Incidence of and Risk Factors for Chemotherapy-Induced Anaphylaxis Agents in the United States

The incidence of chemotherapy-induced anaphylaxis (CIA) is unknown. The objective of this study is to analyze the incidence of CIA in the United States; and to compare patient characteristics and risk factors. Using the Nationwide Inpatient Sample from 2005 through 2014, we identified cases of chemotherapy administration using the clinical classification software code 224. Anaphylaxis was identified using the ICD-9 CM code 995.0 (other anaphylactic reaction) or the combination of one of the following: 995.3 (allergy, unspecified) or 995.2 (adverse drug effect), or E930-E949 with a code for acute respiratory compromise (519.11 or 786.1) or hypotension (458.9). Among 336,610 patients, there were 209 (0.06%) patients with CIA with a mortality of 1.9%. The mean age was 40 (±9.13); 52.6% were female and 69.4% were white. Univariate analysis revealed that age <18 year old (OR 1.65; 95%; CI 1.30-2.08; P<.001), female sex (OR, 1.36; 95% CI, 1.03-1.78; P = .028), and chronic pulmonary disease (OR, 1.53; 95% CI, 1.02-2.31; P = .041) showed increased odds of anaphylaxis. Compared to controls, CIA patients had a higher median hospital cost ($38,226 versus $25,344; P <.0001) while length of stay was not significantly affected. The incidence of chemotherapy-induced anaphylaxis is 1 in 1,610 with a mortality of 2%. Patients age <18 years old and women are at increased risk for chemotherapy-induced anaphylaxis. Patients with CIA also have higher cost of hospitalization compared to controls. To the extent of our knowledge this is the first study to report the incidence of CIA in the US.