Study Finds Significant Gaps in Physician Knowledge and Attitudes When it Comes to Anaphylaxis

Results from a recent survey indicate that efforts to educate American doctors about the diagnosis and treatment of anaphylaxis have achieved mixed results. Substantial majorities of physicians who can expect to encounter anaphylaxis know many of the most important facts but substantial majorities also lack knowledge that could help them save dying patients.

Researchers interviewed 318 physicians who constituted a roughly representative sample of doctors in 5 relevant specialties: allergy and immunology, pediatric allergy and immunology, emergency medicine, family medicine, and pediatrics. Each telephone interview consisted of 47 questions and lasted about 20 minutes.

The overwhelming majority of physicians said they were familiar with the term “anaphylaxis” (range across the 5 specialties, 89% to 100%) and a significant majority knew to treat anaphylaxis with injections of epinephrine (81% to 93%).

Questions about what symptoms indicate anaphylaxis, however, stumped a majority of all doctors and an overwhelming majority of those who do not specialize in treating allergies. The percentage that could correctly identify common symptoms ranged as follows: cough (30% to 55%), skin reactions (26% to 54%) and abdominal pain (6% to 46%).

In other words, a large majority of participating doctors knew to treat a condition called “anaphylaxis” with epinephrine, but considerably less than half of the group knew how to make the diagnosis that would lead them to deliver the treatment.

Asked about foods that can trigger anaphylaxis, most doctors from all groups identified peanuts (70% to 95%) and then struggled to finger other common culprits such as tree nuts (30% to 72%), milk (6% to 47%) and eggs (9% to 57%).

On most questions, though not all, allergists were most likely to answer correctly, family doctors were most likely to answer incorrectly and emergency room doctors and pediatricians finished somewhere in the middle.

All 5 groups, however, disappointed the researchers who conducted the study for the Asthma and Allergy Foundation of America (AAFA), a not-for-profit organization for patients and their families.

“Given that anaphylaxis is common and can have potentially deadly consequences, the findings from this survey raise concern about overall physician knowledge of this condition,” they wrote in a letter to the editor that was recently published in the Journal of Allergy and Clinical Immunology. “Knowledge gaps are especially apparent for primary care and emergency physicians, who are most often the physicians on the front line in the treatment of this common and life-threatening condition.”

In addition to assessing factual knowledge, the survey also asked doctors how much impact they though severe allergies had on a typical patient’s daily existence.

The overwhelming majority of patients who actually have severe allergies typically report a major effect, but only 31% of pediatricians and 10% of family doctors believed that such a condition had a substantial impact on quality of life.

This view may have stemmed from their (incorrect) perceptions about the availability of anaphylaxis treatment. A significant number of the doctors (19% to 13%) mistakenly believed that restaurants are generally required to carry epinephrine auto-injectors and the overwhelming majority of them (77% to 94%) mistakenly believed the same of ambulances.

“It's concerning to see how much physicians' perception of quality of life for anaphylaxis patients differs from the patients' perception,” said Lynda Mitchell, an AAFA Vice President who launched its Kids With Food Allergies division, in a news release. “We need to work even harder to ensure that physicians across these practices are better prepared to treat and care for patients at-risk for anaphylaxis.”