Drug‐induced anaphylaxis in the emergency room

Abstract

Anaphylaxis is a life‐threatening, systemic allergic reaction that presents unique challenges for emergency care practitioners. Anaphylaxis occurs more frequently than previously believed. Therefore, proper knowledge regarding the epidemiology, mechanisms, symptoms, diagnosis, and treatment of anaphylaxis is essential. In particular, the initial treatment strategy, followed by correct diagnosis, in the emergency room is critical for preventing fatal anaphylaxis, although making a diagnosis is not easy because of the broad and often atypical presentation of anaphylaxis. To this end, the clinical criteria proposed by the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network are useful, which, together with a differential diagnosis, could enable a more accurate diagnosis. Additional in vitro tests, such as plasma histamine and tryptase measurements, are also helpful. It should be emphasized that adrenaline is the only drug recommended as first‐line therapy in all published national anaphylaxis guidelines. Most international anaphylaxis guidelines recommend injecting adrenaline by the intramuscular route in the mid‐anterolateral thigh, whereas i.v. adrenaline is an option for patients with severe hypotension or cardiac arrest unresponsive to intramuscular adrenaline and fluid resuscitation. In addition to the route of administration, choosing the appropriate dose of adrenaline is essential, because serious adverse effects can potentially occur after an overdose of adrenaline. Furthermore, to avoid future recurrence of anaphylaxis, providing adrenaline auto‐injectors and making an etiological diagnosis, including confirmation of the offending trigger, are recommended for patients at risk of anaphylaxis before their discharge from the emergency room.

Small nucleolar RNA networks are up‐regulated during human anaphylaxis

“…Anaphylaxis is diagnosed in the emergency department (ED) based on clinical presentation. Cases that lack conventional symptoms, or where a trigger cannot be identified, can therefore mimic other types of distributive shock 2‐4 . Both anaphylaxis and sepsis are types of distributive shock that develop through inflammatory mediator release and vasodilation 5,6 .…”

“…Cases that lack conventional symptoms, or where a trigger cannot be identified, can therefore mimic other types of distributive shock. [2][3][4] Both anaphylaxis and sepsis are types of distributive shock that develop through inflammatory mediator release and vasodilation. 5,6 In severe cases, both conditions present with hypotension, and excluding either possibility can be difficult.…”

Drug Allergy and Anaphylaxis in Dentistry

“…Despite the increase in anaphylaxis incidence, the mortality rate remains the same. The reason why the mortality rate of anaphylaxis does not show any changes could be due to the fact that anaphylaxis has become a well-recognized disease with time and it is treatable (2,3). Food allergy, venom allergy and drug allergy can be shown among the most common causes of anaphylaxis (4,5).…”

Anaphylaxis from The Eyes of Family Physicians

“…Anaflaksi; hızlı başlangıçlı ve ölümcül olabilen alerjik bir reaksiyon olarak tanımlanabilir (1). En sık sebepler gıdalar, ilaçlar ve arı venom alerjileridir (2).…”