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Increases in Anaphylaxis Among Children, Adolescents Require Targeted Prevention Strategies
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Key Takeaways
- Anaphylaxis prevalence is rising, with children and adolescents most affected; females show increased rates post-2014.
- Key risk factors for recurrence include neighborhood deprivation, comorbidities, and male gender, with adults at higher risk than children.
Prevalence increased across all subgroups among children and adolescents, with decreases observed in young adults and elderly populations.
In an investigation of national trends in anaphylaxis prevalence across ages and subgroups of sex and age, key risk factors for recurrent anaphylaxis included neighborhood deprivation status and the presence of comorbidities, with the highest prevalence found among children and adolescents, according to the authors of study results published in the World Allergy Organization Journal.1
Image Credit: © Марина Терехова | stock.adobe.com
Anaphylaxis, often triggered by foods, medications, and venom, has a low prevalence but remains a potentially life-threatening allergic reaction and a major burden for families and individuals dealing with the condition. Due to its low prevalence, population-based epidemiological research is essential for an accurate determination of who is affected nationwide.2
Recurrent anaphylaxis represents a particularly major health burden, with the mechanisms behind recurrence not fully understood. Previous reviews have highlighted the broad spectrum of risk factors that may be behind recurrent anaphylaxis, including the role of comorbidities and age-related variations. Studies have also demonstrated the role of socioeconomic position in the development of allergies and asthma, which oftentimes cannot be controlled by an individual.1,3
The current trial authors sought to address these gaps in research by investigating the epidemiology of anaphylaxis among individuals of all ages from 2002 to 2019, with an emphasis on the risk factors commonly associated with recurrence. Factors examined included comorbid conditions and socioeconomic deprivation status, with a definition in which a patient had to meet at least 1 of 3 conditions associated with their anaphylaxis.1
Among a cohort of 1,137,861 individuals, 37,012 (3.25%) were diagnosed with anaphylaxis, with an approximately equal distribution of sex among the participants. Of those diagnosed, 21.7% had atopic dermatitis, 30.2% had allergic rhinitis, and 19.5% has asthma, with varying levels of comorbid conditions.1
Across all age groups, the study authors observed a gradual increase in the prevalence of anaphylaxis from 2002 to 2019, with the highest incidences observed in 2016 and 2017. A surge of age-adjusted prevalence was seen from 2002 to 2006, followed by a moderate rise until 2013 and a stabilization thereafter. Until 2014, males and females demonstrated similar rates of anaphylaxis; from that point, females exhibited a rising trend, while male prevalence decreased. Importantly, adolescents and children consistently showed the highest prevalence of anaphylaxis, followed by middle-aged adults, young adults, and elderly patients, according to the investigators.1
Recurring episodes of anaphylaxis were experienced by 5783 individuals (15.6%). Overall, males had a higher risk of recurrence when compared with females (adjusted hazard ratio [aHR], 1.08; 95% CI, 1.04-1.13). Adults demonstrated a 1.2 to 1.5 times higher risk of recurrence than children and adolescents, according to the investigators. In an interesting trend, those living in areas with intermediate (aHR, 1.14; 95% CI, 1.08–1.20) and high (aHR, 1.38; 95% CI, 1.30–1.46) neighborhood deprivation scores had a much higher risk of recurrent anaphylaxis, compared with those with low scores.1
The presence of comorbidities such as atopic dermatitis, allergic rhinitis, and asthma were associated with a higher risk of anaphylaxis recurrence; these findings were consistent when the investigators considered death as a competing risk.1
This trial had a major strength, in that its 18-year-long analysis provided a comprehensive data set of anaphylaxis prevalence across all age groups. Accordingly, this trial was deemed by the study authors as the longest study duration of epidemiological research on anaphylaxis since the 2000s, especially considering the research covers all age groups.1
“Early recognition and diagnosis of anaphylaxis, along with proper education on its management at the time of the initial event, are crucial to reduce the disease burden, especially in areas of high neighborhood deprivation,” the investigators wrote.1
