Anaphylaxis and Systemic Allergic Reactions

  • Jocelyn Celestin
Living reference work entry


Anaphylaxis is a severe and potentially life-threatening reaction associated with massive release in the circulation of potent, vasoactive products from mast cells and basophils. Those vasoactive chemicals can profoundly impact the integrity of multiple life-sustaining organs and systems such as the cardiovascular and pulmonary systems. Anaphylaxis is most commonly due to exposure to allergens such as medications, usually antibiotics, foods, hymenoptera stings, and triatoma bites and mast cell activators such as radiocontrast media and certain medications. In some cases, anaphylaxis is labeled idiopathic when no etiology can be found.

During anaphylaxis, patients may experience hives, itching, and hypotension that may lead to dizziness, unconsciousness, and seizures as well as swelling of the upper and lower airways causing respiratory distress. One of the clinical manifestations of anaphylaxis is wheezing due to acute bronchospasm. Wheezing tends to occur particularly in patients with a history of asthma. Many of the symptoms of anaphylaxis are due to the effects of histamine, platelet-activating factor (PAF), and proteases on the cardiovascular, respiratory, and cutaneous systems.

The diagnosis of anaphylaxis can be challenging due to its syndromic nature and the variability of its manifestations as well as its transient duration. Perioperative anaphylaxis is a case in point as the signs and symptoms may not be obvious in the anesthetized and draped patient. During childhood, anaphylaxis can be confused with irritability, foreign body aspiration, and sepsis. Anaphylaxis can be uniphasic, biphasic, or protracted. Therefore, patients should be monitored closely and treated for recurrent symptoms. Several factors can put patients at higher risk of anaphylaxis including mast cell disease, exercise, and medications such as beta-blockers.

Anaphylaxis can be fatal, especially when treatment with epinephrine is delayed or is ineffective because of concomitant use of drugs such as beta-blockers and/or ACE inhibitors. Patients with uncontrolled asthma may also be at higher risk of fatal anaphylaxis. Anaphylaxis should be addressed promptly and aggressively and almost always can be managed successfully.


Anaphylaxis Epinephrine Histamine Tryptase Hymenoptera venom allergy Anaphylactic shock Hypotension Biphasic anaphylaxis Mastocytosis Antihistamine Glucagon 


  1. Akin C, Scott LM, Kocabas CN, Kushnir-Sukhov N, Brittain E, Noel P, Metcalfe DD. Demonstration of an aberrant mast-cell population with clonal markers in a subset of patients with “idiopathic” anaphylaxis. Blood. 2007;110:2331–3.PubMedPubMedCentralCrossRefGoogle Scholar
  2. Bender L, Weidmann H, Rose-John S, Renne T, Long AT. Factor XII-driven inflammatory reactions with implications for anaphylaxis. Front Immunol. 2017;8:1115.PubMedPubMedCentralCrossRefGoogle Scholar
  3. Boden SR, Wesley Burks A. Anaphylaxis: a history with emphasis on food allergy. Immunol Rev. 2011;242: 247–57.PubMedPubMedCentralCrossRefGoogle Scholar
  4. Bonadonna P, Perbellini O, Passalacqua G, Caruso B, Colarossi S, Dal Fior D, Castellani L, Bonetto C, Frattini F, Dama A, Martinelli G, Chilosi M, Senna G. Clonal mast cell disorders in patients with systemic reactions to Hymenoptera stings and increased serum tryptase levels. J Allergy Clin Immunol. 2009;123:680–6.PubMedCrossRefPubMedCentralGoogle Scholar
  5. Brown SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol. 2004;114:371–6.PubMedCrossRefGoogle Scholar
  6. Brown SG, Stone SF, Fatovich DM, Burrows SA, Holdgate A, Celenza A, Coulson A, Hartnett L, Nagree Y, Cotterell C, Isbister GK. Anaphylaxis: clinical patterns, mediator release, and severity. J Allergy Clin Immunol. 2013;132:1141–9.e5.PubMedCrossRefPubMedCentralGoogle Scholar
  7. Caubet JC, Ford LS, Sickles L, Jarvinen KM, Sicherer SH, Sampson HA, Nowak-Wegrzyn A. Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol. 2014;134:382–9.PubMedCrossRefPubMedCentralGoogle Scholar
  8. Celestin J, Heiner DC. Food-induced anaphylaxis. West J Med. 1993;158:610–1.PubMedPubMedCentralGoogle Scholar
  9. Chaudhuri K, Gonzales J, Jesurun CA, Ambat MT, Mandal-Chaudhuri S. Anaphylactic shock in pregnancy: a case study and review of the literature. Int J Obstet Anesth. 2008;17:350–7.PubMedCrossRefPubMedCentralGoogle Scholar
  10. Cheng A. Emergency treatment of anaphylaxis in infants and children. Paediatr Child Health. 2011;16:35–40.PubMedPubMedCentralGoogle Scholar
  11. Cianferoni A, Muraro A. Food-induced anaphylaxis. Immunol Allergy Clin North Am. 2012;32:165–95.PubMedCrossRefGoogle Scholar
  12. Dona I, Salas M, Perkins JR, Barrionuevo E, Gaeta F, Cornejo-Garcia JA, Campo P, Torres MJ. Hypersensitivity reactions to non-steroidal anti-inflammatory drugs. Curr Pharm Des. 2016;22:6784–802.PubMedCrossRefGoogle Scholar
  13. Eastman NJ. Mount Everest in utero. Am J Obstet Gynecol. 1954;67:701–11.PubMedCrossRefGoogle Scholar
  14. Feldweg AM. Food-dependent, exercise-induced anaphylaxis: diagnosis and management in the outpatient setting. J Allergy Clin Immunol Pract. 2017;5:283–8.PubMedCrossRefGoogle Scholar
  15. Fellinger C, Hemmer W, Wohrl S, Sesztak-Greinecker G, Jarisch R, Wantke F. Clinical characteristics and risk profile of patients with elevated baseline serum tryptase. Allergol Immunopathol (Madr). 2014;42: 544–52.CrossRefGoogle Scholar
  16. Fenny N, Grammer LC. Idiopathic anaphylaxis. Immunol Allergy Clin North Am. 2015;35:349–62.PubMedCrossRefGoogle Scholar
  17. Finkelman FD. Anaphylaxis: lessons from mouse models. J Allergy Clin Immunol. 2007;120:506–15; quiz 516–7.PubMedCrossRefGoogle Scholar
  18. Frapsauce C, Berthaut I, de Larouziere V, d’Argent EM, Autegarden JE, Elloumi H, Antoine JM, Mandelbaum J. Successful pregnancy by insemination of spermatozoa in a woman with a human seminal plasma allergy: should in vitro fertilization be considered first? Fertil Steril. 2010;94:753.e1–3.CrossRefGoogle Scholar
  19. Friedman SA, Bernstein IL, Enrione M, Marcus ZH. Successful long-term immunotherapy for human seminal plasma anaphylaxis. JAMA. 1984;251:2684–7.PubMedCrossRefGoogle Scholar
  20. Geha RS, Beiser A, Ren C, Patterson R, Greenberger PA, Grammer LC, Ditto AM, Harris KE, Shaughnessy MA, Yarnold PR, Corren J, Saxon A. Multicenter, double-blind, placebo-controlled, multiple-challenge evaluation of reported reactions to monosodium glutamate. J Allergy Clin Immunol. 2000;106:973–80.PubMedCrossRefGoogle Scholar
  21. Gei AF, Pacheco LD, Vanhook JW, Hankins GD. The use of a continuous infusion of epinephrine for anaphylactic shock during labor. Obstet Gynecol. 2003;102:1332–5.PubMedGoogle Scholar
  22. Gill P, Jindal NL, Jagdis A, Vadas P. Platelets in the immune response: revisiting platelet-activating factor in anaphylaxis. J Allergy Clin Immunol. 2015;135: 1424–32.PubMedCrossRefGoogle Scholar
  23. Gonzalez-de-Olano D, Lombardo C, Gonzalez-Mancebo E. The difficult management of anaphylaxis in the elderly. Curr Opin Allergy Clin Immunol. 2016;16: 352–60.PubMedCrossRefGoogle Scholar
  24. Greenberger PA, Patterson R. The prevention of immediate generalized reactions to radiocontrast media in high-risk patients. J Allergy Clin Immunol. 1991;87:867–72.PubMedCrossRefGoogle Scholar
  25. Greenberger PA, Rotskoff BD, Lifschultz B. Fatal anaphylaxis: postmortem findings and associated comorbid diseases. Ann Allergy Asthma Immunol. 2007;98: 252–7.PubMedCrossRefGoogle Scholar
  26. Grunau BE, Li J, Yi TW, Stenstrom R, Grafstein E, Wiens MO, Schellenberg RR, Scheuermeyer FX. Incidence of clinically important biphasic reactions in emergency department patients with allergic reactions or anaphylaxis. Ann Emerg Med. 2014;63:736–44.e2.PubMedCrossRefGoogle Scholar
  27. Horakova Z, Keiser HR, Beaven MA. Blood and urine histamine levels in normal and pathological states as measured by a radiochemical assay. Clin Chim Acta. 1977;79:447–56.PubMedCrossRefGoogle Scholar
  28. Hosseinian L, Weiner M, Levin MA, Fischer GW. Methylene blue: magic bullet for vasoplegia? Anesth Analg. 2016;122:194–201.PubMedCrossRefGoogle Scholar
  29. Hox V, Desai A, Bandara G, Gilfillan AM, Metcalfe DD, Olivera A. Estrogen increases the severity of anaphylaxis in female mice through enhanced endothelial nitric oxide synthase expression and nitric oxide production. J Allergy Clin Immunol. 2015;135:729–36.e5.PubMedCrossRefGoogle Scholar
  30. Hsu Blatman KS, Hepner DL. Current knowledge and management of hypersensitivity to perioperative drugs and radiocontrast media. J Allergy Clin Immunol Pract. 2017;5:587–92.PubMedCrossRefGoogle Scholar
  31. Hungerford JM. Scombroid poisoning: a review. Toxicon. 2010;56:231–43.PubMedCrossRefPubMedCentralGoogle Scholar
  32. Itsekson AM, Seidman DS, Zolti M, Alesker M, Carp HJ. Steroid hormone hypersensitivity: clinical presentation and management. Fertil Steril. 2011;95: 2571–3.PubMedCrossRefPubMedCentralGoogle Scholar
  33. Jarvinen KM, Celestin J. Anaphylaxis avoidance and management: educating patients and their caregivers. J Asthma Allergy. 2014;7:95–104.PubMedPubMedCentralCrossRefGoogle Scholar
  34. Koplin JJ, Martin PE, Allen KJ. An update on epidemiology of anaphylaxis in children and adults. Curr Opin Allergy Clin Immunol. 2011;11:492–6.PubMedCrossRefPubMedCentralGoogle Scholar
  35. Kounis NG, Soufras GD, Hahalis G. Anaphylactic shock: Kounis hypersensitivity-associated syndrome seems to be the primary cause. N Am J Med Sci. 2013;5:631–6.PubMedPubMedCentralCrossRefGoogle Scholar
  36. Lafforgue E, Sleth JC, Pluskwa F, Saizy C. Successful extracorporeal resuscitation of a probable perioperative anaphylactic shock due to atracurium. Ann Fr Anesth Reanim. 2005;24:551–5.PubMedCrossRefPubMedCentralGoogle Scholar
  37. Lee S, Peterson A, Lohse CM, Hess EP, Campbell RL. Further evaluation of factors that may predict biphasic reactions in emergency department anaphylaxis patients. J Allergy Clin Immunol Pract. 2017; 5:1295–301.PubMedCrossRefPubMedCentralGoogle Scholar
  38. Leonardi S, Pecoraro R, Filippelli M, Miraglia del Giudice M, Marseglia G, Salpietro C, Arrigo T, Stringari G, Rico S, La Rosa M, Caffarelli C. Allergic reactions to foods by inhalation in children. Allergy Asthma Proc. 2014;35:288–94.PubMedCrossRefPubMedCentralGoogle Scholar
  39. Levy JH. Biomarkers in the diagnosis of anaphylaxis: making nature disclose her mysteries. Clin Exp Allergy. 2009;39:5–7.PubMedCrossRefPubMedCentralGoogle Scholar
  40. Lieberman P. Biphasic anaphylactic reactions. Ann Allergy Asthma Immunol. 2005;95:217–26; quiz 226, 258.PubMedCrossRefPubMedCentralGoogle Scholar
  41. Lieberman P. Epidemiology of anaphylaxis. Curr Opin Allergy Clin Immunol. 2008;8:316–20.PubMedCrossRefGoogle Scholar
  42. 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;115:341–84.PubMedCrossRefGoogle Scholar
  43. Limb SL, Starke PR, Lee CE, Chowdhury BA. Delayed onset and protracted progression of anaphylaxis after omalizumab administration in patients with asthma. J Allergy Clin Immunol. 2007;120:1378–81.PubMedCrossRefGoogle Scholar
  44. Lin RY, Trivino MR, Curry A, Pesola GR, Knight RJ, Lee HS, Bakalchuk L, Tenenbaum C, Westfal RE. Interleukin 6 and C-reactive protein levels in patients with acute allergic reactions: an emergency department-based study. Ann Allergy Asthma Immunol. 2001;87:412–6.PubMedCrossRefGoogle Scholar
  45. Lowenstein CJ, Michel T. What’s in a name? eNOS and anaphylactic shock. J Clin Invest. 2006;116:2075–8.PubMedPubMedCentralCrossRefGoogle Scholar
  46. Mertes PM, Volcheck GW, Garvey LH, Takazawa T, Platt PR, Guttormsen AB, Tacquard C. Epidemiology of perioperative anaphylaxis. Presse Med. 2016;45: 758–67.PubMedCrossRefGoogle Scholar
  47. Mittman RJ, Bernstein DI, Adler TR, Korbee L, Nath V, Gallagher JS, Bernstein IL. Selective desensitization to seminal plasma protein fractions after immunotherapy for postcoital anaphylaxis. J Allergy Clin Immunol. 1990;86:954–60.PubMedCrossRefGoogle Scholar
  48. Murali MR, Uyeda JW, Tingpej B. Case records of the Massachusetts General Hospital. Case 2-2015. A 25-year-old man with abdominal pain, syncope, and hypotension. N Engl J Med. 2015;372:265–73.PubMedCrossRefPubMedCentralGoogle Scholar
  49. Niedoszytko M, Bonadonna P, Oude Elberink JN, Golden DB. Epidemiology, diagnosis, and treatment of Hymenoptera venom allergy in mastocytosis patients. Immunol Allergy Clin North Am. 2014;34: 365–81.PubMedCrossRefPubMedCentralGoogle Scholar
  50. Ostrow CL, Hupp E, Topjian D. The effect of Trendelenburg and modified trendelenburg positions on cardiac output, blood pressure, and oxygenation: a preliminary study. Am J Crit Care. 1994;3:382–6.PubMedGoogle Scholar
  51. Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy. 2000;30:1144–50.PubMedCrossRefPubMedCentralGoogle Scholar
  52. Pumphrey RS. Fatal posture in anaphylactic shock. J Allergy Clin Immunol. 2003;112:451–2.PubMedCrossRefGoogle Scholar
  53. Rachid O, Simons FE, Wein MB, Rawas-Qalaji M, Simons KJ. Epinephrine doses contained in outdated epinephrine auto-injectors collected in a Florida allergy practice. Ann Allergy Asthma Immunol. 2015;114: 354–6.e1.PubMedCrossRefGoogle Scholar
  54. Reber LL, Hernandez JD, Galli SJ. The pathophysiology of anaphylaxis. J Allergy Clin Immunol. 2017;140: 335–48.PubMedPubMedCentralCrossRefGoogle Scholar
  55. Rueff F, Przybilla B, Bilo MB, Muller U, Scheipl F, Aberer W, Birnbaum J, Bodzenta-Lukaszyk A, Bonifazi F, Bucher C, Campi P, Darsow U, Egger C, Haeberli G, Hawranek T, Korner M, Kucharewicz I, Kuchenhoff H, Lang R, Quercia O, Reider N, Severino M, Sticherling M, Sturm GJ, Wuthrich B. Predictors of severe systemic anaphylactic reactions in patients with Hymenoptera venom allergy: importance of baseline serum tryptase-a study of the European Academy of Allergology and Clinical Immunology Interest Group on Insect Venom Hypersensitivity. J Allergy Clin Immunol. 2009;124: 1047–54.PubMedCrossRefGoogle Scholar
  56. Sala-Cunill A, Bjorkqvist J, Senter R, Guilarte M, Cardona V, Labrador M, Nickel KF, Butler L, Luengo O, Kumar P, Labberton L, Long A, Di Gennaro A, Kenne E, Jamsa A, Krieger T, Schluter H, Fuchs T, Flohr S, Hassiepen U, Cumin F, McCrae K, Maas C, Stavrou E, Renne T. Plasma contact system activation drives anaphylaxis in severe mast cell-mediated allergic reactions. J Allergy Clin Immunol. 2015;135:1031–43.e6.PubMedCrossRefGoogle Scholar
  57. Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, Brown SG, Camargo CA Jr, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD Jr, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O’Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW. Second symposium on the definition and management of anaphylaxis: summary report – second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006; 117:391–7.PubMedCrossRefGoogle Scholar
  58. Savic LC, Kaura V, Yusaf M, Hammond-Jones AM, Jackson R, Howell S, Savic S, Hopkins PM. Incidence of suspected perioperative anaphylaxis: a multicenter snapshot study. J Allergy Clin Immunol Pract. 2015; 3:454–5.e1.PubMedCrossRefGoogle Scholar
  59. Schwartz LB. Diagnostic value of tryptase in anaphylaxis and mastocytosis. Immunol Allergy Clin North Am. 2006;26:451–63.PubMedCrossRefGoogle Scholar
  60. Shim WS, Oh U. Histamine-induced itch and its relationship with pain. Mol Pain. 2008;4:29.PubMedPubMedCentralCrossRefGoogle Scholar
  61. Sicherer SH, Sampson HA. Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141:41–58.PubMedCrossRefGoogle Scholar
  62. Simons FE, Schatz M. Anaphylaxis during pregnancy. J Allergy Clin Immunol. 2012;130:597–606.PubMedCrossRefGoogle Scholar
  63. Simons FE, Sampson HA. Anaphylaxis: unique aspects of clinical diagnosis and management in infants (birth to age 2 years). J Allergy Clin Immunol. 2015;135: 1125–31.PubMedCrossRefGoogle Scholar
  64. Snyder JL, Krishnaswamy G. Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review. Ann Allergy Asthma Immunol. 2003;90:469–77; quiz 477, 571.PubMedCrossRefGoogle Scholar
  65. Steinke JW, Platts-Mills TA, Commins SP. The alpha-gal story: lessons learned from connecting the dots. J Allergy Clin Immunol. 2015;135:589–96; quiz 597.PubMedPubMedCentralCrossRefGoogle Scholar
  66. Stoevesandt J, Hain J, Kerstan A, Trautmann A. Over- and underestimated parameters in severe Hymenoptera venom-induced anaphylaxis: cardiovascular medication and absence of urticaria/angioedema. J Allergy Clin Immunol. 2012;130:698–704.e1.PubMedCrossRefGoogle Scholar
  67. Stone SF, Bosco A, Jones A, Cotterell CL, van Eeden PE, Arendts G, Fatovich DM, Brown SG. Genomic responses during acute human anaphylaxis are characterized by upregulation of innate inflammatory gene networks. PLoS One. 2014;9:e101409.PubMedPubMedCentralCrossRefGoogle Scholar
  68. Sublett JW, Bernstein JA. Characterization of patients with suspected seminal plasma hypersensitivity. Allergy Asthma Proc. 2011;32:467–71.PubMedCrossRefGoogle Scholar
  69. Tankersley MS, Ledford DK. Stinging insect allergy: state of the art 2015. J Allergy Clin Immunol Pract. 2015;3:315–22; quiz 323.PubMedCrossRefGoogle Scholar
  70. Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal anaphylaxis: mortality rate and risk factors. J Allergy Clin Immunol Pract. 2017;5:1169–78.PubMedPubMedCentralCrossRefGoogle Scholar
  71. Vadas P, Gold M, Perelman B, Liss GM, Lack G, Blyth T, Simons FE, Simons KJ, Cass D, Yeung J. Platelet-activating factor, PAF acetylhydrolase, and severe anaphylaxis. N Engl J Med. 2008;358:28–35.PubMedCrossRefGoogle Scholar
  72. Vadas P, Perelman B, Liss G. Platelet-activating factor, histamine, and tryptase levels in human anaphylaxis. J Allergy Clin Immunol. 2013;131:144–9.PubMedCrossRefGoogle Scholar
  73. Valent P. Risk factors and management of severe life-threatening anaphylaxis in patients with clonal mast cell disorders. Clin Exp Allergy. 2014;44:914–20.PubMedPubMedCentralCrossRefGoogle Scholar
  74. Vally H, Misso NL. Adverse reactions to the sulphite additives. Gastroenterol Hepatol Bed Bench. 2012; 5:16–23.PubMedPubMedCentralGoogle Scholar
  75. Vazquez-Ortiz M, Alvaro M, Piquer M, Giner MT, Dominguez O, Lozano J, Jimenez-Feijoo R, Cambra FJ, Plaza AM. Life-threatening anaphylaxis to egg and milk oral immunotherapy in asthmatic teenagers. Ann Allergy Asthma Immunol. 2014;113: 482–4.PubMedCrossRefGoogle Scholar
  76. Ventura MT, Scichilone N, Gelardi M, Patella V, Ridolo E. Management of allergic disease in the elderly: key considerations, recommendations and emerging therapies. Expert Rev Clin Immunol. 2015; 11:1219–28.PubMedCrossRefGoogle Scholar
  77. Wang M, Shibamoto T, Tanida M, Kuda Y, Kurata Y. Mouse anaphylactic shock is caused by reduced cardiac output, but not by systemic vasodilatation or pulmonary vasoconstriction, via PAF and histamine. Life Sci. 2014;116:98–105.PubMedCrossRefPubMedCentralGoogle Scholar
  78. Webb LM, Lieberman P. Anaphylaxis: a review of 601 cases. Ann Allergy Asthma Immunol. 2006;97: 39–43.PubMedCrossRefPubMedCentralGoogle Scholar
  79. Williams SJ, Gupta S. Anaphylaxis to IVIG. Arch Immunol Ther Exp (Warsz). 2017;65:11–9.CrossRefGoogle Scholar
  80. Wolbing F, Fischer J, Koberle M, Kaesler S, Biedermann T. About the role and underlying mechanisms of cofactors in anaphylaxis. Allergy. 2013; 68:1085–92.PubMedCrossRefPubMedCentralGoogle Scholar
  81. Worm M, Francuzik W, Renaudin JM, Bilo MB, Cardona V, Hofmeier KS, Kohli A, Bauer A, Christoff G, Cichocka-Jarosz E, Hawranek T, Hourihane JO, Lange L, Mahler V, Muraro A, Papadopoulos NG, Pfohler C, Poziomkowska-Gesicka I, Rueff F, Spindler T, Treudler R, Fernandez-Rivas M, Dolle S. Factors increasing the risk for a severe reaction in anaphylaxis: an analysis of data from The European Anaphylaxis Registry. Allergy. 2018;73:1322.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Allergy and ImmunologyAlbany Medical CollegeAlbanyUSA

Section editors and affiliations

  • Dennis K. Ledford
    • 1
  1. 1.Division of Allergy & Immunology, Dept. of Internal MedicineUniversity of South Florida Morsani College of Medicine, James A Haley Veterans' Hospital, Asthma and Immunology Associates of Tampa BayTampaUSA

Personalised recommendations