Diagnostics différentiels de l’anaphylaxie

Abstract

Anaphylaxis definition has been recently updated. Despite a rigorous allergy evaluation, there are still anaphylaxis cases without any identified cause, called “idiopathic” for which it is essential to evoke differential diagnoses. These situations are major challenges for the physician and sometimes require a multidisciplinary approach and the advice of expert allergists or internal medicine physicians. Differential diagnoses will be evoked in various circumstances: atypical clinical manifestations, severe anaphylaxis without modification of tryptasemia values, absence of clearly identified allergen, multiplicity of suspected allergens, repeated occurrence of subjective symptoms or in stereotyped circumstances (at restaurant, for example). The variety of these differential diagnoses must be considered according to age, history, clinical presentation and predominant symptoms, circumstances of occurrence. This article aims to remind the criteria for the positive diagnosis of anaphylaxis and to discuss the main differential diagnoses.