A brief, evidence-based patient education session yielded modest improvements in anaphylaxis-related quality of life and care self-efficacy and could be easily incorporated into a busy clinical practice setting. 

Such an intervention could be part of broader efforts to increase more timely use of epinephrine autoinjection, according to Caroline Belin, DNP, MPH, MBA, a nurse practitioner/clinician quality manager at APLA Health, in Los Angeles, California, and Cecília Tomori, PhD, an associate professor at Johns Hopkins School of Nursing and Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

The study was published in the Journal of Asthma and Allergy.

“We had observed that patients with a history of allergic anaphylaxis often left medical visits without fully understanding when and how to use epinephrine or without confidence in their ability to respond in an emergency,” Tomori told Medscape Medical News. “At the same time, many patients expressed ongoing anxiety, lifestyle restriction, and diminished quality of life, and we felt it was important to design a quality improvement study to help address these concerns.”

Belin, who coauthored the study as a doctoral student at Johns Hopkins, added that although guidelines emphasize epinephrine as first-line therapy, far less attention has been paid to the psychosocial burden of anaphylaxis and the measurable impact of education on quality of life. 

“We wanted to translate the best available evidence in an educational session to see if this could improve quality of life and empower patients with allergic anaphylaxis,” she explained.

Clinical visits are often time-pressured, and education can become secondary to diagnosis and prescribing, Belin said. “Even in specialty practices, education may be informal or inconsistent,” she added. 

Concerningly, the authors noted, baseline data had indicated large gaps in patients’ understanding of their confirmed diagnosis of severe anaphylaxis allergy, poor rates of epinephrine autoinjector carriage, and difficulties refilling prescriptions even in this relatively privileged population. 

The Education Program

The intervention was conducted with 66 affluent patients over 12 weeks in an allergy specialty practice. Most participants (52%) were 30 to 49 years old, 75% were female, and 67% were White. Overall, 44% had a 4-year college degree and 53% reported an annual individual income of $100,000 to $149,999.

Based on the 21-item Anaphylaxis Quality of Life Scale for Adults, after the intervention, quality of life was slightly but significantly higher overall: 3.88 pre-test median (interquartile range [IQR], 2.85-4.81) vs 3.95 pre-test median (IQR, 3.38-4.68; P < .01).

Significant improvements in social, emotional, and limitation subscales were also found (P < .01), with the largest improvement evident in the emotional subscale. A small but significant increase was also found in self-efficacy on the New General Self Efficacy Scale: 3.94 pretest median (IQR, 3.25-4.28) vs 4.13 post-test median (IQR, 4.12-4.75; P < .01).

On the subjective front, several participants informally commented that no one had previously walked them through a clear, step-by-step emergency plan, Tomori said. “That insight alone underscores how much opportunity remains for routine clinical education.”

Offering her perspective on the findings, Kristin Sokol, MD, MPH, an allergist/immunologist at Schreiber Allergy in Rockville, Maryland, who was not involved in the study, said the researchers showed that educational intervention can produce significant and clinically meaningful improvements in anaphylaxis-related quality of life and self-efficacy. “Although the magnitude of change was modest, the most impacted domains, particularly emotional burden, are highly relevant to real-world allergy practice,” she told Medscape Medical News. 

Sokol noted that patients in clinic frequently demonstrate adequate technical knowledge of epinephrine autoinjector use yet continue to experience decisional hesitation, anticipatory anxiety, and social restriction in everyday life. 

“The findings align with this observation: targeted, prevention-focused education appears to strengthen patients’ perceived control and emotional readiness, which are critical determinants of timely epinephrine administration.”

She stressed that quality of life and self-efficacy should not be secondary outcomes in anaphylaxis care. “These directly influence epinephrine carriage, willingness to act during early symptoms, and overall safety planning,” she said. 

Structured quality-of-life–centered education is a potentially high-yield adjunct to traditional avoidance counseling and device instruction, she said. Extending this model to parents of children with food allergy may be especially valuable, as caregiver confidence is a critical determinant of timely epinephrine administration, she added. 

The authors agreed that quality of life is not a soft endpoint because it directly affects avoidance behaviors, emergency response decisions, and psychological well-being. 

“Our findings reinforce that structured education should be considered a core component of anaphylaxis management, not an optional add-on. 

“Even small, structured educational efforts can move the needle. However, they likely represent a starting point rather than a complete solution,” Belin said. 

Expanded education models — including reinforcement sessions, digital tools, simulation practice, or follow-up check-ins — may yield greater improvements. 

Sokol agreed that refresher sessions would be necessary to maintain gains. “And future work should evaluate durability of effect, optimal timing of booster interventions, and adaptation for caregiver populations, in which improvements in self-efficacy may have downstream effects on both child safety and family quality of life,” she said.

Ultimately, Tomori said, preparing someone for anaphylaxis isn’t just about handing them a prescription. It’s about teaching three very practical things: “How to recognize symptoms early, how to make the decision to use epinephrine without hesitation, and exactly what to do next.”

Belin and Tomori have reported no specific funding for the study and had no conflicts of interest. Sokol has reported no competing interests relevant to her comments.