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Clinical and demographic characteristics of fatal anaphylaxis in Spain (1998‐2011): A comparison between a series from the hospital system and a national forensic series
Author(s) -
TejedorAlonso Miguel A.,
MartínezFernandez Pilar,
VallejodeTorres Gloria,
NavarroEscayola Esperanza,
MoroMoro Mar,
AlbertiMasgrau Nuria
Publication year - 2019
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/cea.13272
Subject(s) - series (stratigraphy) , anaphylaxis , medicine , forensic science , medical emergency , allergy , immunology , biology , veterinary medicine , paleontology
Summary Background Reports of fatal anaphylaxis remain scarce because of the rarity of the condition and the fact that information is limited to a few countries. Objective Our objective was to investigate clinical and demographic characteristics and the causes of fatal anaphylaxis in Spain using two databases of cases of fatal anaphylaxis. Methods We analysed fatal anaphylaxis in a series from the Spanish hospital system and a series from the National Institute of Toxicology and Forensic Sciences (Instituto Nacional de Toxicología y Ciencias Forenses [ INTCF ]), which predominantly comprise extrahospital deaths. Deaths from the Spanish hospital system were retrieved from among all deaths occurring during 1998‐2011 using codes related to anaphylaxis. Deaths due to anaphylaxis in the INTCF database during the same period were retrieved by 2 allergists, who identified cases in which anaphylaxis was a possible cause of death. A logistic regression model was constructed to predict the characteristics of fatal anaphylaxis in each database. Results The incidence of death by anaphylaxis in Spain using both databases was 0.25 (95% CI , 0.24‐0.26) deaths per million person‐years. The most frequent causes of death in the hospital system were drugs (46.1%), unknown causes (40.0%), and foods (10.4%); in the INTCF , the most common causes of death were drugs (47.2%), insect stings (30.6%), and foods (11.1%). The logistic regression model showed that fatal anaphylaxis due to unknown causes ( OR 15.2, 95% CI 1.8‐129.8) was more likely in the hospital database, whereas insect stings ( OR 100, 95% CI 10‐833.3) and previous atopic comorbidity ( OR 15.2, 95% CI 6.3‐33.3) were more likely in the INTCF database. Conclusions & Clinical Relevance The estimated frequency of fatal anaphylaxis in Spain was among the lowest reported. Future studies of fatal anaphylaxis should use databases from different origins in order to show the considerable heterogeneity in this type of death.