Question 1 of 10

    Anaphylaxis

    Angioedema2010[1]

    Anaphylaxis is a rapidly progressing, life-threatening allergic reaction.

    The disease is related to the following process: auto-immune.

    Presentation

    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.

    Skin
    Angioedema
    • Signs of anaphylaxis include hypotension, tachycardia, urticaria, angioedema, wheezing, stridor, cyanosis, and syncope.[merckmanuals.com]
    • Full-blown anaphylaxis includes urticaria (hives) and/or angioedema (tissue swelling) with hypotension (low blood pressure) and bronchospasm (asthma).[dermnetnz.org]
    • Cutaneous: Diffuse erythema, flushing, urticaria, pruritus, angioedema.[worldallergy.org]
    • Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension).[openanesthesia.org]
    • Examination may reveal urticaria, angioedema, wheezing, or laryngeal edema.[aafp.org]
    Flushing
    • Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension).[openanesthesia.org]
    • […] 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 warmth and flushing[health.howstuffworks.com]
    • ., generalized hives, pruritis or flushing, swollen lip-tongue-uvula) AND AT LEAST ONE OF THE FOLLOWING Respiratory compromise Reduced BP or associated symptoms of end-organ dysfunction Persistent GI Symptoms, Significant abdominal pain and/or significant[chop.edu]
    • Possible symptoms include: swelling in your mouth, throat, or other body part hives, rash, or itchy skin pale skin, or skin that is red and warm (flushed) trouble breathing or gasping for breath a tight feeling in your chest dizziness fainting stomach[familydoctor.org]
    • Within five minutes, she felt hot and flushed and began to have difficulty breathing.[asthmaandallergies.org]
    Urticaria
    • Signs of anaphylaxis include hypotension, tachycardia, urticaria, angioedema, wheezing, stridor, cyanosis, and syncope.[merckmanuals.com]
    • Cutaneous symptoms include pruritus, erythema, urticaria, and angioedema.[medical-dictionary.thefreedictionary.com]
    • Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension).[openanesthesia.org]
    • Cutaneous: Diffuse erythema, flushing, urticaria, pruritus, angioedema.[worldallergy.org]
    Pruritus
    • The most common clinical manifestations are cutaneous symptoms, including urticaria and angioedema, erythema, and pruritus.[aacijournal.biomedcentral.com]
    • The most common cutaneous clinical signs include erythema, urticaria, pruritus, wheals, and angioedema.[todaysveterinarypractice.navc.com]
    • Oral: Pruritus of lips, tongue and palate, edema of lips and tongue.[worldallergy.org]
    • Skin Affected in 85% of reactions Pruritus (itching) either localised or general Urticaria (hives), red rash and angioedema (swelling) Skin may feel hot Respiratory Affected in about 50% of reactions Shortness of breath, throat tightness, coughing, sneezing[dermnetnz.org]
    • Cutaneous symptoms include pruritus, erythema, urticaria, and angioedema.[medical-dictionary.thefreedictionary.com]
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  • urogenital
    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, metallic taste in mouth During anaphylaxis, a person may have trouble breathing or experience a drop in blood pressure.[foodallergycanada.ca]
    • 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]
    • Lower back pain in women (due to uterine cramping).[health.harvard.edu]
    • Genito-urinary: Uterine cramps, urinary urgency or incontinence.[worldallergy.org]
    Flank Pain
    • […] the transfusion must be stopped ; most Pts survive if 200 ml has been transfused in cases of red cell incompatibility-induced transfusion reaction; over 50% die when 500 ml or more has been transfused; TF mortality is 1.13/105 transfusions Clinical Flank[medical-dictionary.thefreedictionary.com]
    Kidney Failure
    • This can contribute to potential complications such as: brain damage kidney failure cardiogenic shock , a condition that causes your heart to not pump enough blood for your body arrhythmias , a heartbeat that is either too fast or too slow heart attacks[healthline.com]
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  • Eyes
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  • cardiovascular
    Hypotension
    • Hypotension often resolves after epinephrine is given.[merckmanuals.com]
    • These patients may have resistant severe hypotension, bradycardia, and a prolonged course.[aafp.org]
    • […] can lead to profound hypotension.[todaysveterinarypractice.navc.com]
    • Fluid therapy including colloid and crystalloid fluid therapy is especially important in patients with severe GI fluid losses and hypotension to replenish intravascular volume.[atdove.org]
    • Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension).[openanesthesia.org]
    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 9-1-1.[medlineplus.gov]
    • 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]
    • Skin: hives, swelling, itching, warmth, redness, rash Breathing (respiratory): coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness/swelling, hoarse voice, nasal congestion or hay fever-like symptoms (runny nose and watery eyes[foodallergycanada.ca]
    • 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]
    • pains Rapid or irregular heart beat Low blood pressure Gastrointestinal Stomach cramps Nausea, vomiting and diarrhoea Systemic Confusion, dizziness Tremor Collapse Diagnosis of anaphylaxis Because acute anaphylaxis can be immediately life threatening[dermnetnz.org]
    Tachycardia
    • Clinical signs of histamine release include rhinitis, pruritus, dyspnea, hypotension, and tachycardia. 13 Other Mediators Heparin is also released from mast cell granules.[todaysveterinarypractice.navc.com]
    • Signs of anaphylaxis include hypotension, tachycardia, urticaria, angioedema, wheezing, stridor, cyanosis, and syncope.[merckmanuals.com]
    • […] abdominal pain , abdominal cramping, nausea , vomiting , and diarrhea Respiratory symptoms : nasal congestion , runny nose , cough , shortness of breath , chest tightness, and wheezing Cardiovascular symptoms : dizziness , lightheadedness , fast heart rate (tachycardia[medicinenet.com]
    • Side effects of epinephrine may include palpitations, tachycardia (an abnormally fast heartbeat), sweating, nausea and vomiting, and respiratory difficulty.[latexallergyresources.org]
    • The symptoms are hypotension, decreasing levels of consciousness, tachycardia, and diminished production of urine.[medical-dictionary.thefreedictionary.com]
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  • musculoskeletal
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  • gastrointestinal
    Vomiting
    • […] swelling of 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[medlineplus.gov]
    • Vomiting Diarrhea Pale gums Cold limbs Excessive salivating or drooling Wheezing and difficulty breathing Increased heart rate or a weak pulse Seizures Shock Coma Some cases of anaphylaxis are less extreme and more localized.[dogtime.com]
    • If your child vomits, lay him on his side.[parents.com]
    • Anaphylaxis Symptoms The following are common symptoms experienced with a severe allergic reaction. swelling of the throat loss of consciousness constriction of airways pale skin hives weak pulse nausea, vomitting, diarrhea dizziness/fainting abdominal[premierallergist.com]
    • Rapid or irregular heart beat Dizziness , faintness Loss of consciousness, collapse General Tingling or sensation of warmth - Often the first symptom Difficulty swallowing Nausea , vomiting Diarrhea , abdominal cramping, bloating Anxiety , fear, feeling[emedicinehealth.com]
    Diarrhea
    • […] 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]
    • Anaphylaxis Symptoms The following are common symptoms experienced with a severe allergic reaction. swelling of the throat loss of consciousness constriction of airways pale skin hives weak pulse nausea, vomitting, diarrhea dizziness/fainting abdominal[premierallergist.com]
    • At least 12 times over the last two years, Jimmy, a 42-yearold construction worker, had a raised itchy rash, along with nausea, vomiting, and diarrhea.[asthmaandallergies.org]
    • Rapid or irregular heart beat Dizziness , faintness Loss of consciousness, collapse General Tingling or sensation of warmth - Often the first symptom Difficulty swallowing Nausea , vomiting Diarrhea , abdominal cramping, bloating Anxiety , fear, feeling[emedicinehealth.com]
    Nausea
    • The adrenaline may cause a fast or irregular heart beat, nausea and breathing difficulties.[dermnetnz.org]
    • Anaphylaxis Symptoms The following are common symptoms experienced with a severe allergic reaction. swelling of the throat loss of consciousness constriction of airways pale skin hives weak pulse nausea, vomitting, diarrhea dizziness/fainting abdominal[premierallergist.com]
    • Rapid or irregular heart beat Dizziness , faintness Loss of consciousness, collapse General Tingling or sensation of warmth - Often the first symptom Difficulty swallowing Nausea , vomiting Diarrhea , abdominal cramping, bloating Anxiety , fear, feeling[emedicinehealth.com]
    • Symptoms may include: Tightness or swelling of the throat Wheezing or difficulty breathing Uneasy sensation or agitation Generalized hives Severe itching of the skin Nausea and vomiting Stomach pain Heart failure Irregular heartbeats Lowered blood pressure[stanfordchildrens.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]
    Abdominal Pain
    • ., generalized hives, pruritis or flushing, swollen lip-tongue-uvula) AND AT LEAST ONE OF THE FOLLOWING Respiratory compromise Reduced BP or associated symptoms of end-organ dysfunction Persistent GI Symptoms, Significant abdominal pain and/or significant[chop.edu]
    • pain Loss of consciousness Diagnosis The diagnosis of allergy with a risk of anaphylactic reactions is made based on the person's history.[outpatientcc.com]
    • Possible symptoms and signs of an anaphylactic reaction include: Skin symptoms : itching , flushing, hives, and swelling (angioedema) Gastrointestinal symptoms : abdominal pain , abdominal cramping, nausea , vomiting , and diarrhea Respiratory symptoms[medicinenet.com]
    • The six patients who died had itching or tingling in the mouth, tightness of the throat, irritability, abdominal pain or vomiting within 3 to 30 minutes of eating the food.[nutramed.com]
    • They may include any of the following: Abdominal pain Feeling anxious Chest discomfort or tightness Diarrhea Difficulty breathing, coughing, wheezing, or high-pitched breathing sounds Difficulty swallowing Dizziness or lightheadedness Hives , itchiness[medlineplus.gov]
    Abdominal Cramps
    • Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension).[openanesthesia.org]
    • cramps or pain sense of impending doom Anaphylaxis Treatment Anaphylaxis is a medical emergency and needs to be addressed right away.[premierallergist.com]
    • Rapid or irregular heart beat Dizziness , faintness Loss of consciousness, collapse General Tingling or sensation of warmth - Often the first symptom Difficulty swallowing Nausea , vomiting Diarrhea , abdominal cramping, bloating Anxiety , fear, feeling[emedicinehealth.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]
    • In addition to shortness of breath, weakness and dizziness, persons suffering from anaphylaxis also frequently complain of a sense of impending doom, cough, chest tightness, trouble swallowing, abdominal cramps, or generalized itching.[wildsafe.org]
    Choking
    • You should also consider that the person could be choking.[icahn.mssm.edu]
    • Blood pressure drops severely and swelling occurs in the bronchial tissues, causing symptoms of choking and loss of consciousness .[my.clevelandclinic.org]
    • Even if he's older, don't give him an antihistamine if he's having any trouble breathing or swallowing, because he may choke on it.[babycenter.com]
    • 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.[merckmanuals.com]
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  • respiratoric
    Cough
    • […] 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]
    • Difficulty breathing, wheezing, chest tightness Coughing , hoarseness Nasal congestion, sneezing Cardiovascular : Blood pressure may drop to dangerously low levels.[emedicinehealth.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]
    • 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]
    • Skin: hives, swelling, itching, warmth, redness, rash Breathing (respiratory): coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness/swelling, hoarse voice, nasal congestion or hay fever-like symptoms (runny nose and watery eyes[foodallergycanada.ca]
    Hoarseness
    • Difficulty breathing, wheezing, chest tightness Coughing , hoarseness Nasal congestion, sneezing Cardiovascular : Blood pressure may drop to dangerously low levels.[emedicinehealth.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]
    • Skin: hives, swelling, itching, warmth, redness, rash Breathing (respiratory): coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness/swelling, hoarse voice, nasal congestion or hay fever-like symptoms (runny nose and watery eyes[foodallergycanada.ca]
    • .) • Wheezing • Passing out • Chest tightness • Trouble breathing, cough • Hoarse voice • Trouble swallowing • Vomiting • Diarrhea • Stomach cramping • Pale or red color to the face and body • Feeling of impending doom Diagnosis To diagnose your risk[aaaai.org]
    • […] red rash and angioedema (swelling) Skin may feel hot Respiratory Affected in about 50% of reactions Shortness of breath, throat tightness, coughing, sneezing, wheeze Upper airway obstruction indicated by nasal congestion, swelling of lips or tongue, hoarseness[dermnetnz.org]
    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]
    • Difficulty breathing, wheezing, chest tightness Coughing , hoarseness Nasal congestion, sneezing Cardiovascular : Blood pressure may drop to dangerously low levels.[emedicinehealth.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]
    • […] hives, swelling, itching, warmth, redness, rash Breathing (respiratory): coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness/swelling, hoarse voice, nasal congestion or hay fever-like symptoms (runny nose and watery eyes, sneezing[foodallergycanada.ca]
    • 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
    • Difficulty breathing, wheezing, chest tightness Coughing , hoarseness Nasal congestion, sneezing Cardiovascular : Blood pressure may drop to dangerously low levels.[emedicinehealth.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]
    • 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]
    • Skin: hives, swelling, itching, warmth, redness, rash Breathing (respiratory): coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness/swelling, hoarse voice, nasal congestion or hay fever-like symptoms (runny nose and watery eyes[foodallergycanada.ca]
    • congestion, swelling of lips or tongue, hoarseness Heart Chest pains Rapid or irregular heart beat Low blood pressure Gastrointestinal Stomach cramps Nausea, vomiting and diarrhoea Systemic Confusion, dizziness Tremor Collapse Diagnosis of anaphylaxis[dermnetnz.org]
    Dyspnea
    • Symptoms can include stridor, dyspnea, wheezing, and hypotension.[merckmanuals.com]
    • They include dyspnea, bronchospasm, stridor, tachypnea, and coughing.[todaysveterinarypractice.navc.com]
    • With the target organ of anaphylaxis in cats being the respiratory tract, cats are more likely to present with collapse and respiratory distress manifests as open mouth breathing, tachypnea, dyspnea, and hypoxemia.[atdove.org]
    • Respiratory compromise (e.g. dyspnea, wheeze, bronchospasm, stridor, reduced PEF, hypoxemia) b.[aacijournal.biomedcentral.com]
    • Anaphylaxis can be protracted, lasting for more than 24 hours, or recur after initial resolution. 5 , 6 View/Print Table TABLE 2 Frequency of Signs and Symptoms Signs and symptoms Frequency (%) Urticaria, angioedema 88 Dyspnea, wheeze 47 Dizziness, syncope[aafp.org]
    Rhinorrhea
    • Consider anaphylaxis if patients have unexplained hypotension, respiratory symptoms, or 2 anaphylactic manifestations (eg, angioedema, rhinorrhea, GI symptoms).[merckmanuals.com]
    • Respiratory: Upper airway obstruction from angioedema of the tongue, oropharynx or larynx; bronchospasm, chest tightness, cough, wheezing; rhinitis, sneezing, congestion, rhinorrhea.[worldallergy.org]
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  • neurologic
    Dizziness
    • […] 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]
    • Anaphylaxis Symptoms The following are common symptoms experienced with a severe allergic reaction. swelling of the throat loss of consciousness constriction of airways pale skin hives weak pulse nausea, vomitting, diarrhea dizziness/fainting abdominal[premierallergist.com]
    • Very quickly, she felt dizzy and nauseated.[asthmaandallergies.org]
    • Rapid or irregular heart beat Dizziness , faintness Loss of consciousness, collapse General Tingling or sensation of warmth - Often the first symptom Difficulty swallowing Nausea , vomiting Diarrhea , abdominal cramping, bloating Anxiety , fear, feeling[emedicinehealth.com]
    • […] 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: lowered heart rate, lowered blood pressure, lightheadedness, dizziness[premierallergyohio.com]
    Seizure
    • Without prompt treatment, anaphylactic shock almost always causes seizures, collapse, coma and/or death.[petwave.com]
    • Medication Allergies – While any medication can cause an allergic reaction , antibiotics and anti-seizure medications are the most common to cause anaphylaxis.[jaxallergy.com]
    • […] especially eggs, peanuts, seafood, cow's milk, soy, fish, shellfish, seeds, and tree nuts Insect stings or bites from bees, wasps, hornets, yellow jackets, and fire ants Medications such as antibiotics (especially penicillin), medications used in anesthesia, seizure[outpatientcc.com]
    • Vomiting Diarrhea Pale gums Cold limbs Excessive salivating or drooling Wheezing and difficulty breathing Increased heart rate or a weak pulse Seizures Shock Coma Some cases of anaphylaxis are less extreme and more localized.[dogtime.com]
    • Common medication triggers are: Penicillin (more often following a shot rather than a pill) Muscle relaxants like the ones used for anesthesia Aspirin , ibuprofen , and other NSAIDs (non-steroidal anti-inflammatory drugs) Anti- seizure medications Anaphylaxis[webmd.com]
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  • Face, Head & Neck
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  • Entire body system
    Malaise
    • Moderate reactions include a range of symptoms, including malaise; urticaria; pulmonary congestion, dyspnea, wheezing, and bronchospasm; hoarseness; edema of the periorbital tissue and/or tongue, larynx, and pharynx; dysphagia; nausea; vomiting; diarrhea[medical-dictionary.thefreedictionary.com]
    Rigor
    • URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability.[umm.edu]
    Chills
    • […] are either minor–occurring in 1:40 transfusions and attributed to nonspecific leukocyte-derived pyrogens, or major–occurring in 1:3000 transfusions and caused by a true immune reaction, which is graded according to the presence of urticaria, itching, chills[medical-dictionary.thefreedictionary.com]
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  • Jaw & Teeth
    Lip Swelling
    • 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]
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  • Workup

    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.

    Laboratory

    Serum
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  • Treatment

    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.

    Prognosis

    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.

    Complications

    Anaphylaxis
    • See anaphylactic shock . an'a·phy·lac'tic (-lāk'tĭk) adj. anaphylaxis in Science Nearby words for anaphylaxis Difficulty index for anaphylaxis Few English speakers likely know this word Word Value for anaphylaxis Scrabble Words With Friends[dictionary.com]
    Shock
    • ) anaphylactic reaction or shock due to adverse food reaction ( T78.0- ) anaphylactic reaction or shock due to serum ( T80.5- ) Anaphylactic shock, unspecified Approximate Synonyms Anaphylaxis Anaphylaxis (severe whole-body allergic reaction) Anaphylaxis[icd10data.com]
    • Severe Allergic Reaction (Anaphylactic Shock) (cont.)[emedicinehealth.com]
    • (Picture Credit: Getty Images) Anaphylaxis in dogs is a severe allergic reaction that can result in anaphylactic shock , respiratory or cardiac failure, or even death.[dogtime.com]
    Urticaria
    • Signs of anaphylaxis include hypotension, tachycardia, urticaria, angioedema, wheezing, stridor, cyanosis, and syncope.[merckmanuals.com]
    • Cutaneous symptoms include pruritus, erythema, urticaria, and angioedema.[medical-dictionary.thefreedictionary.com]
    • Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension).[openanesthesia.org]
    • Cutaneous: Diffuse erythema, flushing, urticaria, pruritus, angioedema.[worldallergy.org]
    Coma
    • Without prompt treatment, anaphylactic shock almost always causes seizures, collapse, coma and/or death.[petwave.com]
    • Vomiting Diarrhea Pale gums Cold limbs Excessive salivating or drooling Wheezing and difficulty breathing Increased heart rate or a weak pulse Seizures Shock Coma Some cases of anaphylaxis are less extreme and more localized.[dogtime.com]
    • If not treated immediately, respiratory arrest, cardiac arrhythmia, circulatory collapse, seizures, coma, and death rapidly ensue. interventions Treatment centers on immediate and aggressive management of emerging symptoms.[medical-dictionary.thefreedictionary.com]
    Sudden Death
    • Idiopathic anaphylaxis , i.e. cause unknown Severity of reactions from anaphylaxis can vary from mild symptoms to sudden death.[dermnetnz.org]
    • Anaphylaxis can be triggered by exertion after eating certain foods and may be responsible for sudden deaths in healthy athletes as well as people with known asthma and food allergy who exercise with unaccustomed vigor.[nutramed.com]
    Cardiac Arrhythmia
    • Cardiac arrhythmias may follow administration of epinephrine.[latexallergyresources.org]
    • Cimetidine offers the theoretical benefit of reducing both histamine-induced cardiac arrhythmias, which are mediated via H2 receptors, and anaphylaxis-associated vasodilation, mediated by H1 and H2 receptors.[worldallergy.org]
    • Although isoproterenol may be able to overcome depression of myocardial contractility caused by beta blockers, it also may aggravate hypotension by inducing peripheral vasodilation and may induce cardiac arrhythmias and myocardial necrosis.[aafp.org]
    • If not treated immediately, respiratory arrest, cardiac arrhythmia, circulatory collapse, seizures, coma, and death rapidly ensue. interventions Treatment centers on immediate and aggressive management of emerging symptoms.[medical-dictionary.thefreedictionary.com]
    • Careful auscultation may reveal cardiac arrhythmias.[todaysveterinarypractice.navc.com]
    Asthma
    • In fact, epinephrine was used to treat asthma attacks before other asthma medications were available.[foodallergyawareness.org]
    • People with asthma often have allergies as well.[aafa.org]
    • Some people with asthma have severe food allergies as well, but the two do not always go together.[icahn.mssm.edu]
    • Annals of Allergy, Asthma & Immunology . 112 (2): 126–31.[en.wikipedia.org]
    • Asthma that isn't well controlled raises the risk of death from anaphylaxis, as does cardiovascular disease.[health.harvard.edu]
    Acidosis
    • Airway needs are maintained, vital signs are monitored for hypotension, blood gases are monitored for acidosis, ECG is monitored for dysrhythmias, and fluid volume is replaced with IV solutions.[medical-dictionary.thefreedictionary.com]
    Laryngeal Edema
    • If pharyngeal or laryngeal edema is present, a tracheostomy may be indicated.[merckvetmanual.com]
    • Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension).[openanesthesia.org]
    • It is less common for dogs to have respiratory distress associated with anaphylaxis unless facial and laryngeal edema are severe.[atdove.org]
    • The usual causes of death are cardiovascular collapse, which means that the heart cannot supply the body with the oxygen it needs; or laryngeal edema, which means that the throat swells up and prevents the person from breathing in enough oxygen to survive[medbroadcast.com]
    • Examination may reveal urticaria, angioedema, wheezing, or laryngeal edema.[aafp.org]
    Hypotension
    • Hypotension often resolves after epinephrine is given.[merckmanuals.com]
    • These patients may have resistant severe hypotension, bradycardia, and a prolonged course.[aafp.org]
    • […] can lead to profound hypotension.[todaysveterinarypractice.navc.com]
    • Fluid therapy including colloid and crystalloid fluid therapy is especially important in patients with severe GI fluid losses and hypotension to replenish intravascular volume.[atdove.org]
    • Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension).[openanesthesia.org]
    Hypoxia
    Pulmonary Edema
    • Pulmonary edema can result from fluids leaking into the alveoli (air sacs) of the lung.[encyclopedia.com]
    Lactic Acidosis
    • acidosis, available calcium, hemoglobin's affinity for O 2 and causes K leakage, a major concern in cold hemoglobinuria • Hemolysis A phenomenon due to blood collection trauma, a clinically insignificant problem • Hyperammonemia and lactic acid Both[medical-dictionary.thefreedictionary.com]
    Syncope
    • Reduced BP or associated symptoms (e.g., hypotonia [collapse], syncope, incontinence) d.[aacijournal.biomedcentral.com]
    • Signs of anaphylaxis include hypotension, tachycardia, urticaria, angioedema, wheezing, stridor, cyanosis, and syncope.[merckmanuals.com]
    • Cardiovascular: Faintness, hypotension, arrhythmias, hypovolemic shock, syncope, chest pain.[worldallergy.org]
    • , and panic attacks . [3] Asthma however typically does not entail itching or gastrointestinal symptoms, syncope presents with pallor rather than a rash, and a panic attack may have flushing but does not have hives. [3] Other conditions that may present[en.wikipedia.org]
    • ., dizziness, syncope, hypotension) affect about one third of patients.[aafp.org]
    Edema
    • If pharyngeal or laryngeal edema is present, a tracheostomy may be indicated.[merckvetmanual.com]
    • It is less common for dogs to have respiratory distress associated with anaphylaxis unless facial and laryngeal edema are severe.[atdove.org]
    • Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension).[openanesthesia.org]
    • Bronchospasm and upper airway edema may require inhaled or injected beta-agonists and sometimes endotracheal intubation.[merckmanuals.com]
    • Reported mild clinical signs include edema, urticaria, vomiting, and dyspnea.[todaysveterinarypractice.navc.com]
    Angioedema
    • Signs of anaphylaxis include hypotension, tachycardia, urticaria, angioedema, wheezing, stridor, cyanosis, and syncope.[merckmanuals.com]
    • Full-blown anaphylaxis includes urticaria (hives) and/or angioedema (tissue swelling) with hypotension (low blood pressure) and bronchospasm (asthma).[dermnetnz.org]
    • Cutaneous: Diffuse erythema, flushing, urticaria, pruritus, angioedema.[worldallergy.org]
    • Presentation can be mild (flushing, rash, urticaria, abdominal cramping, diarrhea) or severe (angioedema, laryngeal edema, bronchospasm, hypotension).[openanesthesia.org]
    • Examination may reveal urticaria, angioedema, wheezing, or laryngeal edema.[aafp.org]
    Upper Airway Obstruction
    • airway obstruction Lower airway symptoms Circulatory abnormality ADDITIONAL ANAPHYLAXIS MEDICATIONS (Dosing) Consider the use of the following adjunctive medications: Antihistamines Corticosteroids EPINEPHRINE DOSING 5 kg 0.01 mg/kg Epinephrine IM (0.1[chop.edu]
    • Respiratory: Upper airway obstruction from angioedema of the tongue, oropharynx or larynx; bronchospasm, chest tightness, cough, wheezing; rhinitis, sneezing, congestion, rhinorrhea.[worldallergy.org]
    • airway obstruction indicated by nasal congestion, swelling of lips or tongue, hoarseness Heart Chest pains Rapid or irregular heart beat Low blood pressure Gastrointestinal Stomach cramps Nausea, vomiting and diarrhoea Systemic Confusion, dizziness Tremor[dermnetnz.org]
    • Physical findings include rapid heart rate, low blood pressure, and other evidence of shock, upper airway obstruction ( stridor ) and lower airway obstructions (wheezes) with labored breathing, generalized skin redness, hives, and swelling of the mouth[wildsafe.org]
    • Tracheostomy tube — A tube which is inserted into an incision in the trachea (tracheostomy) to relieve upper airway obstruction.[medical-dictionary.thefreedictionary.com]
    Septic Shock
    • Other conditions, such as heart attacks, blood clots to the lungs (pulmonary embolus ), septic shock, and panic attacks can also be confused with anaphylaxis.[medicinenet.com]
    • These include a life-threatening asthma attack , or a severe blood infection (septic shock) .[patient.info]
    • View/Print Table TABLE 4 Differential Diagnosis for Anaphylaxis Presentation Differential diagnosis Hypotension Septic shock Vasovagal reaction Cardiogenic shock Hypovolemic shock Respiratory distress with wheezing or stridor Airway foreign body Asthma[aafp.org]
    Drug Hypersensitivity
    • "Acute symptoms of drug hypersensitivity (urticaria, angioedema, anaphylaxis, anaphylactic shock)" (PDF) .[en.wikipedia.org]
    • Anaphylaxis triggered by antibiotics involves primarily penicillins and cephalosporins (70%) which share the β-lactam ring. 20 It may occur at first exposure. 1,21 The European Network Drug Allergy interest group on drug hypersensitivity proposed the[anesthesiology.pubs.asahq.org]
    Food Allergy
    • Learn about available treatments for severe food allergy reactions.[foodallergy.org]
    • However, any food allergy could potentially result in anaphylaxis.[icahn.mssm.edu]
    • FAACT’s Food allergy is the leading cause of anaphylaxis.[foodallergyawareness.org]
    • Second symposium on the definition and management of anaphylaxis: summary report--second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium.[arupconsult.com]
    Atopic Dermatitis
    • A history of environmental allergies , eczema ( atopic dermatitis ), or asthma may also raise the risk of anaphylaxis.[medicinenet.com]
    • In the Rochester Epidemiology Project, 53% of the patients with anaphylaxis had a history of atopic diseases (eg, allergic rhinitis , asthma , atopic dermatitis ). [11] The Memphis study detected atopy in 37% of the patients. [ 29 ] Other studies have[emedicine.medscape.com]
    Respiratory Failure
    • Equipment for endotracheal intubation should be available for immediate use in event of respiratory failure and is indicated for poor mentation, respiratory failure, or stridor not responding immediately to supplemental oxygen and epinephrine.[worldallergy.org]
    • If an airway is not maintained and supplemental oxygen provided, the person will die of respiratory failure.[medical-dictionary.thefreedictionary.com]
    • Hypotension was reported in 80% and respiratory failure occurred in 10% of NFRs, exclusively in subjects with asthma.[emedicine.medscape.com]
    Eosinophilia
    • […] person who died from anaphylaxis, autopsy may show an "empty heart" attributed to reduced venous return from vasodilation and redistribution of intravascular volume from the central to the peripheral compartment. [35] Other signs are laryngeal edema, eosinophilia[en.wikipedia.org]
    • Lab workup Tissue eosinophilia, serum mast cell tryptase, allergen-specific IgE antibodies.[medical-dictionary.thefreedictionary.com]

    Etiology

    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.

    Causes

    Hypoxia
    Peanut Allergy

    Epidemiology

    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.

    Sex distribution
    Age distribution

    Pathophysiology

    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.

    Prevention

    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.

    Summary

    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.

    Patient Information

    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.

    Other symptoms

    Bites and Stings
    • First Aid Basics Symptoms Bites and Stings Orthopedic Emergencies Soft Tissue Injuries Breathing Emergencies Emergency Preparedness First Aid at Home Allergies and Anaphylaxis Infections Calling for Help Heat and Cold Exposure Pediatric Emergencies Glossary[verywell.com]
    • These include insect bites and stings, food or chemicals used to prepare food , injections of medication or vaccines, and other types of medication.[dogtime.com]
    • If insect bites or stings cause trouble, help your baby find places to play that are free of bugs.[babycenter.com]
    • It may occur directly after a bite or sting, or in some cases it can take up to an hour.[premierallergyohio.com]
    • […] or stings , foods, and medication . [8] [18] Foods are the most common trigger in children and young adults while medications and insect bites and stings are more common in older adults. [3] Less common causes include: physical factors, biological agents[en.wikipedia.org]

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    References

    1. Simons FE. Anaphylaxis. The Journal of allergy and clinical immunology. Feb 2010;125(2 Suppl 2):S161-181.
    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.

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