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Anaphylaxis

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


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.

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]
  • […] 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]
  • 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]
  • .) • 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]
Hoarseness
  • 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]
  • .) • 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]
  • A warning sign of dangerous throat swelling is a very hoarse or whispered voice, or coarse sounds when the person is breathing in air. If necessary, begin rescue breathing and CPR. Call 911. Calm and reassure the person.[nlm.nih.gov]
  • The respiratory symptoms include nasal congestion, sneezing, rhinorrhea, hoarseness, stridor, dyspnea, bronchospasm and hypoxia.[symptoma.com]
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]
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]
  • The respiratory symptoms include nasal congestion, sneezing, rhinorrhea, hoarseness, stridor, dyspnea, bronchospasm and hypoxia.[symptoma.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]
Dyspnea
  • PATIENT CONCERNS: 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]
  • A 39-year-old man was referred to emergency room for loss of consciousness and dyspnea after taking of PEG-3350 (Colyte ).[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.[merckmanuals.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]
  • Epidemiology: Lifetime prevalence anaphylaxis 0.05% to 2% ( Simons 2010 ) Increasing in children and adolescents 1% ED visits allergy-related ( Grunau 2015 ) Presentation (Davis 2011) : Signs and Symptoms Frequency (%) Urticaria and angioedema 85-90 Dyspnea[coreem.net]
Vomiting
  • 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 causes constriction of the airways, resulting in wheezing ; difficulty breathing ; and gastrointestinal symptoms such as abdominal pain, cramps, vomiting, and diarrhea.[web.archive.org]
  • […] 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]
  • 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
  • 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]
  • Shigella causes roughly 500,000 cases of diarrhea in the United States each year.[niaid.nih.gov]
  • Cardiovascular symptoms: lowered heart rate, lowered blood pressure, lightheadedness, dizziness, pale or blue appearance Epidermal symptoms: large number of hives, itching, redness around the eyes and all over Gastrointestinal symptoms: stomach ache, vomiting, diarrhea[premierallergyohio.com]
Nausea
  • 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]
  • […] symptoms: lowered heart rate, lowered blood pressure, lightheadedness, dizziness, pale or blue appearance Epidermal symptoms: large number of hives, itching, redness around the eyes and all over Gastrointestinal symptoms: stomach ache, vomiting, diarrhea, nausea[premierallergyohio.com]
  • The adrenaline may cause a fast or irregular heart beat, nausea and breathing difficulties. The EpiPen needs to be stored away from heat and light. Ask your specialist to explain when you should use it.[dermnetnz.org]
  • 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]
Abdominal Pain
  • 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]
  • 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]
  • 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[nlm.nih.gov]
  • This condition affects many systems of the body at the same time: Skin: hives, itchiness, and flushing Respiratory: shortness of breath Gastrointestinal: abdominal pain, diarrhea, and vomiting Cardiovascular: coronary artery spasm and possible heart attack[vitamindcouncil.org]
Abdominal Cramps
  • 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]
  • 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]
  • 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]
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]
  • For example, many people develop an itchy throat, cough, or lip swelling during immunotherapy. Desensitization is also possible for many medications, however it is advised that most people simply avoid the agent in question.[en.wikipedia.org]
  • 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]
Hypotension
  • Use of vasopressors should be considered if hypotension persists.[ncbi.nlm.nih.gov]
  • BACKGROUND AND OBJECTIVE: The present review investigated cold-induced anaphylaxis, a potentially life-threatening condition that occurs after exposure to cold stimuli and is characterized by respiratory distress and/or hypotension.[ncbi.nlm.nih.gov]
  • Persistent hypotension requires IV fluids and sometimes vasopressors.[merckmanuals.com]
  • Within seconds of applying 2% w/v chlorhexidine (ChloraPrep 3 mL Wand Applicator) to the skin surrounding the insertion point of his dialysis catheter (Tesio catheter), he developed pruritus, urticaria, shortness of breath, hypotension and reduced responsiveness[ncbi.nlm.nih.gov]
  • Four minutes later, he developed hypotension and a widespread erythematous rash. Multiple epinephrine boluses were administered and a continuous intravenous infusion of epinephrine commenced.[ncbi.nlm.nih.gov]
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]
  • 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
  • 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]
  • On the third day of treatment with amikacin, the newborn suddenly developed tachypnea, tachycardia, angioedema and cyanosis. Anaphylaxis was diagnosed and treated. Latent reaction occurred after one hour of clinical improvement.[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]
  • Wheezing Upper airway Laryngeal wheezing Lip swelling Rhinitis Stridor Tongue edema Cutaneous/mucosal tissue Most common symptoms Urticaria Generalized pruritus without rash Angioedema Erythema/flush Conjunctivitis Rhinitis Cardiovascular Hypotension Tachycardia[arupconsult.com]
  • Signs of anaphylaxis include hypotension, tachycardia, urticaria, angioedema, wheezing, stridor, cyanosis, and syncope. Shock can develop within minutes, and patients may have seizures, become unresponsive, and die.[merckmanuals.com]
Urticaria
  • Anaphylaxis is rarely associated to cold-induced urticarial (CU), a particular form of physical urticaria that is difficult to diagnose and manage.[ncbi.nlm.nih.gov]
  • Abstract Immediate reactions against contact to raw potato has been reported in adults with generally being in the form of an oral contact dermatitis or contact urticaria, but it may also manifest as rhinitis symptoms, wheezing or even anaphylaxis.[ncbi.nlm.nih.gov]
  • PATIENT CONCERNS: 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]
  • Yet because its symptoms imitate those of other diseases, such as asthma and urticaria, current data suggest that its diagnosis is often missed, with underuse of tryptase measurement; its treatment is delayed, with little use of epinephrine; and its underlying[ncbi.nlm.nih.gov]
  • The patient was challenged with lansoprazole at increasing doses (7.5 mg, 15 mg, 30 mg capsule) every 60 minutes and she reacted with urticaria to 52.5 mg cumulative dose of lansoprazole. She could tolerate ranitidine and famotidine tablets via OPT.[ncbi.nlm.nih.gov]
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]
  • On the third day of treatment with amikacin, the newborn suddenly developed tachypnea, tachycardia, angioedema and cyanosis. Anaphylaxis was diagnosed and treated. Latent reaction occurred after one hour of clinical improvement.[ncbi.nlm.nih.gov]
  • Patient electronic records with the diagnoses of allergy, angioedema, urticaria, and anaphylaxis (ICD-9 codes 9953, 9951, 7080, 9950, 7089) were screened and cases fulfilling World Allergy Organisation criteria for anaphylaxis were included.[ncbi.nlm.nih.gov]
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]
  • Abstract A 75-year-old Japanese woman presented with acute flushing pruritus and a feeling of diffuse warmth followed by collapse while dancing.[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
  • Abstract A 75-year-old Japanese woman presented with acute flushing pruritus and a feeling of diffuse warmth followed by collapse while dancing.[ncbi.nlm.nih.gov]
  • Within seconds of applying 2% w/v chlorhexidine (ChloraPrep 3 mL Wand Applicator) to the skin surrounding the insertion point of his dialysis catheter (Tesio catheter), he developed pruritus, urticaria, shortness of breath, hypotension and reduced responsiveness[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 most common clinical manifestations are cutaneous symptoms, including urticaria and angioedema, erythema, and pruritus.[aacijournal.biomedcentral.com]
  • 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]
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]
  • There may be confusion, a loss of bladder control or pelvic pain similar to that of uterine cramps. Dilation of blood vessels around the brain may cause headaches. A feeling of anxiety or of "impending doom" has also been described.[en.wikipedia.org]
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 to your body arrhythmias, a heartbeat that is either too fast or too slow heart attacks[healthline.com]
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]
  • 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]
  • […] 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]
  • […] 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]
  • 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]
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]
  • A 58-year-old woman undergoing bilateral knee replacements under spinal anesthesia experienced sudden seizure and cardiovascular collapse from acute anaphylactic shock while administering a cephalosporin.[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]
  • 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]
  • 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]

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.

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.

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.

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.

References

Article

  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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Last updated: 2017-08-09 17:41