Risk factors for severe food anaphylaxis: Data from the Allergy-Vigilance Network

Abstract

Prérequis/Contexte

Having a better understanding of the risk factors of severe anaphylaxis is a crucial challenge for physicians.

Objectifs

This survey aimed to analyze food anaphylaxis cases and assess potential risk factors for severity.

Méthodes

We retrospectively analyzed severe food anaphylaxis cases recorded by the Allergy-Vigilance Network (2002–2021) and compared the main characteristics of grade 3 (Ring classification) to grade 4 cases to identify risk factors for severity using univariate/multivariate statistical analyses.

Résultats/Discussions

Of the 2621 food anaphylaxis cases, 731 (27.9%) were considered as severe (grade 3, n = 687 [94%] and grade 4, n = 44 [6%]), 56.1% were adults (mean age: 28.3 y [SD: 21.8]) and 53.7% were male. 19 deaths have been reported. In all, the most frequent triggers were peanut (13.9%), wheat (9.4%), cashew (5.8%), shrimp (5.3%) and cow's milk (4.6%). There were more grade 4 anaphylaxis cases in children than in adults (n = 26 versus n = 18, P = 0.01). In the univariate statistical analysis, individuals with a grade 4 anaphylaxis had more likely a history of allergy to the culprit food (71.1% versus 42.1%, P ˂ 0.001), a history of asthma (59.5% versus 30.4%, P ˂ 0.001), a peanut-induced anaphylaxis (34.1% versus 12.6%, P ˂ 0.001). In the multivariate analysis, individual with a grade 4 anaphylaxis had more likely a history of asthma (OR [95%CI]: 5.46 [2.02–14.73], P ˂ 0.001), peanut and cow's milk as culprit food triggers (OR: 4.94 [1.50–16.23], P = 0.009; OR: 6.44 [1.20–34.56], P = 0.03; respectively), convulsions as clinical anaphylaxis manifestation (OR: 24.81 [2.21–278.75], P = 0.009). Hives as clinical manifestation were more likely observed in individuals with a grade 3 anaphylaxis compared to grade 4 (OR: 0.18 [0.06–0.59], P = 0.004).

Conclusion

Our data highlight risk factors for severe food anaphylaxis including a history of asthma, peanut and cow's milk as anaphylaxis triggers. These individuals should benefit personalized management strategies.