Physicians’ knowledge and self-reported practice concerning diagnosis and management of anaphylaxis: a multi-hospital cross-sectional study in the West Bank, Palestine

Anaphylaxis is a life-threatening allergic emergency requiring prompt treatment with intramuscular epinephrine (adrenaline). Despite clear international guidelines, physician knowledge deficits have been documented globally. No prior study has assessed anaphylaxis-related knowledge or practice among physicians in the West Bank, Palestine. This study aimed to evaluate physicians’ knowledge and self-reported practices regarding anaphylaxis diagnosis and management across multiple specialties and governorates in the West Bank. A cross-sectional study was conducted across 12 hospitals in five West Bank governorates between October 2025 and January 2026. Physicians from seven clinical specialties were recruited via convenience sampling. An adapted questionnaire, originally validated in an Egyptian physician cohort, assessed knowledge of anaphylaxis diagnosis, first-line treatment, epinephrine route and dosing, and self-reported clinical practice. Chi-square and Fisher’s exact tests were used to examine associations between physician characteristics and knowledge outcomes. Multivariable binary logistic regression was performed to identify independent predictors of knowledge outcomes. All statistical analyses were performed using IBM SPSS Statistics version 27. Among 317 physicians (median age 29 years; 61.8% male), 85.5% correctly identified epinephrine as the first-line treatment and 88.0% selected the intramuscular route. However, only 36.3% identified the correct weight-based dose, and only 24.0% accurately recognized all four valid anaphylactic scenarios without endorsing the distractor. Among those who had encountered anaphylaxis cases (89.3%), 13.8% reported never administering epinephrine. Fewer than half (46.7%) of workplaces had both a written protocol and accessible epinephrine. Younger physicians significantly outperformed older colleagues on first-line agent identification ( p = 0.017) and route knowledge ( p < 0.001), while specialists demonstrated higher dose knowledge than residents and general practitioners ( p < 0.001). Self-reported prior exposure to anaphylaxis-related training was not significantly associated with knowledge performance in unadjusted analyses. Physicians in the surveyed West Bank hospitals demonstrate relatively high recognition of epinephrine as the first-line treatment for anaphylaxis; however, critical gaps persist in dose knowledge, diagnostic discrimination, and self-reported epinephrine administration. Targeted educational interventions emphasizing dosing and atypical presentations, alongside institutional measures to ensure protocol availability and epinephrine access, are urgently needed. Not applicable.