Development and Validation of the Anaphylaxis Quality of Life Scale for Adults

Rebecca C. Knibb*, Aarnoud P. Huissoon, Richard Baretto, Anjali Ekbote, Sham Onyango-Odera, Cassandra Screti, Kristina L. Newman, Mamidipudi T. Krishna

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Anaphylaxis is a severe and potentially life-threatening allergic reaction that 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. Objective: The aim of this study was to develop and assess the reliability and validity of a QoL scale for adults with anaphylaxis (Anaphylaxis Quality of Life Scale for Adults [A-QoL-Adults]). Methods: All participants were recruited from a specialist allergy clinic and had a confirmed diagnosis of anaphylaxis (as per the World Allergy Organization diagnostic criteria) to food, drugs, venom, or latex or had spontaneous anaphylaxis. Interviews were conducted with 13 adults; data were analyzed using thematic analysis to extract items for a QoL scale. A prototype QoL scale was then completed by 115 participants alongside validated scales to measure generic QoL (World Health Organization Quality of Life Scale [Brief Version] [WHOQoL BREF]), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), and stress (Perceived Stress Scale [PSS]). Results: The A-QoL-Adults scale has 21 items demonstrating excellent internal reliability (Cronbach α = 0.96). Factor analysis produced 3 subscales: Emotional Impact; Social Impact; and Limitations on Life. Each has excellent internal reliability (0.92, 0.92, and 0.91, respectively). Poorer anaphylaxis-related QoL (total A-QoL-Adults score and subscale scores) correlated significantly with poorer general QoL and greater anxiety, depression, and stress (all P < .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 health care professionals a means to further understand the impact of anaphylaxis on adult patients and could help direct and monitor allergy management and the need for further psychological intervention.

Original languageEnglish
Pages (from-to)1527-1533.e3
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number6
Early online date5 Mar 2022
Publication statusPublished - Jun 2022

Bibliographical note

© 2022 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY license (

Funding: The project was paid for by a grant from the Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.


  • Adults
  • Anaphylaxis
  • Quality of life
  • Scale


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