Food, drug, insect sting allergy, and anaphylaxis
Anaphylaxis in America: The prevalence and characteristics of anaphylaxis in the United States

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Background

Although anaphylaxis is recognized as an important life-threatening condition, data are limited regarding its prevalence and characteristics in the general population.

Objective

We sought to estimate the lifetime prevalence and overall characteristics of anaphylaxis.

Methods

Two nationwide, cross-sectional random-digit-dial surveys were conducted. The public survey included unselected adults, whereas the patient survey captured information from household members reporting a prior reaction to medications, foods, insect stings, or latex and idiopathic reactions in the previous 10 years. In both surveys standardized questionnaires queried anaphylaxis symptoms, treatments, knowledge, and behaviors.

Results

The public survey included 1,000 adults, of whom 7.7% (95% CI, 5.7% to 9.7%) reported a prior anaphylactic reaction. Using increasingly stringent criteria, we estimate that 5.1% (95% CI, 3.4% to 6.8%) and 1.6% (95% CI, 0.8% to 2.4%) had probable and very likely anaphylaxis, respectively. The patient survey included 1,059 respondents, of whom 344 reported a history of anaphylaxis. The most common triggers reported were medications (34%), foods (31%), and insect stings (20%). Forty-two percent sought treatment within 15 minutes of onset, 34% went to the hospital, 27% self-treated with antihistamines, 10% called 911, 11% self-administered epinephrine, and 6.4% received no treatment. Although most respondents with anaphylaxis reported 2 or more prior episodes (19% reporting ≥5 episodes), 52% had never received a self-injectable epinephrine prescription, and 60% did not currently have epinephrine available.

Conclusions

The prevalence of anaphylaxis in the general population is at least 1.6% and probably higher. Patients do not appear adequately equipped to deal with future episodes, indicating the need for public health initiatives to improve anaphylaxis recognition and treatment.

Section snippets

Methods

Two independent, nationwide, cross-sectional random-digit-dial (RDD) landline telephone surveys were conducted between July and November 2011 by using screening questions and standardized questionnaires, including demographic data and detailed information regarding anaphylaxis symptoms, treatments, knowledge, awareness, perceptions, behaviors, and quality of life (see Supplemental documents 1 and 2 in this article's Online Repository at www.jacionline.org). The study and survey instruments were

Public survey

Overall characteristics of the 1,000 respondents are presented in Table I, Table II. The median respondent age was 45 years, 93% were high school graduates, and 38% had a 4-year college degree or greater. Of note, 8.6% of respondents who had visited the emergency department in the past 12 months (1.9% of the total surveyed population) did so for allergy-related reasons (which could include environmental allergens), and 5.6% of those hospitalized in the past 12 months (0.7% of the total

Discussion

We performed 2 national RDD surveys to evaluate the prevalence and characteristics of anaphylaxis in the United States. In the public survey we sought to estimate the prevalence of anaphylaxis in subjects 18 years of age and older. Remarkably, 7.7% of respondents reported a history of anaphylaxis. By using increasingly stringent criteria, 5.1% were deemed to have a probable history of anaphylaxis, and 1.6% were deemed to have a very likely history of anaphylaxis. This final case definition

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  • Cited by (0)

    Supported by the Asthma and Allergy Foundation of America.

    Disclosure of potential conflict of interest: R. A. Wood has consultant arrangements with the Asthma and Allergy Foundation of America, is employed by Johns Hopkins University, and has grants/grants pending with the National Institutes of Health (NIH) and receives royalties from UpToDate. C. A. Camargo has received consulting fees or honoraria from the Asthma and Allergy Foundation of America, is a board member for Dey/Mylan and Sanofi-Aventis, and has grants/grants pending with Sanofi-Aventis. P. Lieberman has received consulting fees or honoraria from the Asthma and Allergy Foundation of America, Mylan, Sanofi, and Meda; has received support for travel to meetings for study or other purposes from Mylan and Meda; has consultant arrangements with Mylan, Meda, Sanofi; and has received payment for lectures including service on speakers bureaus from Mylan and Meda. H. A. Sampson has received grants from the National Institute of Allergy and Infectious Diseases (NIAID), has received consulting fees or honoraria from the Asthma and Allergy Foundation of America, is a board member for the Danone Scientific Advisory Board, has consultant arrangements with Allertein Therapeutics, is employed by Mount Sinai Medical School, has grants/grants pending with NIAID and the NIH, receives royalties from Elsevier-Wiley and UpToDate, and receives travel reimbursements from the NIAID, EACCI, and Thermo Fisher Scientific. L. B. Schwartz has received consulting fees or honoraria from the Asthma and Allergy Foundation of America; is a board member for Asthma and the Allergy Foundation of America; is a past president for the Clinical Immunology Society; has consultant arrangements with Sanofi, ViroPharma, and Genentech; has grants/grants pending with Genentech, GlaxoSmithKline, NeilMed, ViroPharma, Novartis, Green Springs, Merck, CSL Behring, and Dyax; receives royalties from Thermo Fisher, Hycult and BioLegend, Millipore in Santa Cruz, Elsevier, and UpToDate. M. Zitt has received consulting fees or honoraria from the Asthma and Allergy Foundation of America; has received payment for lectures, including service on speakers' bureaus from Integrity/Pylan Pharmaceuticals; and has received payment for development of educational presentations from Integrity. C. Collins has received sponsorship funding from Sanofi-Aventis and has received unrestricted educational grants from Mylan Specialty and Pfizer. M. Tringale has received sponsorship funding for AAFA to independently conduct the survey from Sanofi. M. Wilkinson has a contract from the Asthma and Allergy Foundation of American for collection of the survey and has contracts for data collection of surveys from GlaxoSmithKline, Merck, Takeda, Teva, Celgene, and Gilead. J. Boyle has a contract for data collection for surveys from the Asthma and Allergy Foundation of America, GlaxoSmithKline, Merck, Takeda, Teva, Celgene, and Gilead. F. E. R. Simons has received consulting fees or honoraria from the Asthma and Allergy Foundation of America and is a board member for the ALK-Abelló Medical Advisory Board, Mylan Medical Advisory Board, and Sanofi Medical Advisory Board.

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