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Introduction
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Anaphylaxis is a severe, life-threatening systemic allergic reaction, typically rapid in onset with airway, breathing, or circulatory problems, and usually but not always, associated with skin and mucosal changes (Cardona et al., 2020). The goal of treatment is rapid recognition and administration of epinephrine to prevent respiratory or cardiac arrest (Campbell & Kelso, 2021).
Clinical Signs and Diagnosis (Campbell & Kelso, 2022; Cardona et al., 2020)
According to the World Allergy Organization, anaphylaxis is highly likely when one of the following two criteria is present:
- Acute onset of an illness (minutes to several hours) with simultaneous involvement of the skin, mucosal tissue, or both (i.e., general hives, pruritis or flushing, swollen lips-tongue-uvula), AND AT LEAST ONE OF THE FOLLOWING:
- Respiratory compromise (i.e., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow [PEF], increased labored breathing, persistent cough, cyanosis, hypoxemia)
- Reduced blood pressure (BP) or associated symptoms of end-organ dysfunction (i.e., hypotonia [collapse], chest pain, dysrhythmias, syncope, incontinence)
- Severe gastrointestinal symptoms (i.e., severe abdominal pain, repetitive vomiting), especially after exposure to non-food allergens
OR
- Acute onset of hypotension or bronchospasm or laryngeal involvement after exposure to a known or highly probable allergen for that patient (minutes to several hours), even in the absence of typical skin involvement.
Common Anaphylaxis Triggers (Cardona et al., 2020)
Immunologic Mechanisms (IgE Dependent): most common and frequent mechanism
- Foods: peanut, tree nuts, egg, soybean, fish, shellfish, milk, seeds (sesame), fruit, wheat
- Insects: bee and wasp venom, fire ants, horse fly
- Drugs: analgesics, antibiotics, biologics, chemotherapeutics, contrast media, proton pump inhibitors
Immunologic Mechanisms (IgE Independent):
- Radiocontrast media
- Non-steroidal anti-inflammatory drugs
- Dextrans such as high molecular weight iron
- Biologic agents (i.e., some monoclonal antibodies)
Nonimmunologic Mechanisms (Direct mast cell activation)
- Physical factors such as exercise, cold, heat, sunlight
- Ethanol
- Medications such as opioids
Idiopathic Anaphylaxis: no apparent triggers
- Previously unrecognized allergen
- Mastocytosis/clonal mast cell disorder