The most common triggers of fatal allergic reactions, also known as anaphylaxis, are wasp and bee venoms, legumes (pulses), animal proteins, and some analgesics.
The incidence of anaphylaxis is age-dependent. In the current issue of Deutsches Ärzteblatt International, Margitta Worm (Berlin) and her co-authors describe the causes and treatment methods for anaphylaxis, based on data from the anaphylaxis registry of the German-speaking countries (Dtsch Arztebl Int 2014; 111: 367).
Worm and co-authors analyzed the data from the registry, which covers Germany, Austria, and Switzerland, for information on triggers, symptoms, and treatment from 2006 to 2013; they also evaluated data recorded from ADAC air rescue callouts in 2010 and 2011.
A total of 4141 persons were affected by anaphylaxis (52.5% female, 47.5% male), 3168 adults and 973 children. Among children, boys were affected more often than girls (640 boys), whereas among adults, women were the more often affected. Most cases (85%) were classified as severity grade II or III. Grade IV reactions, which are very severe, were less frequently reported: 3% of adult cases and 0.9% of pediatric cases. Among children, foods were the most frequent triggers of allergic reactions; among adults, the most frequent triggers were insect venoms. Of these, wasp stings were reported most often (70%), bee stings more rarely (20%).Analysis of medical emergency cases showed that epinephrine was used to treat only 14.5% of patients in the anaphylaxis registry with grade III reactions and 43.9% of those with grade IV reactions. Of the patients who had to be treated by air rescue personnel, 19% and 78% respectively received epinephrine. Epinephrine was not used often enough, even though it is recommended in the treatment guidelines for reactions from grade II upward.