The epidemiology of anaphylaxis in Europe: a systematic review

Authors

  • S. S. Panesar,

    1. Allergy & Respiratory Research Group, Center for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
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  • S. Javad,

    1. School of Public Health, Imperial College, London, UK
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  • D. de Silva,

    1. The Evidence Centre Ltd, London, UK
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  • B. I. Nwaru,

    1. School of Health Sciences, University of Tampere, Tampere, Finland
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  • L. Hickstein,

    1. Biometry and Epidemiology, Institute for Medical Informatics, University of Munich, Munich, Germany
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  • A. Muraro,

    1. Department of Pediatrics, Center for Food Allergy Diagnosis and Treatment, Veneto Region, University of Padua, Padua, Italy
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  • G. Roberts,

    1. David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK
    2. NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
    3. Faculty of Medicine, Human Development and Health and Clinical Experimental Sciences Academic Units, University of Southampton, Southampton, UK
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  • M. Worm,

    1. Allergy-Center-Charité, Department of Dermatology and Allergy, Charité Universitätsmedizin Berlin, Berlin, Germany
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  • M. B. Bilò,

    1. Allergy Unit, Department Internal Medicine, University Hospital, Ospedali Riuniti, Ancona, Italy
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  • V. Cardona,

    1. Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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  • A. E. J. Dubois,

    1. Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
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  • A. Dunn Galvin,

    1. Department of Paediatrics and Child Health, University College, Cork, Ireland
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  • P. Eigenmann,

    1. University Hospitals of Geneva, Geneva, Switzerland
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  • M. Fernandez-Rivas,

    1. Department of Allergy, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
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  • S. Halken,

    1. Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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  • G. Lack,

    1. MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
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  • B. Niggemann,

    1. Allergy Center Charité, University Hospital Charité, Berlin, Germany
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  • A. F. Santos,

    1. Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College, London, UK
    2. MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
    3. Department of Immunoallergology, Coimbra University Hospital, Coimbra, Portugal
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  • B. J. Vlieg-Boerstra,

    1. Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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  • Z. Q. Zolkipli,

    1. NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
    2. Faculty of Medicine, Human Development and Health and Clinical Experimental Sciences Academic Units, University of Southampton, Southampton, UK
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  • A. Sheikh,

    Corresponding author
    1. Allergy & Respiratory Research Group, Center for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
    2. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
    • Correspondence

      Aziz Sheikh, Professor of Primary Care Research & Development and Co-Director, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Doorway 3, Teviot Place, Edinburgh EH8 9AG, UK

      Tel.: +44 (0)131 651 4151

      Fax: +44 (0)131 650 9119

      E-mail: aziz.sheikh@ed.ac.uk

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  • and on behalf of the EAACI Food Allergy and Anaphylaxis Group

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    • EAACI Food Allergy and Anaphylaxis Group: C. A. Akdis, A. Bellou, C. Bindslev Jensen, K. Brockow, A. Clark, P. Demoly, L. Harada, K. Hoffman-Sommergruber, L. Poulsen, F. Rueff, M. Jutel, N. Papadopoulos, F. Timmermans, R. Van Ree, T. Werfel

  • Edited by: Werner Aberer
  • Review registration: PROSPERO registration number CRD42013003702

Abstract

Background

Anaphylaxis is an acute, potentially fatal, multi-organ system, allergic reaction caused by the release of chemical mediators from mast cells and basophils. Uncertainty exists around epidemiological measures of incidence and prevalence, risk factors, risk of recurrence, and death due to anaphylaxis. This systematic review aimed to (1) understand and describe the epidemiology of anaphylaxis and (2) describe how these characteristics vary by person, place, and time.

Methods

Using a highly sensitive search strategy, we identified systematic reviews of epidemiological studies, descriptive and analytical epidemiological investigations, and studies involving analysis of routine data.

Results

Our searches identified a total of 5 843 potentially eligible studies, of which 49 satisfied our inclusion criteria. Of these, three were suitable for pooled estimates of prevalence. The incidence rates for all-cause anaphylaxis ranged from 1.5 to 7.9 per 100 000 person-years. These data indicated that an estimated 0.3% (95% CI 0.1–0.5) of the population experience anaphylaxis at some point in their lives. Food, drugs, stinging insects, and latex were the most commonly identified triggers.

Conclusions

Anaphylaxis is a common problem, affecting an estimated 1 in 300 of the European population at some time in their lives. Future research needs to focus on better understanding of the trends across Europe and identifying those most likely to experience fatal reactions.

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