Background: Anaphylaxis is a severe and potentially life-threatening allergic reaction which can have a detrimental impact on quality of life (QoL). There are no validated scales to measure the impact of anaphylaxis on QoL of adults. The aim of this study was to develop and assess the reliability and validity of a QoL scale for adults with anaphylaxis (the A-QoL-Adults). Methods: Interviews were conducted with 13 adults with anaphylaxis; data was analysed using thematic analysis to extract items for a QoL scale. A 28-item prototype QoL scale was then completed by 115 participants (with a confirmed diagnosis of anaphylaxis as per the WAO diagnostic criteria) alongside validated scales to measure generic QoL (WHOQoL BREF), anxiety and depression (HADS) and stress (PSS). All participants were recruited from a specialist allergy clinic. Results: After factor analysis, the A-QoL-Adults scale was reduced to 21 items which had excellent internal reliability (Cronbach’s alpha=0.96). Factor analysis produced 3 sub-scales: Emotional Impact; Social Impact; Limitations on Life. Each had excellent internal reliability (0.92; 0.92; 0.91 respectively). Poorer anaphylaxis-related QoL (total A-QoL-Adults score and sub-scale scores) correlated significantly with poorer general QoL and greater anxiety, depression and stress (all p<0.01 with medium to large effect sizes). Conclusions: The A-QoL-Adults scale is a reliable measure of QoL in adults with anaphylaxis and shows good construct validity. It will offer healthcare professionals a means to further understand the impact of anaphylaxis on adult patients and could help direct and monitor clinical care and the need for further psychological intervention.

Background. Anaphylaxis is a severe and potentially life-threatening allergic reaction which has a detrimental impact on quality of life (QoL), however little is known about the impact of anaphylaxis, across the various causes, on adults. The aim of this study was to assess the impact of anaphylaxis on QoL and mental health in adults. Methods. Participants (n=142; 60% female) were recruited from a regional allergy centre (Birmingham, U.K) following systematic specialist evaluation. They completed measures of generic QoL (WHOQoL BREF), anaphylaxis specific QoL (A-QoL-Adults), anxiety and depression (HADS) and stress (PSS). Results. Anaphylaxis triggers were mainly to medication or during general anaesthesia (29.6%), food (29.6%), wasp or bee venom (16.2%), or were spontaneous (21.1%). Adults with anaphylaxis had significantly poorer general QoL and stress than published data from a healthy population. Females had significantly poorer anxiety and depression than norm data (all p<0.01). Poorer anaphylaxis specific QoL was significantly related to greater stress, depression, anxiety, poorer general QoL and demographic and clinical variables such as age, gender, severity of anaphylaxis, presence of other atopic conditions (all p<0.05). Regression analysis showed that anxiety, depression and number of anaphylactic reactions were significant predictors for anaphylaxis specific QoL. Conclusions. Anaphylaxis has an adverse impact on QoL and mental health of adults across different triggers. Anxiety, depression and number of reactions in particular seem to be important in explaining the impact on QoL and should be of particular note for clinicians managing adults with this condition, and when considering specialist psychological support.