Anaphylaxis: underdiagnosed, underreported, and undertreated

Am J Med. 2014 Jan;127(1 Suppl):S1-5. doi: 10.1016/j.amjmed.2013.09.007. Epub 2013 Sep 30.


Diagnostic criteria and administrative codes for anaphylaxis have evolved in recent years, partly reflecting the challenges in recognizing anaphylaxis and understanding its symptoms. Before the diagnostic criteria were disseminated by the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network, several studies showed that a substantial proportion of anaphylaxis cases presenting to the emergency department (ED) were not recognized as such. Furthermore, epinephrine, the first-line treatment, was used in fewer than half of cases, especially if anaphylaxis was not diagnosed at the time. Although management practices may have improved since that time, anaphylaxis continues to be underrecognized and undertreated in the US. Of particular concern are findings that the majority of patients who visited the ED for an acute allergic reaction or anaphylaxis were not given a prescription for an epinephrine autoinjector, educated about avoiding the offending allergen, or advised to consult with an allergist. Improvements in the recognition and management of anaphylaxis have the potential to reduce the substantial burden that it currently places on the health care system. The articles in this supplement cover a wide range of issues surrounding anaphylaxis and seek to disseminate information helpful to health care professionals in general and primary care providers in particular.

Keywords: Allergy; Anaphylaxis; Drug utilization; Epidemiology; Epinephrine; Health care costs; Physician practice patterns.

Publication types

  • Introductory Journal Article
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adrenergic Agonists / administration & dosage
  • Anaphylaxis / diagnosis*
  • Anaphylaxis / epidemiology
  • Anaphylaxis / etiology
  • Anaphylaxis / therapy*
  • Bronchodilator Agents / administration & dosage
  • Delayed Diagnosis
  • Drug Hypersensitivity / diagnosis
  • Drug Hypersensitivity / therapy
  • Drug Prescriptions / statistics & numerical data
  • Emergency Service, Hospital
  • Epinephrine / administration & dosage
  • Food Hypersensitivity / diagnosis
  • Food Hypersensitivity / therapy
  • Humans
  • Injections, Intramuscular / instrumentation
  • National Institute of Allergy and Infectious Diseases (U.S.)
  • Patient Education as Topic / statistics & numerical data
  • Referral and Consultation
  • United States / epidemiology


  • Adrenergic Agonists
  • Bronchodilator Agents
  • Epinephrine