Anaphylaxis in the community: learning from the survivors

J Allergy Clin Immunol. 2009 Aug;124(2):301-6. doi: 10.1016/j.jaci.2009.03.050. Epub 2009 Jun 21.


Background: Most studies of anaphylaxis in the community focus on persons at risk who might, or might not, have experienced anaphylaxis.

Objective: We sought to focus on survivors of anaphylaxis in the community and their experiences in using, or not using, an epinephrine autoinjector for first-aid treatment.

Methods: An e-mail survey was conducted. Responses were anonymous and could not be traced to any person or location. Anaphylaxis was defined as the most severe sudden-onset allergic reaction ever experienced by the participants or a person for whom they were responsible (eg, a child). There were 17 core multiple-choice questions for all participants, with 16 additional questions for users who injected epinephrine either into themselves or someone else, and 1 additional question for nonusers.

Results: Of the 1885 participants, 500 (27%) were epinephrine users, and 1385 (73%) were nonusers. The groups were similar with regard to multisystem organ involvement (82% vs 78%, P = .07) and many other aspects of anaphylaxis; however, epinephrine users were more likely (all P < .05) to report respiratory or shock symptoms; to report peanut, fish, or insect sting triggers; to be asthmatic; and to have taken or been given asthma medication on the day of the episode. Epinephrine users reported problems in deciding whether to give the injection, repeat the dose, and/or go to an emergency department. Nonusers reported not injecting epinephrine for various reasons, including use of an H(1)-antihistamine (38%), no prescription for epinephrine (28%), and/or a mild anaphylaxis episode (13%).

Conclusions: In a unique population composed of 1885 survivors of anaphylaxis in the community, users of epinephrine autoinjectors for first-aid treatment were outnumbered by nonusers. The insights reported by epinephrine users and the reasons why nonusers did not inject epinephrine are documented.

MeSH terms

  • Adolescent
  • Adrenergic Agonists / administration & dosage
  • Adrenergic Agonists / adverse effects
  • Adrenergic Agonists / therapeutic use*
  • Adult
  • Aged
  • Allergens / immunology
  • Anaphylaxis / drug therapy*
  • Anaphylaxis / mortality*
  • Child
  • Child, Preschool
  • Epinephrine / administration & dosage
  • Epinephrine / adverse effects
  • Epinephrine / therapeutic use*
  • Humans
  • Infant
  • Middle Aged
  • Surveys and Questionnaires
  • United States / epidemiology
  • Young Adult


  • Adrenergic Agonists
  • Allergens
  • Epinephrine