Idiopathic anaphylaxis yardstick

Abstract

Anaphylaxis is considered idiopathic when there is no known trigger. The signs and symptoms of idiopathic anaphylaxis (IA) are identical to those of anaphylaxis because of a known cause and can include cutaneous, circulatory, respiratory, gastrointestinal, and neurologic symptoms. Idiopathic anaphylaxis can be a frustrating disease for patients and health care providers. Episodes are unpredictable, and differential diagnosis is challenging. Current anaphylaxis guidelines have little specific guidance regarding differential diagnosis and long-term management of IA. Therefore, the objective of the Idiopathic Anaphylaxis Yardstick is to use published data and the authors' combined clinical experience to provide practical recommendations for the diagnosis and management of patients with IA.

EAACI guidelines: Anaphylaxis (2021 update)

“…Co‐factors may be aggravating factors in anaphylaxis, examples are exercise, stress, infection, non‐steroidal anti‐inflammatory drugs, and alcohol 14–16 . In some cases, the cause is not obvious (idiopathic anaphylaxis) and investigations for rarer allergens or differential diagnoses should be considered 17–19 …”

“…[14][15][16] In some cases, the cause is not obvious (idiopathic anaphylaxis) and investigations for rarer allergens or differential diagnoses should be considered. [17][18][19] This guideline, updated from 2014, 20 provides evidence-based guidance to help manage anaphylaxis. The primary audience is clinical allergists (specialists and subspecialists), primary care, paediatricians, emergency physicians, anaesthetists and intensivists, nurses, dieticians, and other healthcare professionals.…”

Secondary adrenal suppression related to high doses of inhaled corticosteroids in patients with severe asthma

“…Salivary cortisol analysis is commercially available and accepted as a screening alternative owing to its substantial positive correlation with serum cortisol. [4][5][6] We included all patients referred to the severe asthma outpatient clinic with a confirmed diagnosis from December 2016 to December 2019. Severe asthma was established according to the definition proposed by the European Respiratory Society and the American Thoracic Society.…”

“…Factors contributing to gradual progression onto severe asthma were not evident in our study; but previously, poor asthma control, ongoing exposure to environmental triggers, frequent exacerbations and airway remodeling have been reported to cause progression to severe disease. 6 Poor asthma control is still prevalent despite the availability of effective treatments with an observed persistent gap between guideline-recommended control goals and real-life experience. 7 Asthma control is also worsened by comorbidities.…”

“…Lastly, our patient was on an elemental formula so food allergy was not initially considered given that hypersensitivity reactions to elemental formulas are extremely rare. 5 Hidden food allergens are infrequently the cause of idiopathic anaphylaxis 6 and can be hard to find. Ultimately, evaluation of her elemental formula for cross contamination with milk revealed the cause of her anaphylaxis, illustrating hidden food allergens should be considered in the differential for patients who present with unexplained anaphylaxis.…”