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
JournalJournal of Allergy and Clinical Immunology: In Practice
Early online date5 Mar 2022
Publication statusE-pub ahead of print - 5 Mar 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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