Mullins R J, Wainstein B K, Barnes E H, Liew W K, Campbell D E
John James Medical Centre, Deakin, ACT, Australia.
Medical School, Australian National University, Canberra, ACT, Australia.
Clin Exp Allergy. 2016 Aug;46(8):1099-110. doi: 10.1111/cea.12748. Epub 2016 May 31.
Recent epidemiological studies indicate increases in Australian, UK and US hospital anaphylaxis admission rates.
The aim of this study was to determine whether Australian anaphylaxis fatalities are increasing in parallel and to examine the characteristics of fatalities recorded in the National Coronial Information System (NCIS).
Time trends in Australian anaphylaxis fatalities were examined using data derived from the Australian Bureau of Statistics (ABS) 1997-2013 and the NCIS 2000-2013, the latter providing additional information to verify cause and identify risk factors.
The ABS recorded 324 anaphylaxis fatalities by cause: unspecified (n = 205); medication (n = 52); insect stings/tick bites (n = 41); food (n = 23); and blood products (n = 3). From 1997 to 2013, all-cause fatal anaphylaxis rates increased by 6.2%/year (95% CI: 3.8-8.6%, P < 0.0001) or from 0.054% to 0.099/10(5) population. Fatal food anaphylaxis increased by 9.7%/year (95% CI: 0.25-20%, P = 0.04) and unspecified anaphylaxis deaths by 7.8% (95% CI: 4.6-11.0, P < 0.0001). There was an insignificant change in medication-related fatalities (5.6% increase/year; 95% CI: 0.3% decrease to 11.8% increase, P = 0.06), and sting/bite fatalities remained unchanged. Hospital anaphylaxis admission rates for all-cause, food, unspecified and medication anaphylaxis increased at rates of 8%, 10%, 4.4% and 6.8%/year, respectively. A total of 147 verified NCIS deaths were examined in detail: medication- and sting/bite-related fatalities occurred predominantly in older individuals with multiple comorbidities. Upright posture after anaphylaxis was associated with risk of sudden death (all causes). Seafood (not nuts) was the most common trigger for food-related anaphylaxis deaths.
Australian anaphylaxis fatality rates (most causes) have increased over the last 16 years, contrasting with UK- and US-based studies that describe overall lower and static overall anaphylaxis fatality rates (0.047-0.069/10(5) population).
近期的流行病学研究表明，澳大利亚、英国和美国医院过敏反应的入院率有所上升。
本研究旨在确定澳大利亚过敏反应死亡人数是否也在相应增加，并研究国家死因信息系统（NCIS）中记录的死亡病例特征。
利用澳大利亚统计局（ABS）1997 - 2013年的数据以及NCIS 2000 - 2013年的数据，研究澳大利亚过敏反应死亡人数的时间趋势，后者提供了额外信息以核实死因并识别风险因素。
ABS按病因记录了324例过敏反应死亡病例：未明确病因（n = 205）；药物（n = 52）；昆虫叮咬/蜱虫叮咬（n = 41）；食物（n = 23）；血液制品（n = 3）。1997年至2013年，全因过敏反应死亡率每年上升6.2%（95%置信区间：3.8 - 8.6%，P < 0.0001），即从每10万人口0.054%升至0.099%。食物过敏反应死亡率每年上升9.7%（95%置信区间：0.25 - 20%，P = 0.04），未明确病因的过敏反应死亡人数上升7.8%（95%置信区间：4.6 - 11.0，P < 0.0001）。药物相关死亡率变化不显著（每年上升5.6%；95%置信区间：下降0.3%至上升11.8%，P = 0.06），叮咬相关死亡率保持不变。全因、食物、未明确病因和药物过敏反应的医院入院率分别以每年8%、10%、4.4%和6.8%的速度上升。对NCIS中147例经核实的死亡病例进行了详细检查：药物和叮咬相关死亡主要发生在患有多种合并症的老年人中。过敏反应后的直立姿势与猝死风险（所有病因）相关。海鲜（而非坚果）是食物相关过敏反应死亡最常见的诱因。
在过去16年中，澳大利亚过敏反应死亡率（大多数病因）有所上升，这与英国和美国的研究结果形成对比，后者描述的总体过敏反应死亡率较低且保持稳定（每10万人口0.047 - 0.069%）。
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