Anaphylaxis deaths have been on the decline in the past 25 years, according to a new retrospective study.

However, while deaths related to food allergy are declining, epinephrine usage is also down. Incorrect administration of the drug may also play a role in allergy mortality, finds the study.

Eighty deaths from anaphylaxis were recorded in Ontario, Canada, between 1986 and 2011. Only one-quarter of these involved an epinephrine shot prior to cardiac arrest. This includes epinephrine shots administered by emergency medical personnel, reports Dr. Ya Sophia Xu from McMaster University in Hamilton, Ontario.

“The low proportion of patients who received epinephrine correctly may indicate that more information is needed by both patients and first responders regarding indications and techniques for administering epinephrine and auto-injectors,” explains Xu.

Low Epinephrine Usage

Of the 80 deaths due to anaphylaxis, 47 had a known allergy to the fatal allergen. Only 18 had been prescribed an epinephrine auto-injector (such as an EpiPen), and only nine were carrying their auto-injector when they experienced the reaction. In at least eight of the 80 cases, the epinephrine was either expired or administered incorrectly.

Dr. Stuart Abramson, head of the American Academy of Allergy Asthma and Immunology scientific program committee, says patient reluctance to administer or receive epinephrine shots may also play a role:

The benefits of epinephrine almost always outweigh the risks, but there’s a reluctance to use it. Patients get palpitations, they might get a headache, their heart rate goes up, but it’s a potentially life-saving treatment.

More than half of the food allergy-related fatalities were caused by food eaten away from the home. “Patients with food allergies should be especially vigilant when eating outside of the home,” Xu noted, adding that “restaurants need to improve the labeling and disclosure of potential allergens to the public.”

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