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Age33
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Infants: Under-recognition, under-diagnosis; no appropriate adrenaline auto-injector dose
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Adolescents/young adult: Increased risk of anaphylaxis triggered by foods due to risk taking behavior, disease denial or treatment non-compliance (not filling scripts for or carrying an AAI)
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Elderly: Increased risk of fatality from insect venom anaphylaxis, concomitant cardiovascular diseases and drugs like analgesics and antibiotics
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Comorbidities34,35,39,40,53
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Asthma if severe or uncontrolled
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Patients with cardiovascular disease or taking antihypertensive medication
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Allergic rhinitis and eczema: atopic diseases are a risk factor for anaphylaxis triggered by food, exercise, and latex
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Intercurrent or recent illness including COVID-19
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Intellectual impairment, communication difficulties, eg, language
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Thyroid disease (some patients with idiopathic anaphylaxis)
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Hereditary alpha hypertryptasemia, mastocytosis
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Impact of concurrent medications37,38
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May affect recognition of anaphylaxis: ethanol, sedatives, hypnotics, antidepressants, recreational drugs, sedatives, hypnotics
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May increase the severity of anaphylaxis: beta-blockers, ACE inhibitors, angiotensin II receptor blockers, aspirin, NSAIDS
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Allergens with increased intrinsic risk of triggering anaphylaxis38
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Food: nuts, seafood, food additives, finned fish, shellfish, egg, milk, sesame
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Insect stings/bites: Hymenoptera (bees, vespids, ants
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Inhalants (cat, hamster, and horse dander; grass pollen)
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Natural rubber latex
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Medications (such as beta-lactam antibiotics, neuromuscular blockers)
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Other relevant factors35,36,38,41, 42, 43,45, 46, 47, 48, 49, 50
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Severity and/or priming effect of previous anaphylaxis episodes
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Strenuous exercise
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Psychologic stress
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Past severe anaphylaxis
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Estrogen, progesterone
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Sleep deprivation
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Alcohol consumption, viral illness, and menstruation
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Delayed or failure to use an AAI to treat an anaphylaxis episode
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Effective training packages for anaphylaxis patients and their care givers to understand and address AAI behaviors
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Uncertainty and fear over how and when to use AAI
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Limited access to emergency medical care, for example, remote location, social factors
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