Anaphylaxis Statistics

Anaphylaxis Prevalence

Between 1.6 and 5.1% of the United States Population have experienced anaphylaxis 10

Definition of Anaphylaxis

Anaphylaxis is a sudden onset of severe and potentially life-threatening symptoms that occur within minutes to hours of exposure to an allergen 1 

Causes of Anaphylaxis

Anaphylaxis is caused by exposure to a trigger or allergen.  The most common triggers include 2:

• Foods (31%) 10
• Peanuts or tree nuts 3
• Cow’s milk 3
• Hen’s egg 3
• Medication (34%) 10
• Non-steroidal anti-inflammatories (NSAIDs) are responsible for 48.7–57.8% of incidents 7
• Antibiotics 4
• Insect sting (20%) 10
• Bees, wasps, hornets, or yellow jackets 6
• Fire ants 6

Symptoms

Symptoms may affect the skin, respiratory system mucosal system (tongue, lips, throat), gastrointestinal system, and cardiovascular system 1

• 80-90% of patients report subjective or general symptoms and skin issues 5
• 62% develop hives 5
• 53% develop angioedema (swelling of the mucous membranes, such as the tongue, lips or throat) 5
• 27% develop vomiting 5
• 24% report nausea 5
• 16% report abdominal pain or cramping 5
• 5% develop diarrhea 5

Treatment of Anaphylaxis

• Primary Treatment: Epinephrine should be the first treatment for anaphylaxis.  It should be administered as soon as symptoms develop, with the preferred method being intramuscular injection 8
• Secondary Treatments – there is no substitute for epinephrine, but other treatments may help manage symptoms.  These may include:
• H1 antihistamines such as cetirizine or diphenhydramine, though the latter may be more sedating.  These may help reduce itching and hives 8
• H2 antihistamines such as ranitidine or famotidine may be used in conjunction with an H1 antihistamine to reduce symptoms 8
• Bronchodilators such as albuterol may help in individuals experiencing bronchospasm 8
• Glucocorticoids have been commonly given, but there is little evidence that these are beneficial 8
• Supportive Treatment:  Focus is to manage airway, breathing and circulation. These may include:
• Positioning to provide circulation to vital organs while ensuring airway is maintained 8
• Supplemental oxygen 8
• Insertion of intravenous catheters which can be used to administer medication and fluids 8
• Monitoring of heart rate, blood pressure, respirations, oxygen level 8
• Maintaining airway, which may require intubation 8
• Cardiopulmonary resuscitation (CPR) when necessary 8

Anaphylaxis Morbidity & Mortality

• Most people report more 2 or more prior episodes of anaphylaxis 10
• 19% report more than 5 episodes 10
• 42% sought treatment within 15 minutes of the onset of symptoms 10
• 34% went to the hospital 10
• 27% treated themselves with antihistamines 10
• 11% self-administered epinephrine 10
• 10% called 911 10
• The fatality rate for an anaphylactic reaction in the United States is about 0.3% 10

School Children & Anaphylaxis

• Approximately 10% of schools reported anaphylactic events in the 2013-2014 school year 12
• 44.9% occurred in high school students 12
• 18.9% occurred in middle school students 12
• 32.5% in elementary school students 12
• 22% of events were in students with no known allergies 12
• Food is the most common trigger (60%) 12
• Unknown trigger in 21.6% of cases 12
• All 50 states permit students to carry and self-administer epinephrine 12
• Many schools provide training on identifying anaphylaxis:
• 37.3% for the school nurse and select staff 12
• 30.4% provided training for all staff 12
• 28.2% for most staff 12
• 2.0% for only the school nurse 12
• Schools often limit who can administer epinephrine:
• 55% school nurse and select trained staff 12
• 21.5% all staff 12
• 15.6% most staff 12
• 3% school nurse only 12

Economic Burden of Anaphylaxis

• The direct costs associated with anaphylaxis are $1.2 billion annually 13
• $294 million for epinephrine alone 13
• Indirect costs associated with anaphylaxis are $609 million annually 13

Includes loss of work productivity 13

References

1. https://www.jacionline.org/article/S0091-6749(11)00128-X/fulltext (3/21/20)
2. https://onlinelibrary.wiley.com/doi/10.1111/all.12437 (3/21/20)
3. https://onlinelibrary.wiley.com/doi/10.1111/all.12272 (3/21/20)
4. https://www.researchgate.net/profile/Alberto_Alvarez-Perea2/publication/281311091_Anaphylaxis_in_AdolescentAdult_Patients_Treated_in_the_Emergency_Department_Differences_Between_Initial_Impressions_and_the_Definitive_Diagnosis/links/564aee2908ae44e7a28e41b0/Anaphylaxis-in-Adolescent-Adult-Patients-Treated-in-the-Emergency-Department-Differences-Between-Initial-Impressions-and-the-Definitive-Diagnosis.pdf (3/21/20)
5. https://www.researchgate.net/profile/Alberto_Alvarez-Perea2/publication/281311091_Anaphylaxis_in_AdolescentAdult_Patients_Treated_in_the_Emergency_Department_Differences_Between_Initial_Impressions_and_the_Definitive_Diagnosis/links/564aee2908ae44e7a28e41b0/Anaphylaxis-in-Adolescent-Adult-Patients-Treated-in-the-Emergency-Department-Differences-Between-Initial-Impressions-and-the-Definitive-Diagnosis.pdf (3/21/20)
6. https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/Insect-hypersensitivity-2011.pdf (3/15/20)
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5446992/ (3/15/20)
8. https://www.uptodate.com/contents/anaphylaxis-emergency-treatment (3/21/20)
9. https://www.ncbi.nlm.nih.gov/pubmed?term=22513951 (3/21/20)
10. https://www.ncbi.nlm.nih.gov/pubmed/24144575 (3/21/20)
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972293/ (3/21/20)
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314730/ (3/21/20)
13. https://www-sciencedirect.com/science/article/pii/S000293431300836X?via%3Dihub#bib6 (3/21/20)