Letal and preletal food-induced anaphylaxis: The Allergy-Vigilance® network data (2002-2020)

Hospital admissions for food-induced anaphylaxis are increasing in most countries but mortality remains stable. Objective. - Analyze retrospectively cases of letal/preletal food-induced anaphylaxis (grade 4 among Ring and Messmer classification) recorded by the Allergy-Vigilance (R) network (2002-2020) and assess factors associated with survival. Results. - Forty-two patients (male sex : 57%) of 2475 food anaphylaxis (1.7%) were recorded as grade 4 [mean age: 22.2 y (CI: 19.3) ; age < 18y: 60%] and 19 (45%) died. Twenty-one (50%) had a history of asthma, 33 (79%) of food allergy [21% (50%) with the same index food allergen] and 13 (31%) of previous anaphylaxis. The most frequent allergens were: peanut (33%), milks (19%), shrimp (7%), hazelnut and wheat (5%, respectively). Food allergen was uncertain in 10%. Clinical symptoms were bronchospasm in 26 (62%) of cases and laryngeal oedema in 6 (14%). A cofactor was identified in 16 (38%) cases, mostly physical exercise (21%) and alcohol (14%). Allergic reaction occurred at home (26%), at school or in a restaurant (10%, each). No factor associated with survival was identified. Children were more likely to have a history of asthma (64% versus 29%, A= 0.01) and less cofactors (20% versus 65%, P = 0.02) than adults. Conclusions. - These data highlight on the high frequency of preletal anaphylaxis cases that are underestimated in epidemiological studies and also on the importance of risk factors (asthma, milks-peanut allergy) and cofactors in adults. It is necessary to better phenotype patients with a high risk of severe anaphylaxis and select those who will benefit a personalized approach (immunotherapy, biologicals). (C) 2021 Elsevier Masson SAS. All rights reserved.