The symptoms of anaphylaxis usually occur within minutes of exposure to an allergen. Symptoms usually vary in severity. Sometimes they only cause mild itching or swelling, but in some people they can be severe and life threatening [8].

The symptoms of anaphylaxis include itchy skin with red, raised rashes known as hives. There may be urticaria, angioedema and flushing.

The respiratory symptoms include nasal congestion, sneezing, rhinorrhea, hoarseness, stridor, dyspnea, bronchospasm and hypoxia.

In the cardiovascular system, anaphylaxis may manifest with dizziness, syncope, hypotension, arrhythmia, palpitations and substernal pain.

The gastrointestinal symptoms include nausea, vomiting, diarrhea, dysphagia and abdominal cramps. The other symptoms include headache, seizures, loss of consciousness, a feeling of anxiety and urinary urgency.

• Unconsciousness

  Symptoms of anaphylaxis include an itching of the scalp and tongue, difficulty in breathing because of swelling or spasm of the bronchi, skin flush of the whole body, an abrupt fall in blood pressure, vomiting or abdominal cramping, and unconsciousness [britannica.com]

  If the person is unconscious, you should move them to the recovery position – on their side, supported by one leg and one arm, with the head tilted back and the chin lifted. [nhsinform.scot]

  If unconscious, place them in the recovery position. If breathing is difficult allow them to sit. Give adrenaline autoinjector. Phone ambulance on triple zero (000). Further adrenaline doses may be given if no response after 5 minutes. [healthdirect.gov.au]

  The condition can quickly cause increased heart rate, sudden weakness, a drop in blood pressure, shock, and ultimately unconsciousness and even death. Cleveland Clinic News & More Cleveland Clinic News & More [my.clevelandclinic.org]

• Rigor

  Finally, the importance of a rigorous allergy work-up in reaching a confident diagnosis and providing the patient with a safe alternative is shown. 2016 S. Karger AG, Basel. [ncbi.nlm.nih.gov]

  This technique has been shown to be no better than placebo in the only rigorously conducted trials available — for bee and wasp sting allergy 30,31 — and is no longer available for the treatment of jack jumper venom allergy. [web.archive.org]

• Chills

  People infected with the seasonal flu virus feel miserable with fever, chills, muscle aches, coughing, congestion, headache and fatigue for a week or so. [niaid.nih.gov]

  Tabs Content Clinical Overview Diagnosis Indications for Testing Flushing, angioedema, pruritus, hives, shortness of breath, wheezing, nausea, vomiting, diarrhea, hypotension, oxygen desaturation, and cardiovascular collapse (Castells, 2017) Atypical – chills [arupconsult.com]

• Cough

  Pertussis, also known as whooping cough, is a highly contagious respiratory disease. It is caused by the bacterium Bordetella pertussis. Pertussis is known for uncontrollable, violent coughing that often makes it hard to breathe. [niaid.nih.gov]

  Recent Examples on the Web Side effects were abdominal pain, vomiting, nausea, tingling in the mouth, itching, cough, runny nose, throat irritation and tightness, hives, wheezing and shortness of breath and anaphylaxis (serious, life-threatening allergic [merriam-webster.com]

  Allergic reactions can cause: trouble breathing throat tightness or feeling like the throat or airways are closing hoarseness or trouble speaking wheezing nasal stuffiness or coughing nausea, belly pain, vomiting, or diarrhea trouble swallowing fast heartbeat [kidshealth.org]

  […] organs: Skin - itching, hives, redness, swelling Nose - sneezing, stuffy nose, runny nose Mouth - itching, swelling of the lips or tongue Throat - itching, tightness, trouble swallowing, swelling of the back of the throat Chest - shortness of breath, coughing [medlineplus.gov]

  Anaphylaxis (only one feature may present) swelling/tightness in the throat difficulty speaking/hoarse voice wheeze or persistent cough persistent dizziness pallor and floppiness (in young children) abdominal pain and vomiting in insect allergy. [pch.health.wa.gov.au]

• Hoarseness

  Your voice may go hoarse, and you may not be able to swallow. Respiratory distress is a life-threatening emergency. It requires immediate medical attention. Untreated, it can lead to respiratory arrest. [healthline.com]

  This whole-body allergic reaction may cause: nausea vomiting abdominal cramps hives swelling of the lips diarrhea itchy skin anxiety headache joint swelling coughing, sneezing, wheezing shortness of breath itchy mouth and throat nasal congestion hoarseness [health.howstuffworks.com]

  Symptoms of anaphylaxis may include: difficult or noisy breathing difficulty talking and/or hoarse voice a swollen tongue persistent dizziness or collapse swelling or tightness in the throat pale and floppy (young children) wheeze or persistent cough [healthdirect.gov.au]

  […] eyes Hives or welts Tingling mouth Abdominal pain, vomiting (these are signs of anaphylaxis for insect allergy) Anaphylaxis (severe allergic reaction) Difficult/noisy breathing Swelling of tongue Swelling/tightness in throat Difficulty talking and/or hoarse [conditions.health.qld.gov.au]

  Severe allergic reaction Watch for any one of the following symptoms: difficulty or noisy breathing swelling of tongue swelling or tightness in throat difficulty talking and/or hoarse voice wheeze or persistent cough persistent dizziness or collapse young [healthywa.wa.gov.au]

• Sneezing

  It can affect many organs: Skin - itching, hives, redness, swelling Nose - sneezing, stuffy nose, runny nose Mouth - itching, swelling of the lips or tongue Throat - itching, tightness, trouble swallowing, swelling of the back of the throat Chest - shortness [medlineplus.gov]

  This whole-body allergic reaction may cause: nausea vomiting abdominal cramps hives swelling of the lips diarrhea itchy skin anxiety headache joint swelling coughing, sneezing, wheezing shortness of breath itchy mouth and throat nasal congestion hoarseness [health.howstuffworks.com]

  Video Transcript Thomas Chacko, MD Allergist THOMAS CHACKO: The difference between allergies and anaphylaxis-- anaphylaxis can be the life-threatening type, meaning-- allergies, when people think about it, could be sneezing, hayfever, or even asthma. [webmd.com]

  Some reactions can be mild or moderate, such as: * Itching * Sneezing * Runny nose * Itchy, red puffy or watery eyes * A red, raised, itchy rash or red flushed blotchy skin * A tight chest and wheezing * Difficulty breathing, swallowing or speaking * [youtube.com]

  The reactions include sneezing, wheezing, cough, itching, skin rashes, stomach pain, diarrhea, or even a fall in blood pressure, which can cause dizziness or passing out. [asthmaandallergies.org]

• Nasal Congestion

  However, a list of common effects would have to include: Respiratory symptoms: upper torso tightness, wheezing, shallow breathing, coughing, swelling or tightness in the throat, itching in the mouth and throat, and nasal congestion Cardiovascular symptoms [premierallergyohio.com]

  This whole-body allergic reaction may cause: nausea vomiting abdominal cramps hives swelling of the lips diarrhea itchy skin anxiety headache joint swelling coughing, sneezing, wheezing shortness of breath itchy mouth and throat nasal congestion hoarseness [health.howstuffworks.com]

  congestion Nausea or vomiting Palpitations Slurred speech Swelling of the face, eyes, or tongue Unconsciousness The health care provider will examine the person and ask about what might have caused the condition. [nlm.nih.gov]

  The respiratory symptoms include nasal congestion, sneezing, rhinorrhea, hoarseness, stridor, dyspnea, bronchospasm and hypoxia. [symptoma.com]

• Dyspnea

  A 42-year-old female presenting with facial edema, dyspnea and urticaria after ingested half teaspoon of flaxseed flour 30 minutes previously. [ncbi.nlm.nih.gov]

  Symptoms range from mild to severe and include flushing, pruritus, urticaria, sneezing, rhinorrhea, nausea, abdominal cramps, diarrhea, a sense of choking or dyspnea, palpitations, and dizziness. [msdmanuals.com]

  […] in severe anaphylaxis Flow cytometry, serum IgE, baseline tryptase (ie, not during acute event), and KIT D816V mutation testing should be considered in addition to clinical evaluation (Bonadonna, 2015) Differential Diagnosis Respiratory symptoms (eg, dyspnea [arupconsult.com]

• Vomiting

  It's considered anaphylaxis if someone has: any severe symptoms, such as trouble breathing, repeated vomiting, passing out, or throat tightness or two or more mild symptoms, such as hives and vomiting or coughing and belly pain The person needs treatment [kidshealth.org]

  Gastrointestinal symptoms, such as severe abdominal pain, vomiting and diarrhea, may also occur. [hopkinsmedicine.org]

  This causes constriction of the airways, resulting in wheezing ; difficulty breathing ; and gastrointestinal symptoms such as abdominal pain, cramps, vomiting, and diarrhea. [web.archive.org]

  Anaphylaxis (only one feature may present) swelling/tightness in the throat difficulty speaking/hoarse voice wheeze or persistent cough persistent dizziness pallor and floppiness (in young children) abdominal pain and vomiting in insect allergy. [pch.health.wa.gov.au]

  Recent Examples on the Web Side effects were abdominal pain, vomiting, nausea, tingling in the mouth, itching, cough, runny nose, throat irritation and tightness, hives, wheezing and shortness of breath and anaphylaxis (serious, life-threatening allergic [merriam-webster.com]

• Nausea

  Recent Examples on the Web Side effects were abdominal pain, vomiting, nausea, tingling in the mouth, itching, cough, runny nose, throat irritation and tightness, hives, wheezing and shortness of breath and anaphylaxis (serious, life-threatening allergic [merriam-webster.com]

  The adrenaline may cause a fast or irregular heartbeat, nausea and breathing difficulties. The autoinjector needs to be stored away from heat and light. Ask your specialist to explain when you should use it. [dermnetnz.org]

  Gastrointestinal and/or heart and circulation problems occur in 65% of cases with abdominal pain, nausea and vomiting with dizziness, racing heart, loss of consciousness, chest pain, and menstrual cramping. [asthmacenter.com]

• Diarrhea

  Gastrointestinal symptoms, such as severe abdominal pain, vomiting and diarrhea, may also occur. [hopkinsmedicine.org]

  This causes constriction of the airways, resulting in wheezing ; difficulty breathing ; and gastrointestinal symptoms such as abdominal pain, cramps, vomiting, and diarrhea. [web.archive.org]

  […] the lips or tongue Throat - itching, tightness, trouble swallowing, swelling of the back of the throat Chest - shortness of breath, coughing, wheezing, chest pain or tightness Heart - weak pulse, passing out, shock Gastrointestinal tract - vomiting, diarrhea [medlineplus.gov]

  Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension). [openanesthesia.org]

• Abdominal Pain

  Gastrointestinal symptoms, such as severe abdominal pain, vomiting and diarrhea, may also occur. [hopkinsmedicine.org]

  This causes constriction of the airways, resulting in wheezing ; difficulty breathing ; and gastrointestinal symptoms such as abdominal pain, cramps, vomiting, and diarrhea. [web.archive.org]

  pain (abdominal pain and vomiting can be a sign of anaphylaxis in insect allergy) difficulty breathing tongue swelling. [pch.health.wa.gov.au]

  Recent Examples on the Web Side effects were abdominal pain, vomiting, nausea, tingling in the mouth, itching, cough, runny nose, throat irritation and tightness, hives, wheezing and shortness of breath and anaphylaxis (serious, life-threatening allergic [merriam-webster.com]

  Gastrointestinal and/or heart and circulation problems occur in 65% of cases with abdominal pain, nausea and vomiting with dizziness, racing heart, loss of consciousness, chest pain, and menstrual cramping. [asthmacenter.com]

• Abdominal Cramps

  The condition is characterized by a sense of impending doom, tingling, flushing, shortness of breath, congestion, syncope, abdominal cramps and palpitations. [symptoma.com]

  Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension). [openanesthesia.org]

  Symptoms of anaphylaxis include an itching of the scalp and tongue, difficulty in breathing because of swelling or spasm of the bronchi, skin flush of the whole body, an abrupt fall in blood pressure, vomiting or abdominal cramping, and unconsciousness [britannica.com]

  This whole-body allergic reaction may cause: nausea vomiting abdominal cramps hives swelling of the lips diarrhea itchy skin anxiety headache joint swelling coughing, sneezing, wheezing shortness of breath itchy mouth and throat nasal congestion hoarseness [health.howstuffworks.com]

  cramps, diarrhea, or vomiting Dizziness or fainting (signs of a drop in blood pressure) If you are experiencing symptoms of anaphylaxis, seek immediate treatment and tell your healthcare professional if you have a history of allergic reactions. [web.archive.org]

• Lip Swelling

  […] that trigger anaphylaxis may change with time Clinical Presentation Acute onset of illness May have biphasic recurrence 6-8 hours after initial episode Respiratory Lower airway Bronchospasm Dyspnea Tachypnea Wheezing Upper airway Laryngeal wheezing Lip [arupconsult.com]

  He subsequently developed tongue and lip swelling and breathlessness. When a paramedic arrived 20-30 minutes later, he was in cardiac arrest. Resuscitation was unsuccessful. Past history and allergies were not recorded. [web.archive.org]

  Oral immunotherapy may be effective at desensitizing some people to certain food including milk, eggs, nuts and peanuts; however, adverse effects are common.[3] For example, many people develop an itchy throat, cough, or lip swelling during immunotherapy [en.wikipedia.org]

• Hypotension

  Use of vasopressors should be considered if hypotension persists. [ncbi.nlm.nih.gov]

  Persistent hypotension requires IV fluids and sometimes vasopressors. [msdmanuals.com]

• Tachycardia

  In this case report, we present an interesting case of a 27-year-old male who experienced symptoms of anaphylaxis (shortness of breath, and swelling of the face, lips and tongue, which was followed by hypotension, tachycardia of 140/min and a sudden loss [ncbi.nlm.nih.gov]

  A's oral temperature is 101 F (38.3 C), heart rate is 108 with sinus tachycardia, respiratory rate is 20 regular and slightly labored, BP is 180/90 with the head of bed at 30 degrees, and SpO 2 is 94% on room air. [journals.lww.com]

  It is characterised by rapidly developing life-threatening problems involving: the airway (pharyngeal or laryngeal oedema) and/or breathing (bronchospasm with tachypnoea) and/or circulation (hypotension and/or tachycardia). [nature.com]

• Chest Pain

  pain or tightness Heart - weak pulse, passing out, shock Gastrointestinal tract - vomiting, diarrhea, cramps Nervous system - dizziness or fainting If someone is having a serious allergic reaction, call 911. [medlineplus.gov]

  Gastrointestinal and/or heart and circulation problems occur in 65% of cases with abdominal pain, nausea and vomiting with dizziness, racing heart, loss of consciousness, chest pain, and menstrual cramping. [asthmacenter.com]

  pain and tightness difficulty breathing low blood pressure shock, loss of consciousness, and even death If you have any of these symptoms after allergy testing or after exposure to an allergen, call 911 immediately. [health.howstuffworks.com]

  Common symptoms of anaphylaxis may include: Shortness of breath, cough, wheezing, difficulty swallowing, chest pain Low pulse, low blood pressure, dizziness, shock, lightheadedness, loss of consciousness Itching, swelling, redness, hive, rashes on the [jaxallergy.com]

• Urticaria

  Food urticaria is common and generally benign, and it may be of viral or idiopathic aetiology. A food origin of the allergy is frequently sought but rarely found. [ncbi.nlm.nih.gov]

  Anaphylaxis is a severe and rapidly developing systemic hypersensitivity reaction that is associated with the skin rash, urticaria. Full-blown anaphylaxis includes urticaria and angioedema with hypotension and bronchospasm. [dermnetnz.org]

• Angioedema

  Hives and angioedema (hives on the lips, eyelids, throat, and/or tongue) often occur, and angioedema may be severe enough to cause obstruction of the airway. Prolonged anaphylaxis can cause heart arrhythmias. [web.archive.org]

  Here, we present a 48-year-old woman without significant medical and family history with recurrent angioedema in the setting of catamenial anaphylaxis or cyclical anaphylaxis in the setting of progesterone hypersensitivity. [ncbi.nlm.nih.gov]

  Site involvement as a predictor of airway intervention in angioedema. Laryngoscope. 2011;121:262–266. PMID 21271571 Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy. 2000;30(8):1144. [coreem.net]

• Flushing

  Symptoms of anaphylaxis include an itching of the scalp and tongue, difficulty in breathing because of swelling or spasm of the bronchi, skin flush of the whole body, an abrupt fall in blood pressure, vomiting or abdominal cramping, and unconsciousness [britannica.com]

  A 75-year-old Japanese woman presented with acute flushing pruritus and a feeling of diffuse warmth followed by collapse while dancing. After resting for 30 min and receiving a rapid infusion of 0.9% sodium chloride, her condition stabilised. [ncbi.nlm.nih.gov]

  Tabs Content Clinical Overview Diagnosis Indications for Testing Flushing, angioedema, pruritus, hives, shortness of breath, wheezing, nausea, vomiting, diarrhea, hypotension, oxygen desaturation, and cardiovascular collapse (Castells, 2017) Atypical [arupconsult.com]

  The condition is characterized by a sense of impending doom, tingling, flushing, shortness of breath, congestion, syncope, abdominal cramps and palpitations. [symptoma.com]

  Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension). [openanesthesia.org]

• Pruritus

  A 75-year-old Japanese woman presented with acute flushing pruritus and a feeling of diffuse warmth followed by collapse while dancing. After resting for 30 min and receiving a rapid infusion of 0.9% sodium chloride, her condition stabilised. [ncbi.nlm.nih.gov]

  Tabs Content Clinical Overview Diagnosis Indications for Testing Flushing, angioedema, pruritus, hives, shortness of breath, wheezing, nausea, vomiting, diarrhea, hypotension, oxygen desaturation, and cardiovascular collapse (Castells, 2017) Atypical [arupconsult.com]

  Arrythmia Blood pressure change III Pruritus Urticaria Angioedema Vomitus Defecation Diarrhoea Laryngeal edema Bronchospasm Cyanosis Shock IV Pruritus Urticaria Angioedema Vomitus Defecation Diarrhoea Respiratory arrest Cardiac arrest Principal targets [zerodonto.com]

  Anaphylaxis is very likely if any one of three criteria is fulfilled: acute onset of illness (minutes to hours), with involvement of skin and/or mucosa, such as pruritus, flushing, hives, angioedema accompanied by either respiratory compromise or falling [medscape.com]

• Eczema

  People with eczema also may be particularly susceptible to bacterial, viral, and fungal skin infections. [niaid.nih.gov]

  Myth #3: Mild reactions are not something to be worried about Fact: Individuals with a family history of serious allergic reactions and those with asthma, eczema, and other allergies, are most likely to experience anaphylaxis. [cottonique.com]

  […] as walnuts, pistachios, pecans and cashews Shellfish (such as shrimp, lobster) Fish such as tuna, salmon, cod (although, like with peanuts, there is some evidence that consuming fish early in life may help prevent allergic diseases such as asthma and eczema [healthychildren.org]

  Those with a history of hayfever, asthma, eczema, and certain medical conditions, like spina bifida, are more likely to be affected. [nhsinform.scot]

  Also at risk are those with a personal or family history of allergic conditions (asthma, eczema, or allergic rhinitis). [foodallergyawareness.org]

• Facial Edema

  A 42-year-old female presenting with facial edema, dyspnea and urticaria after ingested half teaspoon of flaxseed flour 30 minutes previously. [ncbi.nlm.nih.gov]

  Moreover, in a recent outbreak of Chagas disease after ingestion of contaminated palm fruit, 100% of the patients manifested facial edema in the absence of any bite [ 16 ]. [doi.org]

• Uterine Cramps

  […] abdominal cramps hives swelling of the lips diarrhea itchy skin anxiety headache joint swelling coughing, sneezing, wheezing shortness of breath itchy mouth and throat nasal congestion hoarseness warmth and flushing widespread, intense skin redness uterine [health.howstuffworks.com]

  cramps Feeling like something awful is about to happen Ask your doctor for a complete list of symptoms and an anaphylaxis action plan. [aafa.org]

  cramps, metallic taste However, a drop in blood pressure without other symptoms may also indicate anaphylaxis. [foodallergycanada.ca]

  Lower back pain in women (due to uterine cramping). [health.harvard.edu]

  cramps.[4][15] Dilation of blood vessels around the brain may cause headaches.[12] A feeling of anxiety or of "impending doom" has also been described.[3] Causes[edit] Anaphylaxis can occur in response to almost any foreign substance.[17] Common triggers [en.wikipedia.org]

• Dizziness

  […] within minutes to several hours after exposure to an allergen: Hives, itchiness, or redness all over the body and swelling of the lips, tongue, or back of the throat Trouble breathing Severe GI symptoms such as abdominal cramps, diarrhea, or vomiting Dizziness [web.archive.org]

  […] itching, tightness, trouble swallowing, swelling of the back of the throat Chest - shortness of breath, coughing, wheezing, chest pain or tightness Heart - weak pulse, passing out, shock Gastrointestinal tract - vomiting, diarrhea, cramps Nervous system - dizziness [medlineplus.gov]

  Gastrointestinal and/or heart and circulation problems occur in 65% of cases with abdominal pain, nausea and vomiting with dizziness, racing heart, loss of consciousness, chest pain, and menstrual cramping. [asthmacenter.com]

  Very quickly, she felt dizzy and nauseated. Her mother immediately drove her to the family physician, who successfully treated her in the office. [asthmaandallergies.org]

  […] may include the following: Respiratory System: coughing, wheezing, shortness of breath, chest pain/tightness, swelling or tightness of the throat, hoarse voice, nasal congestion, trouble swallowing (70% of reactions) Cardiovascular System: weak pulse, dizzy [nasn.org]

• Headache

  In milder cases hives may spread over the whole body, and often there is a severe headache. [britannica.com]

  dizziness, confusion, tunnel vision (10-15% of reactions) Other symptoms: swelling of the tongue, anxiety, headache, metallic taste, and some report a sense of impending doom. [nasn.org]

  This whole-body allergic reaction may cause: nausea vomiting abdominal cramps hives swelling of the lips diarrhea itchy skin anxiety headache joint swelling coughing, sneezing, wheezing shortness of breath itchy mouth and throat nasal congestion hoarseness [health.howstuffworks.com]

  Common side effects include fast, irregular or “pounding” heartbeat, sweating, nausea or vomiting, breathing problems, paleness, dizziness, weakness, shakiness, headache, feelings of over excitement, nervousness or anxiety. [epipen.com]

  The other symptoms include headache, seizures, loss of consciousness, a feeling of anxiety and urinary urgency. Anaphylaxis can be diagnosed on the basic of complete medical history including history about drugs and previous allergic reactions. [symptoma.com]

• Seizure

  Seizures as a manifestation of anaphylaxis are rare with 1 study claiming 13% of cases of anaphylaxis having LOC and only 1.5% cases with loss of bladder or bowel control. [ncbi.nlm.nih.gov]

  The past medical history of seizure disorders, psychological issues, mastocytosis and food allergies may also help to confirm the diagnosis. [symptoma.com]

  These include heart attacks, anxiety attacks, choking and seizures, among others. If you experience any unusual symptoms, it is vitally important to call 911 for prompt treatment and to determine the cause of the symptoms. [kcallergycenter.com]

  Cardiogenic shock (eg, acute congestive heart failure) Hypoglycemia Hypovolemic shock Panic attack Pulmonary embolism Septic shock Thyrotoxicosis Vasovagal response Neurologic symptoms (eg, syncope) Acute poisoning Anxiety/panic disorder Hypoglycemia Seizure [arupconsult.com]

Anaphylaxis can be diagnosed on the basic of complete medical history including history about drugs and previous allergic reactions. The past medical history of seizure disorders, psychological issues, mastocytosis and food allergies may also help to confirm the diagnosis.

On general physical examination, the common signs include arrhythmia, pulmonary edema, hives, low blood pressure, mental confusion, rapid pulse, swelling of the eyes and face, wheezing and weakness.

Blood tests for histamine might be useful in diagnosing anaphylaxis due to insect stings or medications. However, they are not specific for the diagnosis.

Anaphylaxis is a medical emergency that may require immediate therapy. There are different international recommendations for the management of anaphylaxis [9]. The general principles involved in the treatment include the following.

Cardiopulmonary resuscitation measures such as airway management, breathing and ventilation, supplemental oxygen, large volumes of intravenous fluids and close monitoring must be taken immediately [10].

The first line of approach to the treatment of anaphylaxis is the administration of adrenaline. It must be given intramuscularly into the mid anterolateral thigh as soon as the anaphylactic reaction is suspected. The injection may be repeated every 5-15 minutes.

Antihistamines and cortisone must be given to reduce inflammation of air passages and improve breathing. For circulatory collapse and hypotension, fluid therapy and vasopressors are given. It is very important to maintain airway by using bronchodilator drugs. Nebulized salbutamol may be effective for bronchospasm that does not resolve with epinephrine. A beta agonist such as albuterol is given to relieve breathing symptoms. Corticosteroids are administered in severe anaphylactic reactions. Oxygen inhalation is given for cyanosis or low oxygen tension PO2.

People prone to anaphylaxis are advised to have an ‘allergy action plan’. The action plan usually include use of epinephrine autoinjectors and counselling on avoidance of allergens. There are three types of autoinjectors including EpiPen, Jext and Emerade.

Immunotherapy is available for certain triggers now-a-days to prevent further episodes of anaphylactic reactions. A subcutaneous desensitization course has been found effective against stinging insects and for many foods.

In case of anaphylactic reactions, the prognosis is good if prompt treatment is available. The symptoms usually resolve with immediate, appropriate treatment. There are no long term effects of anaphylaxis other than the possibility of recurrence of the disease. Death usually occurs due to respiratory asphyxia or cardiovascular shock.

Anaphylaxis can occur in response to any allergen [3]. Foods are the most common triggers in children and young adults. Many foods can trigger anaphylaxis such as ingestion of peanuts, wheat, nuts, milk, eggs, grapes, bananas and certain types of seafood such as shell fish [4].

Medications including certain antibiotics, vaccines, opiates, aspirin, non-steroidal anti-inflammatory drugs, local anesthetics, intravenous fluids and insulin can cause life threatening allergic reactions [5].

The stings of fire ants, bees, wasps, yellow jackets, hornets, kissing bugs can also trigger anaphylactic reactions in susceptible individuals [6].

Pollens and other inhaled allergens rarely cause anaphylaxis. The other risk factors include use of latex products such as gloves, blood products including plasma, immunoglobulins and beta-blockers such as epinephrine.

Anaphylaxis is a severe allergic reaction that affects people of all ages. The number of people who gets anaphylaxis is 4 to 5 per 100,000 persons per year. The rates of anaphylactic reactions appear to be increasing being approximately 20 per 100,000 per year. In the United States, anaphylaxis leads to 500-1000 deaths per year. Food anaphylaxis is more common in children. Death from anaphylaxis is most commonly triggered by medications.

Anaphylaxis is a severe allergic reaction that is triggered by foreign antigens [7]. The route of entry of the allergen is usually parenteral. Ingestion also is common. Inhalation is less common.

Anaphylaxis occurs within few minutes to hours after exposure to the antigen. Immunoglobulin E binds to the antigen and the systemic manifestations are caused by the release of inflammatory mediators such as histamine from mast cells and basophils. These mediators trigger vasodilation, increase the leakage of fluid from blood vessels, and cause heart muscle depression.

Non-immunological mechanisms involve substances that directly cause the degranulation of mast cells and basophils. These include agents such as contrast medium, opioids, hot and cold temperature and vibration.

Anaphylaxis can be prevented by avoidance of known triggers such as foods and medications that have caused an allergic reaction in the past. The allergic reactions by stinging insects can be avoided by using insect repellents, wearing long sleeved shirts and pants and staying away from fields and grass.

A properly stocked emergency kit with prescribed medications available should be kept all the time. Wear a medical alert bracelet to indicate an allergy to specific drugs. The chances of exposure to food allergen can be reduced by checking the labels of foods before eating.

People who have a history of drug allergies may safely be given the offending medication after pretreatment with corticosteroids and antihistamines.

Anaphylaxis is a severe, life threatening systemic reaction caused by an IgE-mediated hypersensitivity reaction [1] [2]. It can be triggered by medications, foods, insect stings, exercise and unknown causes.

The condition is characterized by a sense of impending doom, tingling, flushing, shortness of breath, congestion, syncope, abdominal cramps and palpitations.

A severe allergic reaction usually occurs within 20 minutes to 2 hours of exposure to the triggering agents. The prognosis is good if the patient obtains medical treatment within 30 minutes.

Anaphylaxis is a serious allergic reaction. The most common allergic triggers are food, insect stings, medication and latex.

The symptoms of anaphylaxis skin rash, itching, shortness of breath, swelling of throat and low blood pressure. It may be life threatening if emergency treatment is not given.

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2. Johansson SG, Bieber T, Dahl R, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. The Journal of allergy and clinical immunology. May 2004;113(5):832-836.
3. Kemp SF, Lockey RF. Anaphylaxis: a review of causes and mechanisms. The Journal of allergy and clinical immunology. Sep 2002;110(3):341-348.
4. Wang J, Sampson HA. Food anaphylaxis. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology. May 2007;37(5):651-660.
5. Suzuki I. [Anaphylaxis due to drugs]. Nihon rinsho. Japanese journal of clinical medicine. Oct 28 2007;65 Suppl 8:313-317.
6. Bee-sting anaphylaxis. The Medical journal of Australia. Mar 6 1989;150(5):288.
7. Simons FE. Anaphylaxis pathogenesis and treatment. Allergy. Jul 2011;66 Suppl 95:31-34.
8. Lucke WC, Thomas H, Jr. Anaphylaxis: pathophysiology, clinical presentations and treatment. The Journal of emergency medicine. 1983;1(1):83-95.
9. Alrasbi M, Sheikh A. Comparison of international guidelines for the emergency medical management of anaphylaxis. Allergy. Aug 2007;62(8):838-841.
10. Willatts SM. Treatment of anaphylaxis. Anaesthesia. Oct 1979;34(9):910.