Comorbidities Frequent in Cases of Fatal Anaphylaxis

A new study reports that the time between exposure and onset of severe symptoms in cases of fatal anaphylaxis is usually less than 30 minutes, and that comorbidities are frequent in such cases.

Researchers at the Northwestern University Feinberg School of Medicine (Chicago, IL, USA) conducted a retrospective case review and examined the causes of death, anatomical findings, and comorbid diseases in 25 episodes of fatal anaphylaxis. Each case report included details on the fatal reaction, a medical record review, and findings from laboratory and autopsy reports. Serum tryptase levels were measured in seven cases. Of the 25 cases of anaphylactic deaths, seven were reactions to medications; six were from radiocontrast media, six from Hymenoptera stings, and four from food. The remaining two cases possibly resulted from reactions to insect repellent and hair coloring products.

The anaphylactic reaction began within 30 minutes of allergen exposure in 21 cases. Thirteen of the cases died within 60 minutes. Four patients died between 1 and 6 hours after exposure, and four died between 24 and 96 hours after exposure. The time was unknown in four patients. Autopsies were performed in 23 cases. Of these, specific anatomical findings consistent with anaphylaxis were present in 18 cases. Of the seven patients in whom serum total tryptase was analyzed, four had markedly elevated levels. Overall, 22 patients (88%) had at least one comorbid condition identified pathologically at the time of death. The study was published in the March 2007 issue of the Annals of Allergy, Asthma, and Immunology.

"Patients who have experienced and survived an episode [of anaphylaxis] should try to identify the cause so that preventive measures...can be carried out,” said lead author Dr. Paul A. Greenberger. "Patients should be taught how and when to self-administer epinephrine if another episode of anaphylaxis begins.”


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Northwestern University Feinberg School of Medicine