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.
Key Words
Abbreviations:
alpha-gal (alpha-galactose), ECLS (extracorporeal life support), IA (idiopathic anaphylaxis), IO (intraosseous), NSAID (nonsteroidal antiinflammatory drug), PAF (platelet-activating factor), VLM (vastus lateralis muscle)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: August 08, 2017
Footnotes
Drs LoVerde and Iweala contributed equally to this manuscript.
Identification
Copyright
Published by Elsevier Inc. under license from the American College of Chest Physicians.
