Jerschow Elina, Lin Robert Y, Scaperotti Moira M, McGinn Aileen P
Department of Medicine, Allergy/Immunology Division, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
Department of Medicine, Weill-Cornell Medical College, New York, NY.
J Allergy Clin Immunol. 2014 Dec;134(6):1318-1328.e7. doi: 10.1016/j.jaci.2014.08.018. Epub 2014 Sep 30.
Anaphylaxis-related deaths in the United States have not been well characterized in recent years.
We sought to define epidemiologic features and time trends of fatal anaphylaxis in the United States from 1999 to 2010.
Anaphylaxis-related deaths were identified by using the 10th clinical modification of the International Classification of Diseases system diagnostic codes on death certificates from the US National Mortality Database. Rates were calculated by using census population estimates.
There were a total of 2458 anaphylaxis-related deaths in the United States from 1999 to 2010. Medications were the most common cause (58.8%), followed by "unspecified" (19.3%), venom (15.2%), and food (6.7%). There was a significant increase in fatal drug-induced anaphylaxis over 12 years: from 0.27 (95% CI, 0.23-0.30) per million in 1999 to 2001 to 0.51 (95% CI, 0.47-0.56) per million in 2008 to 2010 (P < .001). Fatal anaphylaxis caused by medications, food, and unspecified allergens was significantly associated with African American race and older age (P < .001). Fatal anaphylaxis to venom was significantly associated with white race, older age, and male sex (P < .001). The rates of fatal anaphylaxis to foods in male African American subjects increased from 0.06 (95% CI, 0.01-0.17) per million in 1999 to 2001 to 0.21 (95% CI, 0.11-0.37) per million in 2008 to 2010 (P < .001). The rates of unspecified fatal anaphylaxis decreased over time from 0.30 (95% CI, 0.26-0.34) per million in 1999 to 2001 to 0.09 (95% CI, 0.07-0.11) per million in 2008 to 2010 (P < .001).
There are strong and disparate associations between race and specific classes of anaphylaxis-related mortality in the United States. The increase in medication-related deaths caused by anaphylaxis likely relates to increased medication and radiocontrast use, enhanced diagnosis, and coding changes.
近年来，美国与过敏反应相关的死亡情况尚未得到充分描述。
我们试图确定1999年至2010年美国致命性过敏反应的流行病学特征和时间趋势。
通过使用美国国家死亡率数据库死亡证明上国际疾病分类系统第10版临床修订版的诊断代码来识别与过敏反应相关的死亡。发病率采用人口普查人口估计数计算。
1999年至2010年美国共有2458例与过敏反应相关的死亡。药物是最常见的原因（58.8%），其次是“未明确说明的”（19.3%）、毒液（15.2%）和食物（6.7%）。在12年期间，致命性药物引起的过敏反应显著增加：从1999年至2001年的每百万人口0.27例（95%可信区间，0.23 - 0.30）增至2008年至2010年的每百万人口0.51例（95%可信区间，0.47 - 0.56）（P <.001）。由药物、食物和未明确说明的过敏原引起的致命性过敏反应与非裔美国人种族和老年显著相关（P <.001）。对毒液的致命性过敏反应与白人种族、老年和男性显著相关（P <.001）。非裔美国男性受试者中食物引起的致命性过敏反应发病率从1999年至2001年的每百万人口0.06例（95%可信区间，0.01 - 0.17）增至2008年至2010年的每百万人口0.21例（95%可信区间，0.11 - 0.37）（P <.001）。未明确说明的致命性过敏反应发病率随时间从1999年至2001年的每百万人口0.30例（95%可信区间，0.26 - 0.34）降至2008年至2010年的每百万人口0.09例（95%可信区间，0.07 - 0.11）（P <.001）。
在美国，种族与特定类型的过敏反应相关死亡率之间存在强烈且不同的关联。过敏反应导致的药物相关死亡增加可能与药物和放射造影剂使用增加、诊断改善以及编码变化有关。
