Anaphylaxis. A review of 266 cases

Abstract

(1) Atopy is common in subjects who experience anaphylaxis, regardless of its origin; (2) crustaceans and nonsteroidal anti-inflammatory drugs are the most common food and medication groups, respectively, thought to cause anaphylaxis; (3) causative agents can be identified for two thirds of the subjects, and recurrent attacks are the rule; and (4) subjects with idiopathic anaphylaxis are more likely to carry epinephrine for self-administration than those with identifiable causes.

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

“…It was acknowledged that no criteria will provide 100% sensitivity and specificity, but it was believed that the criteria proposed are likely to capture more than 95% of cases of anaphylaxis. Because the majority of anaphylactic reactions include skin symptoms, [5][6][7][8][9][10] which are noted in more than 80% of cases when carefully assessed, it was judged that at least 80% of anaphylactic reactions should be identified by criterion 1, even when the allergic status of the patient and potential cause of the reaction might be unknown. However, cutaneous symptoms might be absent in up to 20% of anaphylactic reactions in children with food allergy or insect sting allergy.…”

ER triage in patients showing acute hypersensitivity reactions: one year's experience

“…Clinicamente caratterizzata, nei casi più severi, da difficoltà respiratoria (ede- ma delle vie aeree prossimali, broncospasmo) e da instabilità emodinamica (sincope, ipotensione arteriosa e shock, aritmie), la reazione anafilattica è dovuta al repentino rilascio di istamina e di altri mediatori chimici da parte dei mastociti e dei basofili circolanti, con meccanismo IgE-mediato (reazione da ipersensibilità di tipo I della classificazione di Gell e Coombs) o non IgE-mediato (reazione anafilattoide) [11][12] . Altre manifestazioni frequenti dell'anafilassi sono costituite da prurito diffuso, senso di morte imminente, angioedema, disfagia, vomito, diarrea, dolore addominale, incontinenza sfinterica [11][12][13][14] . La diagnosi differenziale nei confronti di condizioni patologiche diverse può essere inizialmente difficoltosa a causa del polimorfismo dei sintomi.…”

Anaphylactic Reaction: An Overview

“…Anaphylaxis is usually thought of as an IgE-mediated allergic reaction to such things as foods, insect venoms, drugs , and latex . The mast cell, however, can be induced to react by other non-immunologic means, including [I] direct acti vation by exercise, opiates, and possibly radi ocontrast agents, [2] disturbances of ar achidonic acid metabolism by cyclo-oxygenase inhibitors such as aspirin and nonsteroidal anti-inflammatory drugs (NSAlDs), and [3] complement activation by immune complexes, caused by reactions to blood products and resulting in production of complement C3a and C5a [2]0 This is the mechanism for anaphylactoid reactions where the term ' anaphylactoid' is used to designate reactions that are indistinguishable from anaphylaxis but lack a demonstrable 19B allergic mechanism. Some anaphylactoid reactions are triggered by an identifiable agent, such as a drug that possesses the pharmacologic property of causing direct, nonimmunologic release of ma st cell mediators.…”

“…In a recent study of 266 patients referred for evaluation when obvious causes (eg, insect sting s, immunotherapy) had been eliminated, 37% were determined to have idiopathic disease [3]. In patients in whom a cause was identified, common triggers included foods (eg, peanuts, fish, nuts, eggs), drugs (NSAIDs, aspirin, penicillin, cephalosporins, insulin, sulfonamides, blood products, vaccines, and enzymes such as trypsin, chymopapain, and streptokinase), exercise, and latex .…”