Motosue MS, et al. - This large contemporary cohort study examined risk factors related to severe and near-fatal anaphylaxis. Among study participants, severe anaphylaxis was reported in 11.6% of patients. Notably, significantly higher odds of severe anaphylaxis were found to be related to age of 65 years or older, medication as a trigger and presence of comorbid conditions (specifically cardiac and lung disease).

Methods

• From Medicare Advantage and privately insured enrollees in the United States from 2005 to 2014, administrative claims data was analyzed.
• Severe anaphylaxis was defined as anaphylaxis resulting in hospital or intensive care unit (ICU) admission, requiring endotracheal intubation, or meeting criteria for near-fatal anaphylaxis.

Results

• This study observed overall 38,695 patients admitted to the emergency department for anaphylaxis, of those, 4,431 (11.5%) required hospitalization, 2,057 (5.3%) were admitted to the ICU, 567 (1.5%) required endotracheal intubation, and 174 (0.45%) were classified as having a near-fatal episode.
• It was demonstrated in multivariable analysis that increased odds of severe anaphylaxis requiring any hospital admission, ICU admission, or intubation or being a near-fatal reaction was associated with medication-related anaphylaxis (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.38–1.63; P < .001), age of 65 years or older (OR, 3.15; 95% CI, 2.88–3.44; P < .001), and the presence of cardiac disease (OR, 1.56; 95% CI, 1.50–1.63; P < .001) or lung disease (OR, 1.23; 95% CI, 1.16–1.30; P < .001).