Recent Insights into the Epidemiology and Management of Anaphylaxis

Abstract

Anaphylaxis is a severe, rapidly developing systemic hypersensitivity reaction that can be life-threatening if not promptly identified and treated. Its global incidence is on the rise, especially among children, though fatal outcomes remain uncommon. This review summarizes the current understanding of anaphylaxis, covering its epidemiology, triggers, acute management, and strategies for long-term prevention, with emphasis on cases caused by food, medications, and insect stings. The estimated lifetime prevalence of anaphylaxis ranges from 0.05% to 2%. In children, food is the primary trigger, whereas in adults, medications are the most commonly responsible. The main culprits for food-related anaphylaxis differ by region: in Western countries, peanuts and tree nuts predominate; in East Asia, hen’s eggs and cow’s milk are most frequent; and in Southeast Asia, seafood is the leading cause. Drug-induced anaphylaxis-often the main cause of anaphylaxis-related deaths worldwide-is increasing due to the growing use of chemotherapies and biologic agents. Insect stings cause about 10% of all cases and remain the most common cause of fatal anaphylaxis. Intramuscular adrenaline continues to be the primary treatment, yet its administration is often delayed or insufficiently used. Patients should be prescribed adrenaline autoinjectors following an initial reaction, but availability and usage rates differ widely across countries. Education for patients and caregivers and the creation of clear action plans are essential. New alternatives, such as intranasal and sublingual adrenaline devices, are being developed to improve access and minimize hesitation in treatment. For prevention, VIT is well established and highly effective, preventing systemic reactions in over 90% of cases. Drug desensitization enables safe administration of necessary medications despite confirmed allergies, and this approach is suitable for all ages, including children. Oral immunotherapy for food allergens can increase tolerance levels and lower the chance of accidental exposure in selected patients, though safety concerns limit its widespread use. Biologic therapies like omalizumab present new treatment avenues for patients with multiple food or drug allergies. Recent studies have shown that omalizumab can raise the threshold for reactions to peanuts and other allergens in children. Case reports also indicate it may improve safety during drug desensitization, including for chemotherapy. Ongoing progress in diagnosis, emergency readiness, immunotherapies, and biologics continue to broaden the range of options for managing anaphylaxis. Nonetheless, gaps in access, awareness, and supporting evidence-particularly for children and older adults-underscore the need for additional research and health system investment.