Tuesday, October 22, 2013

New Anaphylaxis Prevalence Findings

Image courtesy of AAFA
We've just received word from Kids with Food Allergies/AAFA about an enlightening study, "Anaphylaxis in America" that was recently published in the Journal of Allergy and Clinical Immunology (JACI).  You can view the full text of the article here.

Dr. Robert Wood was the head researcher, along with 10 other authors and research panel members.  The study was conceived and conducted by the Asthma and Allergy Foundation of America (AAFA), with the financial support of Sanofi, maker of the Auvi-Q.

This study sought to get a better understanding of the prevalence of anaphylaxis in America, but reaching out to a broader population.  Tens of thousands of numbers were called, in order to find individuals who have had an anaphylactic reaction within the past 10 years.  If the patient was a child, then the caregiver responded on their behalf.  From this search, they found 1,059 patients to survey.  They also interview 1,000 members of the general public, to assess awareness levels and attitudes surrounding anaphylaxis.

For the purposes of the study, they defined anaphylaxis as "a severe, sudden allergic reaction that typically involves two or more [systems], such as the skin, airways, lungs, stomach, heart and blood pressure."  The study included anaphylaxis from all triggers.

  • They found that anaphylaxis was "very likely" to have occurred in approximately 1-in-50 (1.6%) Americans, based on certain stricter criteria and "probably occurred" in roughly 1-in-20 (5.1%) Americans, based on slightly broader criteria.  This includes patients of all ages.
  • They found that the top 3 causes of anaphylaxis were medications (34%), food (31%) and insect stings (20%).  Idiopathic (reactions with an unknown cause) were found in 11% of participants and latex was the cause in 2.6% of patients.
  • As is most likely no surprise to many of us, the following concomitant condition were also found, with corresponding percentages: asthma (32%), hay fever (41%) and eczema (26%)
  • In what I feel is a disturbing, yet unfortunately unsurprising, finding is that when surveyed about actions taken during a reaction, roughly 27% of patients self-administered anti-histamines as their treatment method, whereas only 11% self-administered epinephrine.  To me, this shows an excessively dangerous reliance on antihistamines, and a dangerously low usage rate of the life-saving treatment with epinephrine.
  • Another unsettling finding was under the "Current Epinephrine Practices" section.   Note that the persons surveyed have experienced anaphylaxis, before.  Despite this, the combined percentage of those who have epinephrine prescribed and do not carry and "none of the above", which I take to mean no prescription and do not carry, adds up to around 60% of patients.  That is simply too high.
  • When asked about their planned treatment method for future reactions, roughly 36% said they would use antihistamines (NO!!!!) and 44% said they would call 911 (YES!!).  Another 32% said they would use epinephrine, which is good, but how can they, when do many of them don't even have it?
  • The study also showed a lack of patient education about what, exactly, anaphylaxis is and how to deal with it.  
The bottom line is there is still so much education that needs to be done, from every angle.  Physicians need to do a better job.  We, as advocates, need to work harder to get the facts out, to the general public.  The numbers are rising and fewer and fewer people are living lives that are completely untouched by anaphylaxis. 

Many thanks to JACI for making this journal article free to the public!


  1. I won't leave home without the epi but still use Benadryl as a first line of defense. I don't want to *have* to use the epi, but will carry it and use it if I *think* I need to... ugh... even those of us who suffer from allergies or care for someone who does have a lot to learn!

    1. I understand, but this is where the thinking (even among some allergists) need to start to shift...Here are a couple of pertinent articles:



      Some may say, "well, I don't want to be in the ER every week!", but I say if that's the case, then one must reevaluate the precautions being taken, because nobody should be accidentally ingested their allergens on a weekly basis. :O Things do get a bit trickier with unknown exposures, or undiagnosed allergies, of course! If only our children had indicator lights...