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Immunol Allergy Clin North Am. 2015 May;35(2):375-86. doi: 10.1016/j.iac.2015.01.001. Epub 2015 Feb 27.

Fatal and near-fatal anaphylaxis: factors that can worsen or contribute to fatal outcomes.

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Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street, #1000, Chicago, IL 60611, USA. Electronic address:


Anaphylaxis implies a risk of death even in patients whose prior episodes have been considered mild and managed easily. Anaphylaxis occurs in all age groups, from infants to the elderly, but most deaths occur in adults. Factors or circumstances associated with near-fatal or fatal anaphylaxis are reviewed from the following 10 perspectives: accidents and mishaps, adulterated products, age, allergens, atopy, comorbidities, Munchausen syndrome or contrived anaphylaxis, patient factors, route of administration, and treatment-related issues. There are no absolute contraindications to self-injectable epinephrine, and epinephrine can be administered for anaphylaxis to elderly patients or to those patients receiving beta-adrenergic blockers.


Allergy; Anaphylaxis; Cardiovascular; Fatalities; Histamine; Leukotriene; Prostaglandin

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