Risk Factors for Fatal and Near-Fatal Food Anaphylaxis: Analysis of the Allergy-Vigilance Network Database

Background Gaining a better understanding of the risk factors for severe anaphylaxis represents a crucial challenge for physicians. This survey aimed to analyse cases of severe food anaphylaxis and assess potential risk factors for severity. Methods We retrospectively analysed food anaphylaxis cases recorded by the French-speaking Allergy-Vigilance Network (2002-2021) and compared the main characteristics of grade 3 (Ring classification) and grade 4 cases using univariate and multivariate statistical analyses. Results Of the 2621 food anaphylaxis cases reported, 731 (27.9%) were considered severe (grade 3, n = 687 [94%] and grade 4, n = 44 [6%]; 19 deaths). Overall, 56.1% of cases were adults (mean age: 28.3 years) and 53.7% were male. The most frequent triggers were peanut (13.9%), wheat (9.4%), cashew (5.8%), shrimp (5.3%), and cow's milk (4.6%). More grade 4 anaphylaxis cases occurred in children than in adults (26 vs. 18; p = 0.01). In univariate analysis, individuals with grade 4 anaphylaxis were more likely to have a history of allergy to the culprit food (71.1% vs. 42.1%; p < 0.001), asthma diagnosis (59.5% vs. 30.4%; p < 0.001), and peanut as the culprit food (34.1% vs. 12.6%; p < 0.001). In multivariate analysis, factors predictive of grade 4 anaphylaxis were asthma diagnosis (OR [95% CI]: 3.41 [1.56-7.44]; p = 0.002) and peanut as the culprit trigger (OR [95% CI]: 3.46 [1.28-9.34]; p = 0.014). Conclusions Our data highlight the risk factors for severe food anaphylaxis, notably a history of asthma and peanut as the culprit food. These individuals should benefit from personalised management strategies.