong and disparate associations between race and specific classes of anaphylaxis-related mortality in the United States,” wrote the authors of the study, who also uncovered significant further evidence concerning the increasing prevalence and severity of food allergies in the African American community.

The rates of fatal anaphylaxis from food allergies in African American men increased from 0.06 (95% CI, 0.01-0.17) per million in 1999 to 2001 to 0.21 (95% CI, 0.11-0.37) per million in 2008 to 2010 (P < .001).

There was, however, at least one reason for optimism. Awareness of anaphylaxis, and the importance of identifying triggers, appears to be on the rise.

The rates of unspecified fatal anaphylaxis decreased over time from 0.30 (95% CI, 0.26-0.34) per million in 1999 to 2001 to 0.09 (95% CI, 0.07-0.11) per million in 2008 to 2010 (P < .001).