Insights from anaphylaxis survivors

Despite an epinephrine injection being the most important emergency treatment for anaphylaxis, in most cases of death from anaphylaxis in the community, it appears epinephrine injection either has not been given at all, given too late or given in too low a dose. Results of an email survey of people who have survived an anaphylactic reaction are to be published in the forthcoming issue of The Journal of Allergy and Clinical Immunology. The paper reports the experiences of 1,885 survivors with regard to using or not using, an epinephrine auto-injector for first-aid treatment.

Of those who responded to the survey, only 500 (27%) reported using an epinephrine auto-injector, in contrast to 1,385 (73%) who did not. An epinephrine auto-injector was more likely to be used for anaphylaxis triggered by peanut, fish or an insect sting.

In the survey, those people who were classified as 'epinephrine users' reported having difficulties in deciding whether to use the auto-injector, whether to repeat the dose and whether to go to an emergency department during the anaphylaxis episode. Of those respondents who did inject epinephrine, 40% reported having used an antihistamine or asthma inhaler before deciding to use an epinephrine injection. The authors report concern over this behaviour, citing a delay in administering an epinephrine injection as increasing the likelihood of death in anaphylaxis.

Reasons for not using epinephrine were given by those anaphylaxis survivors classified as 'non-epinephrine users', and included self-treatment with an antihistamine (38%), not having a prescription for an epinephrine auto-injector (28%) or believing the reaction to be mild (13%).

The authors believe healthcare professionals working with people at risk for anaphylaxis can utilise these insights in developing anaphylaxis management plans for their patients.

Reference: Simons et al. 2009. The Journal of Allergy and Clinical Immunology DOI:10.1016/j.jaci.2009.03.050