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Anaphylaxis.

Authors
  • LoVerde, Daniel1
  • Iweala, Onyinye I2
  • Eginli, Ariana3
  • Krishnaswamy, Guha4
  • 1 Division of Pulmonary, Critical Care, Allergy and Immunology, Department of Medicine, Wake Forest University School of Medicine and Wake Forest Baptist Medical Center, Winston-Salem, NC.
  • 2 Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
  • 3 Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
  • 4 Division of Pulmonary, Critical Care, Allergy and Immunology, Department of Medicine, Wake Forest University School of Medicine and Wake Forest Baptist Medical Center, Winston-Salem, NC; Division of Allergy and Clinical Immunology, Department of Medicine, W.G. (Bill) Hefner VA Medical Center, Salisbury, NC; Division of Allergy and Clinical Immunology, Department of Medicine, Kernersville Health Care Center, Kernersville, NC. Electronic address: [email protected]
Type
Published Article
Journal
CHEST Journal
Publisher
Elsevier
Publication Date
Feb 01, 2018
Volume
153
Issue
2
Pages
528–543
Identifiers
DOI: 10.1016/j.chest.2017.07.033
PMID: 28800865
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Anaphylaxis is a systemic, life-threatening disorder triggered by mediators released by mast cells and basophils activated via allergic (IgE-mediated) or nonallergic (non-IgE-mediated) mechanisms. It is a rapidly evolving, multisystem process involving the integumentary, pulmonary, gastrointestinal, and cardiovascular systems. Anaphylaxis and angioedema are serious disorders that can lead to fatal airway obstruction and culminate in cardiorespiratory arrest, resulting in hypoxemia and/or shock. Often, these disorders can be appropriately managed in an outpatient setting; however, these conditions can be severe enough to warrant evaluation of the patient in the ED and in some cases, hospitalization, and management in an ICU. Reports suggest that underdiagnosis and undertreatment of anaphylaxis are common. Several new syndromes have been described recently including bird-egg, pork-cat, delayed allergy to mammalian meat and a diverse group of mast cell activation disorders. Conditions such as postural orthostatic tachycardia syndrome, carcinoid syndrome, Munchausen stridor, and factitious anaphylaxis can present similarly and need to be included in the differential diagnosis. Anaphylaxis is a clinical diagnosis, but plasma tryptase and urinary histamine levels are often elevated, allowing diagnostic confirmation; however, diagnostic testing should not delay treatment as results may not be immediately available. The sine qua non of treatment is avoidance of any known triggers and epinephrine, which should never be delayed if this disorder is suspected. Secondary treatments include fluids, bronchodilators, antihistamines, and glucocorticoids. Patients with cardiopulmonary arrest or airway or vascular compromise require mechanical ventilation, vasopressors, and other advanced life support in the ICU. Published by Elsevier Inc.

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