Fatal anaphylaxis in Italy: Analysis of cause-of-death national data, 2004-2016
- 1 October 2020
- Vol. 75 (10), 2644-2652
- https://doi.org/10.1111/all.14352
Abstract
Background Epidemiological data on fatal anaphylaxis are underestimated worldwide. Few Italian data do exist. The aims of the study are to determine the anaphylaxis mortality rate in Italy and its associations with demographic characteristics (gender, age, and geographical distribution), and to investigate which are the most common triggers of fatal anaphylaxis. Material and methods This is a descriptive study analyzing data reported to the National Register of Causes of Death database and managed by the Italian National Institute of Statistics for the years 2004-2016. An analytical method was developed to identify all the ICD-10 codes related to anaphylaxis deaths, which were divided into two classes: "Definite anaphylaxis deaths" and "Possible anaphylaxis deaths." Results From 2004 through 2016, 392 definite anaphylaxis deaths and 220 possible anaphylaxis deaths were recorded. The average mortality rate for definite anaphylaxis, from 2004 to 2016, was 0.51 per million population per year. Definite fatal anaphylaxis was mostly due to the use of medications (73.7%), followed by unspecified causes (20.7%) and hymenoptera stings (5.6%). Concerning possible anaphylaxis deaths, the most common cause was venom-stinging insect (51.4%). We did not find any data on food fatal anaphylaxis. Unspecified anaphylaxis accounted for 21%-28% of all cases, underlining the difficulty in accurately ascertaining the causes of fatal anaphylaxis and therefore in assigning the proper ICD-10 code. Conclusion This is the first study of anaphylaxis-related mortality coming from an official database of the whole Italian population. However, the actual number of deaths by anaphylaxis, and their related triggers, is probably underreported, mostly due to limitations of the current recording system, and to a poor allergy education. Corrective actions should be undertaken for the benefit of the Health System.This publication has 23 references indexed in Scilit:
- Constructing a classification of hypersensitivity/allergic diseases for ICD-11 by crowdsourcing the allergist communityAllergy, 2015
- Mapping hypersensitivity/allergic diseases in the International Classification of Diseases (ICD)‐11: cross‐linking terms and unmet needsClinical and Translational Allergy, 2015
- Increase in anaphylaxis-related hospitalizations but no increase in fatalities: An analysis of United Kingdom national anaphylaxis data, 1992-2012Journal of Allergy and Clinical Immunology, 2014
- Fatal anaphylaxis in the United States, 1999-2010: Temporal patterns and demographic associationsJournal of Allergy and Clinical Immunology, 2014
- Anaphylaxis: guidelines from the European Academy of Allergy and Clinical ImmunologyAllergy, 2014
- Case fatality and population mortality associated with anaphylaxis in the United StatesJournal of Allergy and Clinical Immunology, 2013
- Undernotification of anaphylaxis deaths in Brazil due to difficult coding under the ICD‐10Allergy, 2012
- World Allergy Organization anaphylaxis guidelines: SummaryJournal of Allergy and Clinical Immunology, 2011
- Epidemiology of insect-venom anaphylaxisCurrent Opinion in Allergy and Clinical Immunology, 2008
- Fatal asthma or anaphylaxis?Emergency Medicine Journal, 2002