Abstract
Anaphylaxis is a severe and often life-threatening allergic reaction mediated by mast cell degranulation in response to a variety of mediators. Early recognition and treatment are essential to reducing morbidity and mortality in patients. Anaphylaxis can have a multitude of presentations, but skin is the most common organ involved in anaphylaxis. However, the absence of cutaneous symptoms does not exclude a diagnosis of anaphylaxis, in fact, it is an independent risk factor for fatal anaphylaxis. Reduced blood pressure for age after exposure to a known allergen can be the only sign of anaphylaxis in some patients. Anaphylaxis is a clinical diagnosis but certain laboratory test, like serum tryptase, can be a helpful diagnostic tool. Many other illnesses like mastocytosis or serotonin syndrome can have similar or even near-identical presentations to anaphylaxis but can be differentiated by laboratory evaluation and a through history and physical exam. Epinephrine is the single most important therapy for the treatment of anaphylaxis. Delayed administration of epinephrine has been associated with fatal anaphylaxis and higher morbidity in patients of all ages. While medications like antihistamines and bronchodilators can help to alleviate some of the symptoms of anaphylaxis like pruritis and mild wheezing, they do not have the same degree of systemic efficacy as prompt administration of epinephrine.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
Abbreviations
- AAAAI:
-
American Academy of Allergy Asthma and Immunology
- ACE:
-
Angiotensin-converting enzyme
- ACEi:
-
Angiotensin-converting enzyme inhibitor
- COX-1:
-
Cyclooxygenase 1
- HaT:
-
Hereditary alpha tryptasemia
- ICAM-1:
-
Intracellular adhesion molecule 1
- IM:
-
Intramuscular
- IO:
-
Intraosseous
- IV:
-
Intravenous
- NMBA:
-
Neuromuscular blocking agent
- NSAID:
-
Non-steroidal anti-inflammatory drug
- PAF:
-
Platelet activating factor
- PGE2:
-
Prostaglandin E2
- PVFM:
-
Paradoxical vocal fold motion
- SC:
-
Subcutaneous
Bibliography
Reber LL, Hernandez JD, Galli SJ. The pathophysiology of anaphylaxis. J Allergy Clin Immunol. 2017;140(2):335–48.
Zilberstein J, et al. Anaphylaxis. J Emerg Med. 2014;47(2):182–7.
Vadas P, Perelman B, Liss G. Platelet-activating factor, histamine, and tryptase levels in human anaphylaxis. J Allergy Clin Immunol. 2013;131(1):144–9.
Payne V, Kam PCA. Mast cell tryptase: a review of its physiology and clinical significance. Anaesthesia. 2004;59(7):695–703.
Zilberstein J, McCurdy MT, Winters ME. Anaphylaxis. J Emerg Med. 2014;47(2):182–7. https://doi.org/10.1016/j.jemermed.2014.04.018. Epub 2014 Jun 2.
White JL, et al. Patients taking β-blockers do not require increased doses of epinephrine for anaphylaxis. J Allergy Clin Immunol Pract. 2018;6(5):1553–8.
Shaker MS, et al. Anaphylaxis—a 2020 practice parameter update, systematic review, and grading of recommendations, assessment, development and evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082–123.
Lyons JJ, et al. Heritable risk for severe anaphylaxis associated with increased α-tryptase–encoding germline copy number at TPSAB1. J Allergy Clin Immunol. 2020; https://doi.org/10.1016/j.jaci.2020.06.035.
Poowuttikul P, Seth D. Anaphylaxis in children and adolescents. Pediatr Clin N Am. 2019;66(5):995–1005.
Hungerford JM. Scombroid poisoning: a review. Toxicon. 2010;56(2):231–43.
Sjöblom S-M. Clinical presentation and prognosis of gastrointestinal carcinoid tumours. Scand J Gastroenterol. 1988;23(7):779–87.
Reubi JC, et al. Detection of somatostatin receptors in surgical and percutaneous needle biopsy samples of carcinoids and islet cell carcinomas. Cancer Res. 1990;50(18):5969–77.
Bork K, et al. Treatment of acute edema attacks in hereditary angioedema with a bradykinin receptor-2 antagonist (Icatibant). J Allergy Clin Immunol. 2007;119(6):1497–503.
Mertes PM, et al. Anaphylaxis during anesthesia in France: an 8-year national survey. J Allergy Clin Immunol. 2011;128(2):366–73.
Mertes PM, et al. Reducing the risk of anaphylaxis during anaesthesia: guidelines for clinical practice. J Investig Allergol Clin Immunol. 2005;15(2):91–101.
Gibbs NM, et al. Survival from perioperative anaphylaxis in Western Australia 2000–2009. Br J Anaesth. 2013;111(4):589–93.
Umasunthar T, et al. Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis. Clin Exp Allergy. 2013;43(12):1333–41.
Turner PJ, et al. Fatal anaphylaxis: mortality rate and risk factors. J Allergy Clin Immunol Pract. 2017;5(5):1169–78.
Jerschow E, et al. Fatal anaphylaxis in the United States, 1999–2010: temporal patterns and demographic associations. J Allergy Clin Immunol. 2014;134(6):1318–28.
Lee S, et al. Trends, characteristics, and incidence of anaphylaxis in 2001-2010: a population-based study. J Allergy Clin Immunol. 2017;139(1):182–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Kepes, J., Poowuttikul, P. (2022). Anaphylaxis. In: Mahmoudi, M. (eds) Absolute Allergy and Immunology Board Review. Springer, Cham. https://doi.org/10.1007/978-3-031-12867-7_25
Download citation
DOI: https://doi.org/10.1007/978-3-031-12867-7_25
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-12866-0
Online ISBN: 978-3-031-12867-7
eBook Packages: MedicineMedicine (R0)