Risk factors for severe anaphylaxis in patients receiving anaphylaxis treatment in US emergency departments and hospitals

J Allergy Clin Immunol. 2014 Nov;134(5):1125-30. doi: 10.1016/j.jaci.2014.05.018. Epub 2014 Jun 27.


Background: Although reported risk factors for severe anaphylaxis include older age, presence of comorbid medical conditions, and concomitant medications, previous studies have used varying definitions for anaphylaxis and heterogeneous methodology.

Objective: To describe risk factors for severe anaphylaxis among US patients treated in emergency departments (EDs) or hospitals for anaphylaxis.

Methods: Individuals with an ED visit/hospitalization for anaphylaxis were identified from 2 MarketScan Research Databases using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. Eligibility for the current study required continuous medical and prescription coverage for at least 1 year before and after the index date. Severe anaphylaxis was defined as a reaction requiring hospital admission.

Results: Among 11,972 individuals, 2,622 (22%) had severe anaphylaxis. Unadjusted analysis showed that severe anaphylaxis was associated with older age and higher comorbidity burden. These patients were also less likely to have filled an epinephrine autoinjector (EAI) prescription or visited an allergist/immunologist, but more likely to have had an ED visit/hospitalization (any cause). On multivariable analysis, filling an EAI prescription (odds ratio [OR], 0.64; 95% CI, 0.53-0.78) or visiting an allergist/immunologist (OR, 0.78; 95% CI, 0.63-0.95) before the index event was associated with a lower risk of severe anaphylaxis, while any previous ED visit (OR, 1.18; 95% CI, 1.07-1.30) or hospitalization (OR, 1.55; 95% CI, 1.36-1.75) was associated with a higher risk of severe anaphylaxis.

Conclusions: In this large cohort with an ED visit or hospitalization for anaphylaxis, 22% had severe anaphylaxis. Pre-index preventive anaphylaxis care (ie, EAI prescription fill and allergist/immunologist visit) was associated with a significantly lower risk, supporting the benefits of preventive anaphylaxis care in real-world practice.

Keywords: Anaphylaxis; emergency department; hospitalization; severity.

MeSH terms

  • Adult
  • Age Factors
  • Anaphylaxis / epidemiology*
  • Anaphylaxis / prevention & control*
  • Bronchodilator Agents / administration & dosage*
  • Databases, Factual
  • Emergency Medical Services*
  • Emergency Service, Hospital*
  • Epinephrine / administration & dosage*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Self Administration
  • Severity of Illness Index
  • United States / epidemiology


  • Bronchodilator Agents
  • Epinephrine