Original Articles: Systemic Allergic Disorders
Increasing anaphylaxis hospitalizations in the first 2 decades of life: New York State, 1990–2006

https://doi.org/10.1016/S1081-1206(10)60315-8Get rights and content

Background

Although an increase in the occurrence of anaphylaxis has been reported in several parts of the world, this phenomenon has not been described in the United States.

Objective

To characterize anaphylaxis hospitalizations in New York State in patients younger than 20 years.

Methods

Using a statewide administrative database, hospital admissions of patients with an allergic disease (anaphylaxis, angioedema, urticaria, and allergy unspecified) as the primary diagnosis were analyzed from 1990 through 2006 in New York State. Admission rates were calculated for the allergic disease groups, as were hospitalization characteristics. Statistical modeling and group comparisons were performed with the use of negative binomial distribution analysis.

Results

For patients younger than 20 years, the anaphylaxis hospitalization rate increased by more than 4-fold during the study period and by 2002 exceeded the combined hospitalization rates for urticaria, angioedema, and unspecified allergy. After the widespread adoption of food anaphylaxis codes in 1994, food anaphylaxis predominated hospitalizations for anaphylaxis. Peanut was the most common food allergen in food anaphylaxis admissions. The anaphylaxis hospitalization rate for males was significantly greater than that of females (risk ratio, 1.45; 95% confidence interval, 1.26-1.66). Blacks were not disproportionately hospitalized for anaphylaxis. An overall bimodal age distribution showed peaks in the very young and in teens.

Conclusion

These data demonstrate that in a populous Northeastern state in the United States, anaphylaxis requiring hospitalization is increasing in the age group younger than 20 years.

Section snippets

INTRODUCTION

Anaphylaxis is a potentially life-threatening allergic condition that often results in hospital and/or emergency department admissions. Although an epidemic of asthma manifested with significant increases in hospitalization rates in several countries1, 2 toward the end of the 20th century, less is known about trends in other allergic conditions such as anaphylaxis. Allergic disorders are thought to have increased in civilized countries in part because of conditions that favor the generation of T

General Aspects

There were 1,972 hospitalizations with a principal diagnosis of anaphylaxis for patients younger than 20 years during the study period (Table 1). The next most common allergic disease admission category was urticaria, followed by angioedema. The median age for anaphylaxis was 11 years, which was older than the mean age for the other allergic disease groups. The overall distribution of admission age in the anaphylaxis groups showed peaks in the very young and in teens (Fig 1). A diagnosis of

DISCUSSION

This study demonstrates that severe anaphylaxis in younger people is increasing in a populous state in the United States. This pattern of increasing rates of anaphylaxis is similar to that reported in Australia from 1994 through 20058 and in the United Kingdom from 1990 through 2004.9 In the Australian report, anaphylaxis admission rates were highest for the youngest age category, and food anaphylaxis admissions in younger people increased at a greater rate than anaphylaxis not related to food.

ACKNOWLEDGMENTS

Shaili N. Shah and Farzana Nurruzzaman were supported by the New York Medical College intramural medical student preceptorship program. We are grateful for the assistance of Dr Ariel D. Teitel.

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    Disclosures: Authors have nothing to disclose.

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