Deterioration After Emergency Treatment for Asthma Attack

  • Sakine Işık
  • Suna Asilsoy

Practical Points

  • Anaphylaxis is a severe, life-threatening, systemic allergic reaction that occurs rapidly after contact with an inducing substance such as food, insect bite, drugs and latex

  • Inhaled beta-2 receptor agonists can cause both pulmonary and extrapulmonary adverse effects including anaphylaxis

  • Cross reaction can be seen between different skin prick test agents

  • SPTs are typically performed with the undiluted drug, in suspicion of drug-induced anaphylaxis. If negative, intradermal test is performed sequentially with increasing concentrations of the drug, to prevent the potential risk of inducing systemic symptoms


Drug-induced anaphylaxis Skin prick test Beta-2 receptor agonists 


  1. 1.
    Muraro A, Roberts G, Worm M, Bilo MB, Brockow K, Fernandez Rivas M, Santos AF, Zolkipli ZQ, Bellou A, Beyer K, Bindslev-Jensen C, Cardona V, Clark AT, Demoly P, Dubois AE, DunnGalvin A, Eigenmann P, Halken S, Harada L, Lack G, Jutel M, Niggemann B, Rueff F, Timmermans F, Vlieg-Boerstra BJ, Werfel T, Dhami S, Panesar S, Akdis CA, Sheikh A, Allergy EF, Anaphylaxis Guidelines Group. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69(8):1026–45.CrossRefGoogle Scholar
  2. 2.
    Simons FE, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK, Lockey RF, El-Gamal YM, Brown SG, Park HS, Sheikh A. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J. 2015;8(1):32.CrossRefGoogle Scholar
  3. 3.
    Lieberman P, Nicklas RA, Randolph C, Oppenheimer J, Bernstein D, Bernstein J, Ellis A, Golden DB, Greenberger P, Kemp S, Khan D, Ledford D, Lieberman J, Metcalfe D, Nowak-Wegrzyn A, Sicherer S, Wallace D, Blessing-Moore J, Lang D, Portnoy JM, Schuller D, Spector S, Tilles SA. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341–84.CrossRefGoogle Scholar
  4. 4.
    Alves B, Sheikh A. Age specific aetiology of anaphylaxis. Arch Dis Child. 2001;85(4):348.CrossRefGoogle Scholar
  5. 5.
    Hamann CP, Rodgers PA, Sullivan KM. Prevalence of type I natural rubber latex allergy among dental hygienists. J Dent Hyg. 2005;79(2):7.PubMedGoogle Scholar
  6. 6.
    Nettis E, Di Leo E, Calogiuri G, Milani M, Delle Donne P, Ferrannini A, Vacca A. The safety of a novel sublingual rush induction phase for latex desensitization. Curr Med Res Opin. 2010;26(8):1855–9.CrossRefGoogle Scholar
  7. 7.
    Cabanes N, Igea JM, de la Hoz B, Agustin P, Blanco C, Dominguez J, Lazaro M, Lleonart R, Mendez J, Nieto A, Rodriguez A, Rubia N, Tabar A, Beitia JM, Dieguez MC, Martinez-Cocera C, Quirce S, Committee of Latex Allergy; SEAIC. Latex allergy: position paper. J Investig Allergol Clin Immunol. 2012;22(5):313–30; quiz follow 30.PubMedGoogle Scholar
  8. 8.
    Windom HH, Burgess CD, Siebers RW, Purdie G, Pearce N, Crane J, Beasley R. The pulmonary and extrapulmonary effects of inhaled beta-agonists in patients with asthma. Clin Pharmacol Ther. 1990;48(3):296–301.CrossRefGoogle Scholar
  9. 9.
    Bonniaud P, Favrolt N, Collet E, Dumas JP, Guilloux L, Pauli G, Camus P. Salbutamol, terbutaline and pirbuterol allergy in an asthmatic patient. Allergy. 2007;62(10):1219–20.CrossRefGoogle Scholar
  10. 10.
    Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, Bircher A, Blanca M, Bonadonna B, Campi P, Castro E, Cernadas JR, Chiriac AM, Demoly P, Grosber M, Gooi J, Lombardo C, Mertes PM, Mosbech H, Nasser S, Pagani M, Ring J, Romano A, Scherer K, Schnyder B, Testi S, Torres M, Trautmann A, Terreehorst I, ENDA/EAACI Drug Allergy Interest Group. Skin test concentrations for systemically administered drugs -- an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68(6):702–12.CrossRefGoogle Scholar
  11. 11.
    Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010;105(4):259–73.CrossRefGoogle Scholar
  12. 12.
    Gonzalez de Olano D, Trujillo Trujillo MJ, Santos Magadan S, Menendez-Baltanas A, Gandolfo Cano M, Ariz Munoz S, Sanz Larruga ML, Gonzalez-Mancebo E. Anaphylaxis to salbutamol. J Investig Allergol Clin Immunol. 2008;18(2):139–40.PubMedGoogle Scholar
  13. 13.
    Mertes PM, Malinovsky JM, Jouffroy L, Working Group of the SFAR and SFA, Aberer W, Terreehorst I, Brockow K, Demoly P, ENDA; EAACI Interest Group on Drug Allergy. Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011;21(6):442–53.PubMedGoogle Scholar
  14. 14.
    Lin RY, Schwartz LB, Curry A, Pesola GR, Knight RJ, Lee HS, Bakalchuk L, Tenenbaum C, Westfal RE. Histamine and tryptase levels in patients with acute allergic reactions: an emergency department-based study. J Allergy Clin Immunol. 2000;106(1 Pt 1):65–71.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sakine Işık
    • 1
  • Suna Asilsoy
    • 2
  1. 1.Department of Pediatric Allergy and ImmunologySüreyyapaşa Chest Diseases and Thoracic Surgery Training HospitalIstanbulTurkey
  2. 2.Department of Pediatric Allergy and ImmunologyDokuz Eylul UniversityİzmirTurkey

Personalised recommendations