Abstract
Anaphylaxis prevalence has increased within the last few years. This may be due to a marked increase in allergic sensitization to foods especially in the pediatric population, as well as to an increase in outdoor recreational habits and the availability of new biologic medications. Furthermore, guidelines for the diagnosis of anaphylaxis have been published, thus facilitating the recognition of this disorder. Diagnosis of anaphylaxis is mainly based on history and clinical criteria of organ system involvement. The serum tryptase assay is now commercially available and may be a helpful diagnostic tool in certain clinical situations involving hypotension, but not in the context of food-induced anaphylaxis. Treatment of anaphylaxis mainly involves the use of epinephrine as a first line medication for severe manifestations followed by symptomatic management of specific symptoms, such as antihistamines for urticaria and albuterol for wheezing. Although commonly practiced, treatment with systemic corticosteroids is not supported by evidence-based literature. Observation in a medical facility for 4-6 hours is recommended to monitor for late phase reactions, although these rarely occur. Education is an essential component of management of a patient with a previous history of anaphylaxis, emphasizing early use of epinephrine and providing a written action plan. Referral to a board-certified allergist/immunologist is recommended to determine the cause of the anaphylaxis as well as to rule out other potential conditions. In this review, our main focus will be on the treatment and prevention of anaphylaxis while providing our readers with a brief introduction to the diagnosis of anaphylaxis, its prevalence and its most common causes.
Highlights
Definition, Prevalence, and Common Triggers There are several accepted definitions of the term anaphylaxis in the medical literature, all of which share the common characteristic of a severe, life-threatening, generalized hypersensitivity reaction[1,2,3]
Antibiotics and primarily penicillin are most commonly involved in subjects aged 18 years and above[5] followed by nonsteroidal anti-inflammatory drugs (NSAIDs)[9]
Idiopathic anaphylaxis remains a diagnosis of exclusion after extensive history and testing to rule out specific triggers, including foods, exercise, medications, and insect hypersensitivity
Summary
Definition, Prevalence, and Common Triggers There are several accepted definitions of the term anaphylaxis in the medical literature, all of which share the common characteristic of a severe, life-threatening, generalized hypersensitivity reaction[1,2,3]. It is important to identify and manage comorbid conditions that increase the risk of a severe anaphylactic reaction when poorly controlled These include asthma, cardiovascular disease, and mastocytosis or mast cell activation syndrome. Patients with a history of insect sting hypersensitivity should be educated on avoidance of stings, carry an epinephrine autoinjector, and obtain a consultation with an allergist/immunologist in order to undergo specific serum IgE testing and skin testing to identify the culprit insects. Patients with mastocytosis and mast cell activation syndrome have an increased risk of anaphylaxis with insect sting, whereby the anaphylactic episode could be the presenting sign of the disorder[62,63]. Idiopathic anaphylaxis remains a diagnosis of exclusion after extensive history and testing to rule out specific triggers, including foods, exercise, medications, and insect hypersensitivity.
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