Current Allergy and Asthma Reports

, Volume 2, Issue 1, pp 40–45 | Cite as

Idiopathic anaphylaxis

  • Johannes Ring
  • Ulf Darsow


Anaphylaxis represents the maximal variant of an immediatetype allergic reaction involving the whole organism with manifestations in different organ systems. IgE-mediated mast cell and basophil activation is the major pathomechanism; however, immune complex and pseudo-allergic reactions also may lead to the same symptomatology. The most common elicitors are drugs, additives, occupational substances, animal venoms, aeroallergens, and contact urticariogens but also physical factors (cold, heat, ultraviolet light, exercise). When no eliciting factors can be detected, the term “idiopathic anaphylaxis’ is used. The diagnosis of idiopathic anaphylaxis is, therefore, a diagnosis of exclusion and may be made only after careful allergy history taking and diagnosis involving in vitro tests. Possible mechanisms underlying the pathophysiology of idiopathic anaphylaxis include undetected diseases (eg, mastocytosis occulta), concomitant anaphylaxis-enhancing medication (â-blockers), secretion of histamine-releasing factor from T lymphocytes, autoantibodies against IgE or IgE receptors, and angiotensin II deficiency. One of the many differential diagnoses of anaphylaxis may have been overlooked. The treatment of idiopathic anaphylaxis follows the rules of antianaphylactic therapy.


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References and Recommended Reading

  1. 1.
    The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee: Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema. Lancet 1998, 351:1225–1232.CrossRefGoogle Scholar
  2. 2.
    Wüthrich B: Epidemiology of the allergic diseases: are they really on the increase? Int Arch Allergy Appl Immunol 1989, 90:3–10.PubMedGoogle Scholar
  3. 3.
    Ring J, Krämer U, Schäfer T, Behrendt H: Why are allergies increasing? Curr Opin Immunol 2001, 13:701–708.PubMedCrossRefGoogle Scholar
  4. 4.
    Korenblat PE, Wedner HJ: Allergy: Theory and Practice, edn. 2. Philadelphia: WB Saunders; 1992.Google Scholar
  5. 5.
    Müller U: Spätkomplikationen bei Anaphylaxie. In Allergie 2000: Probleme, Strategien und praktische Konsequenzen. Edited by Ring J, Darsow U. München, Germany: Dustri; 2001:249–252.Google Scholar
  6. 6.
    Yocum MW, Butterfield JH, Klein JS, et al.: Epidemiology of anaphylaxis in Olmsted County: A population-based study. J Allergy Clin Immunol 1999, 104:452–456. Few data on anaphylaxis are available on a population-based study background. This study provides evidence for prevalence that previously was assumed from clinical observations.PubMedCrossRefGoogle Scholar
  7. 7.
    Bochner BS, Lichtenstein LM: Anaphylaxis. N Engl J Med 1991, 324:81–88.Google Scholar
  8. 8.
    Klein JS, Yocum MW: Underreporting of anaphylaxis in a community emergency room. J Allergy Clin Immunol 1995, 95:637–638.PubMedCrossRefGoogle Scholar
  9. 9.
    Sorensen HT, Nielsen B, Ostergaard Nielsen J: Anaphylactic shock occurring outside hospitals. Allergy 1989, 44:288–290.PubMedCrossRefGoogle Scholar
  10. 10.
    Weiler S: Anaphylaxis in the general population: a frequent and occasionally fatal disorder that is underrecognized. J Allergy Clin Immunol 1999, 104:271–273.PubMedCrossRefGoogle Scholar
  11. 11.
    Ring J, Behrendt H: Anaphylaxis and anaphylactoid reactions. classification and pathophysiology. Clin Rev Allergy Immunol 1999, 17:387–399.PubMedGoogle Scholar
  12. 12.
    Ring J, Galosi A, Przybilla B: Contact anaphylaxis from emulgade F. Contact Dermatitis 1986, 15:49–40.CrossRefGoogle Scholar
  13. 13.
    Richet C, Portier P: De l’action anaphylactique de certains venins. C R Soc Biol (Paris) 1902, 54:170.Google Scholar
  14. 14.
    Hedin H, Richter W, Ring J: Dextran-induced anaphylactoid reactions in man. Int Arch Allergy Appl Immunol 1976, 52:145–159.PubMedGoogle Scholar
  15. 15.
    Ring J, Messmer K: Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet 1977, 1:466–469.PubMedCrossRefGoogle Scholar
  16. 16.
    Smedegard G, Revenäs B, Arfors KE: Anaphylaxis in the monkey: hemodynamics and blood flow distribution. Acta Physiol Scand 1979, 106:191.PubMedCrossRefGoogle Scholar
  17. 17.
    Smith PL, Kagey-Sobotka A, Bleecker ER et al.: Physiologic manifestations of human anaphylaxis. J Clin Invest 1980, 66:1072–1080.PubMedCrossRefGoogle Scholar
  18. 18.
    James LP, Austen KF: Fatal systemic anaphylaxis in man. N Engl J Med 1964, 270:597–603.PubMedCrossRefGoogle Scholar
  19. 19.
    Kemp SF, Lockey RF, Wolf BL, Lieberman P: Anaphylaxis: a review of 266 cases. Arch Intern Med 1995, 155:1749–1754.PubMedCrossRefGoogle Scholar
  20. 20.
    Lockey RF, Benedict LM, Turkeltaub TB, Bukantz SC: Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol 1987, 79:666–677.Google Scholar
  21. 21.
    Pumphrey RS: Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 2000, 30:1144–1150.PubMedCrossRefGoogle Scholar
  22. 22.
    Stark BJ, Sullivan TJ: Biphasic and protracted anaphylaxis. J Allergy Clin Immunol 1986, 78:76–83.PubMedCrossRefGoogle Scholar
  23. 23.
    Dorsch W, ed.: Late Phase Reactions. Boca Raton, FL: CRC Press; 1991.Google Scholar
  24. 24.
    Capurro N, Levi R: The heart as target organ in systemic allergic reactions: Circ Res 1975, 36:520–528.PubMedGoogle Scholar
  25. 25.
    Fisher MMD: Clinical observations on the pathophysiology and treatment of anaphylactic cardiovascular collapse. Anesth Intensive Care 1986, 17:17–21.Google Scholar
  26. 26.
    Marone G, Patelle V, de Crescanzo A, Genovese M: Human heart mast cells in anaphylaxis and cardiovascular disease. Int Arch Allergy Immunol 1995, 107:72–75.PubMedCrossRefGoogle Scholar
  27. 27.
    Pavek K, Wegmann A, Nordström L, Schwander D: Cardiovascular and respiratory mechanisms in anaphylactic and anaphylactoid shock reactions. Klin Wochenschr 1982, 60:941–947.PubMedCrossRefGoogle Scholar
  28. 28.
    Sullivan TJ: Cardiac disorders in penicillin-induced anaphylaxis: association with intravenous epinephrine therapy. JAMA 1982, 248:2161.PubMedCrossRefGoogle Scholar
  29. 29.
    Delage C, Irey HC: Anaphylactic deaths: a clinicopathologic study of 43 cases. J Forensic Sci 1972, 17:525–540.PubMedGoogle Scholar
  30. 30.
    Valentine MD, Lichtenstein LM: Anaphylaxis and stinging insect hypersensitivity. JAMA 1987, 258:2881–2885.PubMedCrossRefGoogle Scholar
  31. 31.
    Sheffer AL, Austen KF: Exercise-induced anaphylaxis. J Allergy Clin Immunol 1980, 66:106–111.PubMedCrossRefGoogle Scholar
  32. 32.
    Felix SB, Baumann G, Hashemi T, et al.: Characterization of cardiovascular events mediated by the platelet-activating factor during systemic anaphylaxis. J Cardiovasc Pharmacol 1990, 6:987–997. Platelet-activating factor as a mediator in anaphylaxis may explain cardiovascular symptoms.Google Scholar
  33. 33.
    Brockow K, Kiehn M, Rietmüller C, et al.: Efficacy of antihistamine pretreatment in the prevention of adverse reactions to hymenopta venom immunotherapy: a prospective randomized placebo-controlled trial. J Allergy Clin Immunol 1997, 100:458–463.PubMedCrossRefGoogle Scholar
  34. 34.
    De Soto H, Turk P: Cimetidine in anaphylactic shock refractory to standard therapy. Anesth Analg 1989, 69:264–265.PubMedCrossRefGoogle Scholar
  35. 35.
    Eisenberg MS, Mengest TJ: Cardiac resuscitation. New Engl J Med 2001, 344:1304–1313.PubMedCrossRefGoogle Scholar
  36. 36.
    Holgate T, Church MK, Lichtenstein LM, eds: Allergy, edn 2. London: Mosby; 2001.Google Scholar
  37. 37.
    Simons FE, Gu X, Johnston LM, Simons KJ: Can epinephrine inhalations be substituted for epinephrine injection in children at risk for systemic anaphylaxis? Pediatrics 2000, 106:1040–1044.PubMedCrossRefGoogle Scholar
  38. 38.
    Tryba M, Ahnefeld FW, Barth J, et al.: Akuttherapie anaphylaktoider Reaktionen. Ergebnisse einer interdisziplinären Konsensuskonferenz. Allergo J 1994, 3:211–222.Google Scholar
  39. 39.
    Meβmer K: Plasma substitutes and indications for their use. In Care of the Critically Ill Patient. Edited by Tinker J, Rapin M. Berlin: Springer; 1983.Google Scholar
  40. 40.
    Endrich B, Ring J, Intaglietta M: Effects of radiopaque contrast media on the microcirculation of the rabbit omentum. Radiology 1979, 132:331–339.PubMedGoogle Scholar
  41. 41.
    Lieberman P: Anaphylaxis and anaphylactoid reactions. In Allergy: Principles and Practice, vol 2, edn 5. Edited by Middleton E, Ellis EF, Yunginger JW, et al. St. Louis: Mosby Year-Book; 1998:1079–1902.Google Scholar
  42. 42.
    Schwartz LB, Bradford TR, Rouse C, et al.: Development of a new, more sensitive immunoassay for human tryptase: use in systemic anaphylaxis. J Clin Immunol 1994, 14:190–204.PubMedCrossRefGoogle Scholar
  43. 43.
    Brockow K, Vieluf D, Püschel K, et al.: Increased postmortem serum mast cell tryptase in a fatal anaphylactoid reaction to nonionic radiocontrast medium. J Allergy Clin Immunol 1999, 104:237–238. Description of methods to provide post-mortem evidence of anaphylaxis.PubMedCrossRefGoogle Scholar
  44. 44.
    Szczeklik A: Adverse reactions to aspirin and nonsteroidal antiinflammatory drugs. Ann Allergy 1987, 59:113–118.PubMedGoogle Scholar
  45. 45.
    Hannaway PJ, Hoppler GDK: Severe anaphylaxis and drug induced beta-blockage. N Engl J Med 1983, 308:1536.PubMedGoogle Scholar
  46. 46.
    Brown MJ, Brown DC, Murphy MB: Hypokalemia from beta-2-receptor stimulation by circulating epinephrine. N Engl J Med 1983, 309:1414–1419. Low levels of angiotensin II are associated with more severe anaphylactic symptoms.PubMedCrossRefGoogle Scholar
  47. 47.
    Zaloga GP, Delacey W, Holmboe E, Chernow B: Glucagon reversal of hypotension in a case of anaphylactoid shock. Ann Intern Med 1986, 105:65–66.PubMedGoogle Scholar
  48. 48.
    Horan RF, Sheffer AL: Food-dependent, exercise-induced anaphylaxis. Immunol Allergy Clin North Am 1991, 11:757.Google Scholar
  49. 49.
    Maulitz RM, Pratt DS, Schocket AL: Exercise-induced anaphylactic reaction to shellfish. J Allergy Clin Immunol 1979, 63:433–434.PubMedCrossRefGoogle Scholar
  50. 50.
    Rohrer CL, Pichler WJ, Helbling A, et al.: Anaphylaxis: clinical aspects, etiology and course in 118 patients [in German]. Schweiz Med Wochenschr 1998, 128:53–63.PubMedGoogle Scholar
  51. 51.
    Wiggins CA, Dykowicz MS, Patterson R: Idiopathic anaphylaxis. Classification, evaluation and treatment of 123 patients. J Allergy Clin Immunol 1988, 82:849–855.PubMedCrossRefGoogle Scholar
  52. 52.
    Przybilla B, Ludolph-Hauser D, Rueff F, et al.: Constitutively raised serum concentrations of mast-cell tryptase and severe anaphylactic reactions to Hymenoptera stings. Lancet 2001, 357:361–362. Occult systemic mastocytosis described as underestimated cause for anaphylactic reactions.PubMedCrossRefGoogle Scholar
  53. 53.
    Greaves MW, Hide M, Francis DM, Grattan CEH: Autoantibodies against the high affinity IgE receptor as a cause for histamine release in chronic urticaria. N Engl J Med 1995, 328:1599–1604. This paper describes a new pathophysiologic mechanism of chronic idiopathic urticaria.Google Scholar
  54. 54.
    Slater JE, Kaliner M: Effects of sex hormones on the histamine release in the recurrent idiopathic anaphylaxis. J Allergy Clin Immunol 1987, 80:285–290.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Johannes Ring
    • 1
  • Ulf Darsow
    • 1
  1. 1.Division Environmental Dermatology and Allergy GSF/TUM, Department of Dermatology and Allergy BiedersteinTechnical University MunichMunichGermany

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