title: Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States.
abstract: 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.
authors.affiliation: Department of Pediatrics, Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: rwood@jhmi.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wood
authors.affiliation: Departments of Medicine and Epidemiology, Massachusetts General Hospital, Boston, Mass.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: Departments of Internal Medicine and Pediatrics, University of Tennessee College of Medicine, Memphis, Tenn.
authors.forename: Philip
authors.initials: P
authors.lastname: Lieberman
authors.affiliation: Department of Pediatrics, Division of Allergy and Immunology, Mount Sinai School of Medicine, New York, NY.
authors.forename: Hugh A
authors.initials: HA
authors.lastname: Sampson
authors.affiliation: Department of Medicine, Division of Rheumatology, Allergy and Immunology, Virginia Commonwealth University, Richmond, Va.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Schwartz
authors.affiliation: Department of Medicine, State University of New York Stony Brook, Stony Brook, NY.
authors.forename: Myron
authors.initials: M
authors.lastname: Zitt
authors.affiliation: Asthma and Allergy Foundation of America, Landover, Md.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Collins
authors.affiliation: Asthma and Allergy Foundation of America, Landover, Md.
authors.forename: Michael
authors.initials: M
authors.lastname: Tringale
authors.affiliation: Abt SRBI, Silver Spring, Md.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Wilkinson
authors.affiliation: ICF International, Calverton, Md.
authors.forename: John
authors.initials: J
authors.lastname: Boyle
authors.affiliation: Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: F Estelle R
authors.initials: FE
authors.lastname: Simons
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000453:epidemiology; D005260:Female; D005512:Food Hypersensitivity / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007299:Insect Bites and Stings / Q000453:epidemiology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Anaphylaxis; RDD; Random-digit-dial; epinephrine; prevalence