Food, drug, insect sting allergy, and anaphylaxis
Anaphylaxis in the community: Learning from the survivors

https://doi.org/10.1016/j.jaci.2009.03.050Get rights and content

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 H1-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.

Section snippets

Methods

We collected information from persons who had survived anaphylaxis or been responsible for someone who survived anaphylaxis in the community, by using a survey consisting of multiple-choice questions that was e-mailed to visitors to the Center for Anaphylactic Support (www.epipen.com). This Web site provides information about anaphylaxis and epinephrine and has links to other relevant online resources. Participants could opt out at any time. Their responses were anonymous and could not be

Results

In total, 1885 persons participated in the survey. Of these, 500 (27%) were epinephrine users, meaning they had injected epinephrine into themselves or into someone else for whom they were responsible during the anaphylaxis episode. Of the 1885 participants, 1385 (73%) were nonusers, meaning they had not injected epinephrine either into themselves or into a person for whom they were responsible during the episode.

Of the 500 epinephrine users, 428 (86%) completed their 33-question survey in its

Discussion

Most studies of anaphylaxis in the community focus on persons at risk, many of whom have never experienced an anaphylaxis episode. In contrast, this study focuses on the experiences of more than 1800 self-selected participants who reported that they or someone for whom they were responsible had survived anaphylaxis in a community setting. The study design does not provide a true denominator to assess the potential magnitude of the selection bias19; however, we know that participants had access

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    Disclosure of potential conflict of interest: F. E. R. Simons has received research grants from the Canadian Institutes of Health Research and is on advisory boards for Dey, Intelliject, ALK-Abelló, and Sciele. S. Clark has received consulting fees from Dey Pharmaceuticals and Partners Healthcare/Massachusetts General Hospital. C. A. Camargo, Jr has served as a consultant for and received research support from Dey Pharmaceuticals.

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