Psychological Symptom Burden after Anaphylaxis in Adults: A Cross-Sectional Study

Anaphylaxis is an acute, potentially life-threatening systemic hypersensitivity reaction. Psychological symptoms, including anxiety, depressive symptoms, and post-traumatic stress symptoms (PTSS), may persist after the acute episode; however, adult data remain limited. This study aimed to describe the prevalence and co-occurrence of psychological symptoms after anaphylaxis in adults and to examine their associations with clinical characteristics, acute severity indicators, and epinephrine/adrenaline auto-injector-related behaviors.

This single-center cross-sectional study included adults with medically confirmed anaphylaxis within the previous 6 months and at least 1 month beyond the index event. Anxiety and depressive symptoms were screened using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), respectively. PTSS were assessed using the Post-traumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Short Form (PCL-5-S). Thresholds were HADS-A ≥10, HADS-D ≥7, and PCL-5-S ≥6. Positivity on at least one threshold was defined as combined psychological risk.

Seventy-five adults were included; the median age was 39 years, and 53.3% were female. The most common triggers were bee venom (38.7%) and drugs (29.3%). According to the World Allergy Organization severity grading system, 57.3% of reactions were classified as grade 4-5. Above-threshold symptoms were observed in 14.7% for anxiety, 25.3% for depression, and 37.3% for PTSS; overall, 50.7% met at least one threshold. Psychometric scores were not significantly associated with reaction severity group, intensive care unit admission, or epinephrine/adrenaline administration. Depression scores differed by trigger type, with higher scores in idiopathic and drug-triggered cases.

Psychological symptom burden was common in the early post-anaphylaxis period among adults and did not appear to parallel acute clinical severity. Brief multidomain psychological screening may support more comprehensive post-anaphylaxis follow-up and help identify patients who may benefit from further assessment or referral.