Materiały źródłowe

• #1 Anaphylaxis: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1115/p1111.html

  Anaphylaxis is a severe, life-threatening, systemic allergic reaction that is almost always unanticipated and may lead to death by airway obstruction or vascular collapse. The diagnosis of anaphylaxis is typically made when symptoms occur within one hour of exposure to a specific antigen. […] Confirmatory testing using serum histamine and tryptase levels is difficult, because blood samples must be drawn with strict time considerations. […] The clinical history is the most important tool to determine whether a patient has had an anaphylactic reaction and the cause of the episode. […] Anaphylaxis is highly likely when any one of the following three sets of criteria is fulfilled: 1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized hives; pruritus or flushing; swollen lips, tongue, or uvula), and at least one of the following: Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia) Reduced blood pressure or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence) 2. Two or more of the following that occur rapidly (minutes to several hours) after exposure to a likely allergen for that patient: Involvement of the skin, mucosal tissue, or both (e.g., generalized hives; pruritus or flushing; swollen lips, tongue, or uvula) Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia) Reduced blood pressure or associated symptoms (e.g., hypotonia [collapse], syncope, incontinence) Persistent gastrointestinal symptoms (e.g., abdominal cramps, vomiting) 3. Reduced blood pressure that occurs rapidly (minutes to several hours) after exposure to a known allergen for that patient.

• #2 Anaphylaxis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/8619-anaphylaxis

  Anaphylaxis is a life-threatening allergic reaction. Signs include breathing difficulties, swelling, hives and a drop in blood pressure. […] If you’ve had an allergic reaction, or suspected allergic reaction, to food or insect stings (even a mild one), talk to a healthcare provider. A provider can often diagnose anaphylaxis based on your symptoms. […] An allergist may recommend performing a skin test or a blood test to confirm an allergy and identify the specific allergic trigger. […] If you’ve had allergic reactions to food or a stinging insect, your provider will prescribe an epinephrine autoinjector injection (EpiPen or a generic version of EpiPen). […] If you think you’re having an anaphylactic reaction, don’t wait to use your injector. […] An allergist is a healthcare provider specially trained to diagnose and treat people with allergies. If you experience or think you’ve experienced an allergic/anaphylactic reaction, you should see an allergist.

• #3 Anaphylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482124/

  Anaphylaxis is an acute, life-threatening hypersensitivity disorder defined as a generalized, rapidly evolving, multi-systemic allergic reaction. […] This activity describes the evaluation and treatment of anaphylaxis and explains the role of the interprofessional team in managing patients with this condition. […] Evaluate the clinical criteria used in the evaluation of anaphylaxis. […] Diagnosing anaphylaxis is clinical; thus, laboratory studies or other diagnostics are unnecessary. […] A consensus criterion has been constructed to improve clinical recognition to prevent delayed treatment, as this poses a great risk to patients. […] Clinical presentation often begins as a mild allergic reaction. […] Rapid treatment should be initiated with intramuscular epinephrine if any of these symptoms are present.

• #4 Anaphylaxis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/135065-overview

  Anaphylaxis is primarily a clinical diagnosis. The first priority in the physical examination should be to assess the patients airway, breathing, circulation, and adequacy of mentation (eg, alertness, orientation, coherence of thought). […] Anaphylaxis has no universally accepted clinical definition. It is a clinical diagnosis based on typical systemic manifestations, often with a history of acute exposure to a causative agent. (See Diagnosis.) […] Because anaphylaxis is primarily a clinical diagnosis, laboratory studies are not usually required and are rarely helpful. However, if the diagnosis is unclear, especially with a recurrent syndrome, or if other diseases need to be excluded, some limited laboratory studies are indicated. Skin testing and in vitro IgE tests may be helpful. (See Workup.)

• #5 Anaphylaxis: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0915/p355.html

  Anaphylaxis is a life-threatening systemic reaction, normally occurring within one to two hours of exposure to an allergen. […] Clinicians can obtain serum tryptase levels, reflecting mast cell degranulation, when the clinical diagnosis of anaphylaxis is not clear. […] Anaphylaxis is a severe allergic reaction that occurs quickly and can be fatal. […] One out of 20 of all anaphylaxis cases may require hospitalization; in the United States, hospitalizations for anaphylaxis have steadily increased over the past 10 years. […] One-half of patients presenting to the emergency department who meet the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network diagnostic criteria for anaphylaxis receive treatment with epinephrine. […] Anaphylaxis is highly likely when any one of the following three sets of criteria is met: Acute onset of an illness (i.e., minutes to several hours) with involvement of the skin, mucosal tissue, or both

• #6 Anaphylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482124/

  Anaphylaxis is an acute, life-threatening hypersensitivity disorder defined as a generalized, rapidly evolving, multi-systemic allergic reaction. […] This activity describes the evaluation and treatment of anaphylaxis and explains the role of the interprofessional team in managing patients with this condition. […] Evaluate the clinical criteria used in the evaluation of anaphylaxis. […] Diagnosing anaphylaxis is clinical; thus, laboratory studies or other diagnostics are unnecessary. […] A consensus criterion has been constructed to improve clinical recognition to prevent delayed treatment, as this poses a great risk to patients. […] Clinical presentation often begins as a mild allergic reaction. […] Rapid treatment should be initiated with intramuscular epinephrine if any of these symptoms are present.

• #7 Laboratory tests to support the clinical diagnosis of anaphylaxis – UpToDate

  https://www.uptodate.com/contents/laboratory-tests-to-support-the-clinical-diagnosis-of-anaphylaxis

  Laboratory tests to support the clinical diagnosis of anaphylaxis […] The diagnosis of anaphylaxis during the acute event is based on the clinical presentation and either a history of a recent exposure to an offending agent or consideration of spontaneous anaphylaxis. […] There are no laboratory tests available in an emergency department or clinic setting to confirm a diagnosis of anaphylaxis in real time. […] However, laboratory tests in serum, plasma, and possibly urine obtained during or shortly after the acute event can help to support the clinical diagnosis of anaphylaxis. […] These tests can also help identify anaphylaxis in the presence of other disorders that have overlapping clinical presentations, such as severe asthma, myocardial infarction, postural orthostatic tachycardia syndrome, flushing disorders, or various shock syndromes.

• #8 Anaphylaxis: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1115/p1111.html

  Anaphylaxis is a severe, life-threatening, systemic allergic reaction that is almost always unanticipated and may lead to death by airway obstruction or vascular collapse. The diagnosis of anaphylaxis is typically made when symptoms occur within one hour of exposure to a specific antigen. […] Confirmatory testing using serum histamine and tryptase levels is difficult, because blood samples must be drawn with strict time considerations. […] The clinical history is the most important tool to determine whether a patient has had an anaphylactic reaction and the cause of the episode. […] Anaphylaxis is highly likely when any one of the following three sets of criteria is fulfilled: 1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized hives; pruritus or flushing; swollen lips, tongue, or uvula), and at least one of the following: Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia) Reduced blood pressure or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence) 2. Two or more of the following that occur rapidly (minutes to several hours) after exposure to a likely allergen for that patient: Involvement of the skin, mucosal tissue, or both (e.g., generalized hives; pruritus or flushing; swollen lips, tongue, or uvula) Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia) Reduced blood pressure or associated symptoms (e.g., hypotonia [collapse], syncope, incontinence) Persistent gastrointestinal symptoms (e.g., abdominal cramps, vomiting) 3. Reduced blood pressure that occurs rapidly (minutes to several hours) after exposure to a known allergen for that patient.

• #9

• #10 Anaphylaxis: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1115/p1111.html

  Anaphylaxis is a severe, life-threatening, systemic allergic reaction that is almost always unanticipated and may lead to death by airway obstruction or vascular collapse. The diagnosis of anaphylaxis is typically made when symptoms occur within one hour of exposure to a specific antigen. […] Confirmatory testing using serum histamine and tryptase levels is difficult, because blood samples must be drawn with strict time considerations. […] The clinical history is the most important tool to determine whether a patient has had an anaphylactic reaction and the cause of the episode. […] Anaphylaxis is highly likely when any one of the following three sets of criteria is fulfilled: 1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized hives; pruritus or flushing; swollen lips, tongue, or uvula), and at least one of the following: Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia) Reduced blood pressure or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence) 2. Two or more of the following that occur rapidly (minutes to several hours) after exposure to a likely allergen for that patient: Involvement of the skin, mucosal tissue, or both (e.g., generalized hives; pruritus or flushing; swollen lips, tongue, or uvula) Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia) Reduced blood pressure or associated symptoms (e.g., hypotonia [collapse], syncope, incontinence) Persistent gastrointestinal symptoms (e.g., abdominal cramps, vomiting) 3. Reduced blood pressure that occurs rapidly (minutes to several hours) after exposure to a known allergen for that patient.

• #11 Anaphylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482124/

  Anaphylaxis is an acute, life-threatening hypersensitivity disorder defined as a generalized, rapidly evolving, multi-systemic allergic reaction. […] This activity describes the evaluation and treatment of anaphylaxis and explains the role of the interprofessional team in managing patients with this condition. […] Evaluate the clinical criteria used in the evaluation of anaphylaxis. […] Diagnosing anaphylaxis is clinical; thus, laboratory studies or other diagnostics are unnecessary. […] A consensus criterion has been constructed to improve clinical recognition to prevent delayed treatment, as this poses a great risk to patients. […] Clinical presentation often begins as a mild allergic reaction. […] Rapid treatment should be initiated with intramuscular epinephrine if any of these symptoms are present.

• #12 Anaphylaxis: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1115/p1111.html

  Anaphylaxis is a severe, life-threatening, systemic allergic reaction that is almost always unanticipated and may lead to death by airway obstruction or vascular collapse. The diagnosis of anaphylaxis is typically made when symptoms occur within one hour of exposure to a specific antigen. […] Confirmatory testing using serum histamine and tryptase levels is difficult, because blood samples must be drawn with strict time considerations. […] The clinical history is the most important tool to determine whether a patient has had an anaphylactic reaction and the cause of the episode. […] Anaphylaxis is highly likely when any one of the following three sets of criteria is fulfilled: 1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized hives; pruritus or flushing; swollen lips, tongue, or uvula), and at least one of the following: Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia) Reduced blood pressure or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence) 2. Two or more of the following that occur rapidly (minutes to several hours) after exposure to a likely allergen for that patient: Involvement of the skin, mucosal tissue, or both (e.g., generalized hives; pruritus or flushing; swollen lips, tongue, or uvula) Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia) Reduced blood pressure or associated symptoms (e.g., hypotonia [collapse], syncope, incontinence) Persistent gastrointestinal symptoms (e.g., abdominal cramps, vomiting) 3. Reduced blood pressure that occurs rapidly (minutes to several hours) after exposure to a known allergen for that patient.

• #13 Anaphylaxis – WikEM

  https://wikem.org/wiki/Anaphylaxis

  Type I hypersensitivity reaction that is either severe in nature or having two or more organ systems involved. […] Clinically Anaphylaxis and its treatment is virtually identical whether it is the traditional IgE dependent anaphylaxis reaction (vast majority), or the IgE independent anaphylactoid reaction. […] Anaphylaxis is highly likely when ANY ONE of the following criteria is fulfilled. […] Acute onset of an illness involving the skin, mucosal tissue, or both AND at least one of the following: Respiratory Compromise, Reduced blood pressure or associated symptoms (Syncope, Dizziness). […] TWO OR MORE of the following that occur rapidly after exposure to a LIKELY allergen for that patient: Involvement of the skin-mucosal tissue (hives, swollen lips-tongue-uvula), Respiratory compromise, Hypotension or associated symptoms, Persistent gastrointestinal symptoms: (vomiting, diarrhea, crampy abdominal pain).

• #14 Anaphylaxis: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1115/p1111.html

  Anaphylaxis is a severe, life-threatening, systemic allergic reaction that is almost always unanticipated and may lead to death by airway obstruction or vascular collapse. The diagnosis of anaphylaxis is typically made when symptoms occur within one hour of exposure to a specific antigen. […] Confirmatory testing using serum histamine and tryptase levels is difficult, because blood samples must be drawn with strict time considerations. […] The clinical history is the most important tool to determine whether a patient has had an anaphylactic reaction and the cause of the episode. […] Anaphylaxis is highly likely when any one of the following three sets of criteria is fulfilled: 1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized hives; pruritus or flushing; swollen lips, tongue, or uvula), and at least one of the following: Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia) Reduced blood pressure or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence) 2. Two or more of the following that occur rapidly (minutes to several hours) after exposure to a likely allergen for that patient: Involvement of the skin, mucosal tissue, or both (e.g., generalized hives; pruritus or flushing; swollen lips, tongue, or uvula) Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia) Reduced blood pressure or associated symptoms (e.g., hypotonia [collapse], syncope, incontinence) Persistent gastrointestinal symptoms (e.g., abdominal cramps, vomiting) 3. Reduced blood pressure that occurs rapidly (minutes to several hours) after exposure to a known allergen for that patient.

• #15 Anaphylaxis

  https://mobile.fpnotebook.com/ENT/Allergy/Anphylxs.htm

  Anaphylaxis is a life threatening condition that requires immediate ABC Management and Epinephrine injection IM. […] High likelihood if ONE of the following three criteria present. […] Criteria 1: Acute illness onset within minutes to hours AND Skin or mucosal effects (e.g. Hives, Pruritus, Flushing, swollen lips/Tongue/uvula) AND Respiratory distress (e.g. Dyspnea, bronchospasm) or cardiovascular collapse (e.g. Hypotension, Syncope). […] Criteria 2: Acute illness onset within minutes to hours after likely allergen exposure AND a least TWO of the following Skin or mucosal effects (e.g. Hives, Pruritus, Flushing, swollen lips/Tongue/uvula). […] Criteria 3: Acute Hypotension, Bronchospasm or laryngeal involvement within minutes to hours after likely allergen exposure. […] Summary: Anaphylaxis is present if allergen exposure and Hypotension or two compromised organ systems.

• #16 Anaphylaxis & Angioedema: Practical Approach to Diagnosis and Management in Emergency Department | RECAPEM

  https://recapem.com/anaphylaxis-angioedema-practical-approach-to-diagnosis-and-management-in-emergency-department-2/

  Skin lesions are frequently common (90%) during an anaphylaxis event. This makes diagnostic criterion one extremely useful for diagnosis. However, in almost 10% of patients skin lesions are totally absent or unrecognized. This can be attributed to factors such as the inability to communicate to express itching (e.g. patient is anesthetized, sedated, or unconscious), taking antihistamines by patients, or failure to fully undress and examine the patient. In this situation, criteria 2 or 3 are helpful for diagnosing the event. […] Anaphylaxis in a patient with asthma may be mistaken for an asthma exacerbation if accompanying skin symptoms and signs, such as itching or hives, mucosal, tongue, or lip edema, or dizziness suggestive of impending shock, are overlooked. […] In a prospective study of 174 children and adults presenting to the emergency department with allergic reactions or suspected anaphylaxis, the NIAID/FAAN criteria diagnostic performance reported as: Sensitivity: 95%; Specificity: 71%; Positive predictive value: 63.7%; Negative predictive value: 96.4%; Positive likelihood ratio: 3.26; Negative likelihood ratio: 0.07.

• #17 Anaphylaxis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000099

  Anaphylaxis presents with sudden onset of life-threatening airway and/or breathing and/or circulation problems (with or without skin changes) after exposure to a trigger (allergen). […] The diagnosis is clinical. Allergy testing is helpful to prevent recurrence. […] Initiating prompt treatment with intramuscular adrenaline (epinephrine) and securing the airway may save lives. […] Key diagnostic factors include acute onset, airway swelling (angio-oedema), inspiratory stridor and hoarse voice, shortness of breath, wheezing, chest hyperinflation, and accessory muscle use, cyanosis, respiratory arrest, pale, clammy skin, hypotension, increased pulse rate (tachycardia), bradycardia, cardiac arrest, confusion or disorientation, urticaria (hives), erythema, pruritus, rhinitis, and bilateral conjunctivitis. […] The first investigations to order include mast cell tryptase, 12-lead ECG, blood gases, and urea and electrolytes.

• #18 Anaphylaxis – Diagnosis & Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/anaphylaxis-diagnosis-treatment/

  Anaphylaxis is a potentially life-threatening emergency that requires immediate diagnosis and treatment. […] Anaphylaxis is a clinical diagnosis and is highly likely when any one of the following three criteria is filled: […] Sudden onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (ie. generalized hives, itching or flushing, swollen lips-tongue-uvula) and at least one of the following: […] Two or more of the following occurring rapidly (minutes to several hours) after exposure to a likely allergen or other trigger for that patient: […] Reduced BP after exposure to a known allergen for that patient (minutes to several hours): […] All patients with suspected anaphylaxis should be closely monitored as above. […] Admission or observation is recommended for patients who do not respond promptly to IM epinephrine, require >1 dose of epinephrine, or received epinephrine only after a significant delay (>60 minutes), as these features may be risk factors for a biphasic response.

• #19 Anaphylaxis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000099

  Anaphylaxis presents with sudden onset of life-threatening airway and/or breathing and/or circulation problems (with or without skin changes) after exposure to a trigger (allergen). […] The diagnosis is clinical. Allergy testing is helpful to prevent recurrence. […] Initiating prompt treatment with intramuscular adrenaline (epinephrine) and securing the airway may save lives. […] Key diagnostic factors include acute onset, airway swelling (angio-oedema), inspiratory stridor and hoarse voice, shortness of breath, wheezing, chest hyperinflation, and accessory muscle use, cyanosis, respiratory arrest, pale, clammy skin, hypotension, increased pulse rate (tachycardia), bradycardia, cardiac arrest, confusion or disorientation, urticaria (hives), erythema, pruritus, rhinitis, and bilateral conjunctivitis. […] The first investigations to order include mast cell tryptase, 12-lead ECG, blood gases, and urea and electrolytes.

• #20 Anaphylaxis – Diagnosis & Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/anaphylaxis-diagnosis-treatment/

  Anaphylaxis is a potentially life-threatening emergency that requires immediate diagnosis and treatment. […] Anaphylaxis is a clinical diagnosis and is highly likely when any one of the following three criteria is filled: […] Sudden onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (ie. generalized hives, itching or flushing, swollen lips-tongue-uvula) and at least one of the following: […] Two or more of the following occurring rapidly (minutes to several hours) after exposure to a likely allergen or other trigger for that patient: […] Reduced BP after exposure to a known allergen for that patient (minutes to several hours): […] All patients with suspected anaphylaxis should be closely monitored as above. […] Admission or observation is recommended for patients who do not respond promptly to IM epinephrine, require >1 dose of epinephrine, or received epinephrine only after a significant delay (>60 minutes), as these features may be risk factors for a biphasic response.

• #21 Anaphylaxis & Angioedema: Practical Approach to Diagnosis and Management in Emergency Department | RECAPEM

  https://recapem.com/anaphylaxis-angioedema-practical-approach-to-diagnosis-and-management-in-emergency-department-2/

  Skin lesions are frequently common (90%) during an anaphylaxis event. This makes diagnostic criterion one extremely useful for diagnosis. However, in almost 10% of patients skin lesions are totally absent or unrecognized. This can be attributed to factors such as the inability to communicate to express itching (e.g. patient is anesthetized, sedated, or unconscious), taking antihistamines by patients, or failure to fully undress and examine the patient. In this situation, criteria 2 or 3 are helpful for diagnosing the event. […] Anaphylaxis in a patient with asthma may be mistaken for an asthma exacerbation if accompanying skin symptoms and signs, such as itching or hives, mucosal, tongue, or lip edema, or dizziness suggestive of impending shock, are overlooked. […] In a prospective study of 174 children and adults presenting to the emergency department with allergic reactions or suspected anaphylaxis, the NIAID/FAAN criteria diagnostic performance reported as: Sensitivity: 95%; Specificity: 71%; Positive predictive value: 63.7%; Negative predictive value: 96.4%; Positive likelihood ratio: 3.26; Negative likelihood ratio: 0.07.

• #22 2. Anaphylaxis: diagnosis and management | The Medical Journal of Australia

  https://www.mja.com.au/journal/2006/185/5/2-anaphylaxis-diagnosis-and-management

  Anaphylaxis is a serious, rapid-onset, allergic reaction that may cause death. Severe anaphylaxis is characterised by life-threatening upper airway obstruction, bronchospasm and/or hypotension. […] Diagnosis can be difficult, with skin features being absent in up to 20% of people. Anaphylaxis must be considered as a differential diagnosis for any acute-onset respiratory distress, bronchospasm, hypotension or cardiac arrest. […] Lack of a universally accepted definition and severity grading system for anaphylaxis, and lack of a reliable biomarker to confirm the diagnosis, has not only hampered research but has also resulted in failure to diagnose and treat anaphylaxis in a consistent and timely manner. […] Anaphylaxis remains a largely clinical diagnosis. Serum mast cell tryptase concentration can be determined, but this is an insensitive biomarker for anaphylaxis, although serial measurements (eg, on arrival, 1 hour later and before discharge) may improve sensitivity and specificity. An elevated tryptase level may be a useful clue when the diagnosis is uncertain, but a normal result does not exclude anaphylaxis. […] Anaphylaxis should be considered in the differential diagnosis of any episode of severe, acute-onset respiratory distress, bronchospasm or cardiovascular collapse.

• #23 Anaphylaxis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/135065-overview

  Anaphylaxis is primarily a clinical diagnosis. The first priority in the physical examination should be to assess the patients airway, breathing, circulation, and adequacy of mentation (eg, alertness, orientation, coherence of thought). […] Anaphylaxis has no universally accepted clinical definition. It is a clinical diagnosis based on typical systemic manifestations, often with a history of acute exposure to a causative agent. (See Diagnosis.) […] Because anaphylaxis is primarily a clinical diagnosis, laboratory studies are not usually required and are rarely helpful. However, if the diagnosis is unclear, especially with a recurrent syndrome, or if other diseases need to be excluded, some limited laboratory studies are indicated. Skin testing and in vitro IgE tests may be helpful. (See Workup.)

• #24 Improving Diagnostic Accuracy of Anaphylaxis in the Acute Care Setting – The Western Journal of Emergency Medicine

  https://westjem.com/articles/improving-diagnostic-accuracy-of-anaphylaxis-in-the-acute-care-setting.html

  Improving Diagnostic Accuracy of Anaphylaxis in the Acute Care Setting – The Western Journal of Emergency Medicine […] The identification and appropriate management of those at highest risk for life-threatening anaphylaxis remains a clinical enigma. The most widely used criteria for such patients were developed in a symposium convened by National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network. In this paper we review the current literature on the diagnosis of acute allergic reactions as well as atypical presentations that clinicians should recognize. Review of case series reveals significant variability in definition and approach to this common and potentially life-threatening condition. Series on fatal cases of anaphylaxis indicate that mucocutaneous signs and symptoms occur less frequently than in milder cases. Of biomarkers studied to aid in the work-up of possible anaphylaxis, drawing blood during the initial six hours of an acute reaction for analysis of serum tryptase has been recommended in atypical cases. This can provide valuable information when a definitive diagnosis cannot be made by history and physical exam.

• #25 Improving Diagnostic Accuracy of Anaphylaxis in the Acute Care Setting – The Western Journal of Emergency Medicine

  https://westjem.com/articles/improving-diagnostic-accuracy-of-anaphylaxis-in-the-acute-care-setting.html

  In one retrospective study reviewing all ED records for a period of four months only one in every four patients who met criteria for anaphylaxis had been correctly diagnosed during their ED visit. The majority were diagnosed as having an acute allergic reaction. Based on the studies discussed above, there appears to be significant evidence of a need to standardize how anaphylaxis is diagnosed in the ED setting. […] Considering all the above reported atypical presentations of anaphylaxis, it may be challenging in a significant number of cases to determine with any certainty the cause of a patients acute symptoms based on history and physical exam alone. This may be complicated even further if a detailed history is unobtainable or if a patient is not seen until after the acute symptoms have subsided.

• #26 2. Anaphylaxis: diagnosis and management | The Medical Journal of Australia

  https://www.mja.com.au/journal/2006/185/5/2-anaphylaxis-diagnosis-and-management

  Anaphylaxis is a serious, rapid-onset, allergic reaction that may cause death. Severe anaphylaxis is characterised by life-threatening upper airway obstruction, bronchospasm and/or hypotension. […] Diagnosis can be difficult, with skin features being absent in up to 20% of people. Anaphylaxis must be considered as a differential diagnosis for any acute-onset respiratory distress, bronchospasm, hypotension or cardiac arrest. […] Lack of a universally accepted definition and severity grading system for anaphylaxis, and lack of a reliable biomarker to confirm the diagnosis, has not only hampered research but has also resulted in failure to diagnose and treat anaphylaxis in a consistent and timely manner. […] Anaphylaxis remains a largely clinical diagnosis. Serum mast cell tryptase concentration can be determined, but this is an insensitive biomarker for anaphylaxis, although serial measurements (eg, on arrival, 1 hour later and before discharge) may improve sensitivity and specificity. An elevated tryptase level may be a useful clue when the diagnosis is uncertain, but a normal result does not exclude anaphylaxis. […] Anaphylaxis should be considered in the differential diagnosis of any episode of severe, acute-onset respiratory distress, bronchospasm or cardiovascular collapse.

• #27 Patient education: Anaphylaxis symptoms and diagnosis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/anaphylaxis-symptoms-and-diagnosis-beyond-the-basics

  Anaphylaxis DIAGNOSIS […] The diagnosis of anaphylaxis is based on symptoms that occur within minutes to an hour or so after exposure to a potential trigger, such as a food, medication, or insect sting. […] Is it anaphylaxis or another problem?—Other health problems can cause symptoms that are similar to those of anaphylaxis. These include a severe asthma attack, a heart attack, a panic attack, or even food poisoning. After the acute anaphylactic episode, follow-up evaluation by an allergy specialist can help to clarify the diagnosis. […] Tryptase is one of the natural chemicals released into the blood during an anaphylactic reaction. An increased amount of tryptase can sometimes be measured in a blood sample collected during the first few hours after anaphylaxis symptoms have begun. However, a normal tryptase level does not exclude the diagnosis of anaphylaxis.

• #28 Laboratory tests to support the clinical diagnosis of anaphylaxis – UpToDate

  https://www.uptodate.com/contents/laboratory-tests-to-support-the-clinical-diagnosis-of-anaphylaxis

  Laboratory tests to support the clinical diagnosis of anaphylaxis […] The diagnosis of anaphylaxis during the acute event is based on the clinical presentation and either a history of a recent exposure to an offending agent or consideration of spontaneous anaphylaxis. […] There are no laboratory tests available in an emergency department or clinic setting to confirm a diagnosis of anaphylaxis in real time. […] However, laboratory tests in serum, plasma, and possibly urine obtained during or shortly after the acute event can help to support the clinical diagnosis of anaphylaxis. […] These tests can also help identify anaphylaxis in the presence of other disorders that have overlapping clinical presentations, such as severe asthma, myocardial infarction, postural orthostatic tachycardia syndrome, flushing disorders, or various shock syndromes.

• #29 Laboratory tests to support the clinical diagnosis of anaphylaxis – UpToDate

  https://www.uptodate.com/contents/laboratory-tests-to-support-the-clinical-diagnosis-of-anaphylaxis

  Laboratory tests to support the clinical diagnosis of anaphylaxis […] The diagnosis of anaphylaxis during the acute event is based on the clinical presentation and either a history of a recent exposure to an offending agent or consideration of spontaneous anaphylaxis. […] There are no laboratory tests available in an emergency department or clinic setting to confirm a diagnosis of anaphylaxis in real time. […] However, laboratory tests in serum, plasma, and possibly urine obtained during or shortly after the acute event can help to support the clinical diagnosis of anaphylaxis. […] These tests can also help identify anaphylaxis in the presence of other disorders that have overlapping clinical presentations, such as severe asthma, myocardial infarction, postural orthostatic tachycardia syndrome, flushing disorders, or various shock syndromes.

• #30 Anaphylaxis

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/anaphylaxis/

  When considering anaphylaxis in the differential diagnosis, it is important to exclude other clinical disorders that can masquerade as anaphylaxis (Box 3). […] In general, anaphylaxis remains a clinical syndrome where careful review of the history and review of all relevant medical records suggests the diagnosis (Table 3). Measurement of selected biomarkers may assist in confirming anaphylaxis. Plasma histamine can be measured, and to be useful should be obtained 15 to 60 minutes after onset of symptoms due to the short half-life of plasma histamine; a transient elevation of peri-event serum histamine with subsequent return to baseline is suggestive. […] Serum tryptase may also be useful in confirming the diagnosis of anaphylaxis. Tryptase is a protease expressed in high concentrations in mast cells and to a much lesser extent in basophils; it is released along with histamine upon mast cell activation and degranulation. If serum specimens can be obtained between 1 and 3 hours after the onset of symptoms, an elevated serum tryptase level compared with a baseline level obtained when the patient is asymptomatic can suggest that symptoms were caused by anaphylaxis.

• #31 Anaphylaxis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anaphylaxis/diagnosis-treatment/drc-20351474

  Your provider might ask you questions about previous allergic reactions, including whether you’ve reacted to: […] To help confirm the diagnosis: […] You might be given a blood test to measure the amount of a certain enzyme (tryptase) that can be elevated up to three hours after anaphylaxis […] You might be tested for allergies with skin tests or blood tests to help determine your trigger. […] Many conditions have signs and symptoms similar to those of anaphylaxis. Your provider might want to rule out other conditions.

• #32 Laboratory tests to support the clinical diagnosis of anaphylaxis – UpToDate

  https://www.uptodate.com/contents/laboratory-tests-to-support-the-clinical-diagnosis-of-anaphylaxis

  In addition, these tests may provide evidence for anaphylaxis as a cause of death. […] These tests are different from those that identify sensitization to the inciting allergen, namely measurements of allergen-specific immunoglobulin E (IgE) and those that identify mast cell disorders, which are reviewed separately. […] Elevations in tryptase and histamine can sometimes be detected in blood samples obtained shortly after the onset of symptoms. […] Elevated levels of histamine, histamine metabolites (N-methylhistamine and N-methylimidazole acetic acid), the prostaglandin D2 (PGD2) metabolites, and the leukotriene C4 (LTC4) metabolite can be measured in urine or, in some cases, in serum or plasma after an anaphylactic event.

• #33 Anaphylaxis: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0915/p355.html

  Making an accurate diagnosis is important because epinephrine is administered more often to patients diagnosed with anaphylaxis. […] For example, syncope and hypotension are more common presentations in drug-induced anaphylaxis, and in children, gastrointestinal and respiratory symptoms are more likely to be overlooked despite the more common occurrence of gastrointestinal symptoms. […] Serum tryptase levels reflect mast cell degranulation and peak one to one and a half hours after the onset of anaphylaxis. […] Referral of patients with an anaphylactic reaction for allergy testing may help determine the offending trigger. […] The mainstay of treatment of acute IgE-mediated or nonimmune anaphylaxis is epinephrine. […] Delayed or lack of epinephrine use continues to be a problem despite current guidelines emphasizing the importance of early administration.

• #34 Anaphylaxis

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/anaphylaxis/

  When considering anaphylaxis in the differential diagnosis, it is important to exclude other clinical disorders that can masquerade as anaphylaxis (Box 3). […] In general, anaphylaxis remains a clinical syndrome where careful review of the history and review of all relevant medical records suggests the diagnosis (Table 3). Measurement of selected biomarkers may assist in confirming anaphylaxis. Plasma histamine can be measured, and to be useful should be obtained 15 to 60 minutes after onset of symptoms due to the short half-life of plasma histamine; a transient elevation of peri-event serum histamine with subsequent return to baseline is suggestive. […] Serum tryptase may also be useful in confirming the diagnosis of anaphylaxis. Tryptase is a protease expressed in high concentrations in mast cells and to a much lesser extent in basophils; it is released along with histamine upon mast cell activation and degranulation. If serum specimens can be obtained between 1 and 3 hours after the onset of symptoms, an elevated serum tryptase level compared with a baseline level obtained when the patient is asymptomatic can suggest that symptoms were caused by anaphylaxis.

• #35 Patient education: Anaphylaxis symptoms and diagnosis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/anaphylaxis-symptoms-and-diagnosis-beyond-the-basics

  Anaphylaxis DIAGNOSIS […] The diagnosis of anaphylaxis is based on symptoms that occur within minutes to an hour or so after exposure to a potential trigger, such as a food, medication, or insect sting. […] Is it anaphylaxis or another problem?—Other health problems can cause symptoms that are similar to those of anaphylaxis. These include a severe asthma attack, a heart attack, a panic attack, or even food poisoning. After the acute anaphylactic episode, follow-up evaluation by an allergy specialist can help to clarify the diagnosis. […] Tryptase is one of the natural chemicals released into the blood during an anaphylactic reaction. An increased amount of tryptase can sometimes be measured in a blood sample collected during the first few hours after anaphylaxis symptoms have begun. However, a normal tryptase level does not exclude the diagnosis of anaphylaxis.

• #36 What is Anaphylaxis? Symptoms, Medications & Treatments Explained

  https://cprcare.com/blog/anaphylaxis-causes-symptoms-diagnosis-treatment/

  Doctors diagnose anaphylaxis by examining your signs and symptoms. […] Blood tests for histamine or tryptase are also useful to diagnose anaphylaxis due to drug allergies or insect stings. However, they are not useful for food allergies. […] Diagnosing anaphylaxis often requires a thorough evaluation by a healthcare professional, but knowing how to treat it with epinephrine and other medical interventions can save lives.

• #37 Laboratory tests to support the clinical diagnosis of anaphylaxis – UpToDate

  https://www.uptodate.com/contents/laboratory-tests-to-support-the-clinical-diagnosis-of-anaphylaxis

  In addition, these tests may provide evidence for anaphylaxis as a cause of death. […] These tests are different from those that identify sensitization to the inciting allergen, namely measurements of allergen-specific immunoglobulin E (IgE) and those that identify mast cell disorders, which are reviewed separately. […] Elevations in tryptase and histamine can sometimes be detected in blood samples obtained shortly after the onset of symptoms. […] Elevated levels of histamine, histamine metabolites (N-methylhistamine and N-methylimidazole acetic acid), the prostaglandin D2 (PGD2) metabolites, and the leukotriene C4 (LTC4) metabolite can be measured in urine or, in some cases, in serum or plasma after an anaphylactic event.

• #38 Anaphylaxis: Practical aspects of diagnosis and treatment | Medicina Universitaria

  https://www.elsevier.es/en-revista-medicina-universitaria-304-articulo-anaphylaxis-practical-aspects-diagnosis-treatment-S1665579615000691

  Useful clinical criteria have been established for the diagnosis of anaphylaxis, which are listed in Table 1. With the proper use of these criteria, it is possible to identify over 95% of anaphylaxis cases. […] […] Serum tryptase, plasmatic histamine and histamine metabolites in urine (methyl-histamine) may be useful to confirm an anaphylaxis diagnosis. The best time for its measurement after the onset of the anaphylaxis episode is between 1 and 6h for serum tryptase, from 10min to 1h for histamine and during the first 24h for methyl-histamine. Nevertheless, these studies are not always available and the administration of the treatment should not be delayed. […]

• #39 Laboratory tests to support the clinical diagnosis of anaphylaxis – UpToDate

  https://www.uptodate.com/contents/laboratory-tests-to-support-the-clinical-diagnosis-of-anaphylaxis

  In addition, these tests may provide evidence for anaphylaxis as a cause of death. […] These tests are different from those that identify sensitization to the inciting allergen, namely measurements of allergen-specific immunoglobulin E (IgE) and those that identify mast cell disorders, which are reviewed separately. […] Elevations in tryptase and histamine can sometimes be detected in blood samples obtained shortly after the onset of symptoms. […] Elevated levels of histamine, histamine metabolites (N-methylhistamine and N-methylimidazole acetic acid), the prostaglandin D2 (PGD2) metabolites, and the leukotriene C4 (LTC4) metabolite can be measured in urine or, in some cases, in serum or plasma after an anaphylactic event.

• #40

  https://www.health.nsw.gov.au/immunisation/Pages/investigations-for-anaphylaxis.aspx

  Anaphylaxis is a serious systemic allergic reaction that is potentially life-threatening. Anaphylaxis has a rapid onset and requires immediate adrenaline administration. Diagnosis of anaphylaxis is based on clinical symptoms and history of a recent exposure of a probable trigger (most commonly foods or drugs, but very occasionally, vaccination). There are some laboratory investigations that may support a diagnosis of anaphylaxis. Serum tryptase should be collected where anaphylaxis is clinically suspected. The diagnosis of anaphylaxis is made based on clinical grounds. The majority of anaphylaxis secondary to the Pfizer BioNTech (Comirnaty) COVID-19 vaccination occurs within 15 minutes of administration. […] Serum tryptase (also known as mast-cell tryptase) may be useful for ruling in anaphylaxis and so should be collected for all suspected cases, however it is much less useful in ruling it out. […] Clinical presentations that can mimic anaphylaxis, but that do not usually result in raised tryptase levels include vasovagal reactions, septic shock or seizures.

• #41 Laboratory tests to support the clinical diagnosis of anaphylaxis – UpToDate

  https://www.uptodate.com/contents/laboratory-tests-to-support-the-clinical-diagnosis-of-anaphylaxis

  In addition, these tests may provide evidence for anaphylaxis as a cause of death. […] These tests are different from those that identify sensitization to the inciting allergen, namely measurements of allergen-specific immunoglobulin E (IgE) and those that identify mast cell disorders, which are reviewed separately. […] Elevations in tryptase and histamine can sometimes be detected in blood samples obtained shortly after the onset of symptoms. […] Elevated levels of histamine, histamine metabolites (N-methylhistamine and N-methylimidazole acetic acid), the prostaglandin D2 (PGD2) metabolites, and the leukotriene C4 (LTC4) metabolite can be measured in urine or, in some cases, in serum or plasma after an anaphylactic event.

• #42 Anaphylaxis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anaphylaxis/diagnosis-treatment/drc-20351474

  Your provider might ask you questions about previous allergic reactions, including whether you’ve reacted to: […] To help confirm the diagnosis: […] You might be given a blood test to measure the amount of a certain enzyme (tryptase) that can be elevated up to three hours after anaphylaxis […] You might be tested for allergies with skin tests or blood tests to help determine your trigger. […] Many conditions have signs and symptoms similar to those of anaphylaxis. Your provider might want to rule out other conditions.

• #43 Anaphylaxis

  https://www.aaaai.org/conditions-treatments/allergies/anaphylaxis

  Anaphylaxis requires immediate medical treatment, including a prompt dose of epinephrine and a trip to a hospital emergency room. If it isnt treated properly, anaphylaxis can be fatal. […] Accurate diagnosis and successful management of allergies is essential. An allergist / immunologist, often referred to as an allergist, has specialized training and experience to diagnose the problem and help you develop a plan to protect you in the future. […] To diagnose your risk of anaphylaxis or to determine whether previous symptoms were anaphylaxis-related, your allergist / immunologist will conduct a thorough investigation of all potential causes. Your allergist will ask for specific details regarding all past allergic reactions. […] If you think you are having an anaphylactic reaction, use your epinephrine and call 911 immediately so you can be transported to the nearest emergency department for evaluation, monitoring and any further treatment by healthcare professionals. Your life depends on this. Don’t take an antihistamine or wait to see if symptoms get better.

• #44 Anaphylaxis: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1115/p1111.html

  Anaphylaxis is a severe, life-threatening, systemic allergic reaction that is almost always unanticipated and may lead to death by airway obstruction or vascular collapse. The diagnosis of anaphylaxis is typically made when symptoms occur within one hour of exposure to a specific antigen. […] Confirmatory testing using serum histamine and tryptase levels is difficult, because blood samples must be drawn with strict time considerations. […] The clinical history is the most important tool to determine whether a patient has had an anaphylactic reaction and the cause of the episode. […] Anaphylaxis is highly likely when any one of the following three sets of criteria is fulfilled: 1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized hives; pruritus or flushing; swollen lips, tongue, or uvula), and at least one of the following: Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia) Reduced blood pressure or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence) 2. Two or more of the following that occur rapidly (minutes to several hours) after exposure to a likely allergen for that patient: Involvement of the skin, mucosal tissue, or both (e.g., generalized hives; pruritus or flushing; swollen lips, tongue, or uvula) Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia) Reduced blood pressure or associated symptoms (e.g., hypotonia [collapse], syncope, incontinence) Persistent gastrointestinal symptoms (e.g., abdominal cramps, vomiting) 3. Reduced blood pressure that occurs rapidly (minutes to several hours) after exposure to a known allergen for that patient.

• #45 Diagnosis and management of anaphylaxis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11250555/

  A detailed clinical history is crucial in diagnosing anaphylaxis. […] The use of these criteria to diagnose anaphylaxis was found to have a positive predictive value of 68.6% and a negative predictive value of 98.4%. […] The diagnosis of -gal syndrome is based on a history of delayed allergic reactions to mammalian meat and the blood test for immunoglobulin E to the oligosaccharide -gal. […] Anaphylaxis in infants typically involves the skin in 98%, the respiratory system in 59%, and the gastrointestinal system in 56%, whereas cardiovascular symptoms are rarely reported. […] The administration of epinephrine at a dose of 0.01 mg/kg (1:1000) intramuscularly (maximum single dose, 0.5 mg) is the first-line treatment for anaphylaxis. […] After treatment of the acute episode and presenting symptoms, monitoring of patients in an appropriately equipped health care facility is essential.

• #46 Anaphylaxis – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/patients/about-allergy/anaphylaxis

  Anaphylaxis requires immediate treatment with adrenaline (epinephrine), which is injected into the outer mid-thigh muscle. Delayed treatment can result in fatal anaphylaxis. […] For people diagnosed as being at risk of anaphylaxis, identifying the cause (also known as a trigger) is a very important step in learning how to manage the condition: […] Allergy testing may be recommended if the doctor suspects an allergy is the cause of anaphylaxis. This will usually include a blood test for allergen specific immunoglobulin E (IgE) or skin prick testing (SPT), to help confirm or rule out allergy triggers. […] Effective management of anaphylaxis saves lives. People at risk of anaphylaxis need ongoing management by a doctor. […] Identification of the trigger/s of anaphylaxis will include a detailed medical history and clinical examination followed by interpretation of allergy test results. […] Adrenaline rapidly reverses the effects of anaphylaxis by reducing throat swelling, opening the airways, and maintaining heart function and blood pressure.

• #47 Anaphylaxis

  https://www.rch.org.au/clinicalguide/guideline_index/anaphylaxis/

  Anaphylaxis is a severe allergic reaction characterised by an acute onset of cardiovascular (eg hypotension) or respiratory (eg bronchospasm) symptoms. It may be associated with typical skin features (urticarial rash or erythema/flushing and/or angioedema) and/or persistent severe gastrointestinal symptoms […] Anaphylaxis is a clinical diagnosis made in the setting of the acute onset of either criteria: Typical skin features (urticaria, flushing and/or angioedema) plus involvement of: Respiratory system and/or Cardiovascular system and/or Persistent severe gastrointestinal symptoms (especially after exposure to non-food allergens eg insect sting) OR Hypotension, bronchospasm or upper airway obstruction where anaphylaxis is possible, even if typical skin features are not present […] A detailed history of pre-hospital events is vital to confirm anaphylaxis and its associated trigger(s) […] Anaphylaxis is a clinical diagnosis. A serum tryptase has no role in acute management of anaphylaxis. It should only be ordered after consultation with a paediatric allergy specialist in special circumstances.

• #48 Anaphylaxis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anaphylaxis/diagnosis-treatment/drc-20351474

  Your provider might ask you questions about previous allergic reactions, including whether you’ve reacted to: […] To help confirm the diagnosis: […] You might be given a blood test to measure the amount of a certain enzyme (tryptase) that can be elevated up to three hours after anaphylaxis […] You might be tested for allergies with skin tests or blood tests to help determine your trigger. […] Many conditions have signs and symptoms similar to those of anaphylaxis. Your provider might want to rule out other conditions.

• #49 Anaphylaxis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/8619-anaphylaxis

  Anaphylaxis is a life-threatening allergic reaction. Signs include breathing difficulties, swelling, hives and a drop in blood pressure. […] If you’ve had an allergic reaction, or suspected allergic reaction, to food or insect stings (even a mild one), talk to a healthcare provider. A provider can often diagnose anaphylaxis based on your symptoms. […] An allergist may recommend performing a skin test or a blood test to confirm an allergy and identify the specific allergic trigger. […] If you’ve had allergic reactions to food or a stinging insect, your provider will prescribe an epinephrine autoinjector injection (EpiPen or a generic version of EpiPen). […] If you think you’re having an anaphylactic reaction, don’t wait to use your injector. […] An allergist is a healthcare provider specially trained to diagnose and treat people with allergies. If you experience or think you’ve experienced an allergic/anaphylactic reaction, you should see an allergist.

• #50

  https://link.springer.com/article/10.1007/s40521-020-00255-x

  The management of anaphylaxis, after a rapid clinical-based hypothesis and prompt treatment introduction, includes diagnosis confirmation. […] Serum tryptase is still the most accurate and available method for diagnosis during the acute phase, although it is necessary to measure baseline levels after a period of time. […] For etiologic diagnosis, serum-specific IgE, component-resolved diagnosis (CRD), and basophil activation test (BAT) are available and sometimes helpful, and the new mast cell activation test (MAT) has been recently proposed to help confirming activation of those cells by a specific trigger. […] In vitro tests can help clinicians to confirm anaphylaxis diagnosis and sometimes its etiology, but many triggers cannot be confirmed by laboratory methods.

• #51 Anaphylaxis | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0283-4

  The clinical history is the most important tool to establish the cause of anaphylaxis and must take precedence over diagnostic tests. […] The diagnosis of a specific cause of anaphylaxis may be supported by the results of skin tests and/or in vitro IgE tests. […] The clinical diagnosis of anaphylaxis can sometimes be supported by the documentation of elevated concentrations of mast cell and basophil mediators such as plasma histamine or serum or plasma total tryptase. […] Other diagnoses that might present with signs and/or symptoms characteristic of anaphylaxis should be excluded. […] Anaphylaxis is the most severe form of an allergic reaction that is rapid in onset and potentially fatal. […] The diagnosis is based primarily on clinical signs and symptoms. […] Referral to an allergist or immunologist should be considered for all persons who have experienced a previous anaphylactic episode.

• #52 What you need to know about shellfish allergy diagnosis, treatment

  https://health.ucdavis.edu/news/headlines/what-you-need-to-know-about-shellfish-allergy-diagnosis-treatment/2022/10

  In some people, an allergic reaction to shellfish can be severe and life-threatening called anaphylaxis. Symptoms may include vomiting, dizziness or fainting and trouble breathing due to constricted airways. In rare cases, without immediate treatment with epinephrine, it can lead to death. […] Despite its prevalence and its potentially lethal symptoms, shellfish allergy remains a big challenge to clinicians to diagnose and treat. […] To diagnose shellfish allergy, the routine workup would involve a thorough review of the patients history, a skin prick test, and a blood test for shellfish allergens and tropomyosin. Clinicians would then assess whether an oral food challenge is necessary to confirm a diagnosis. […] A blind food challenge remains the gold standard for food allergy diagnosis. However, this method is resource-intensive, time-consuming, expensive and with the risk of severe reaction that hampers its clinical use.

• #53

  https://www.wyndly.com/blogs/learn/anaphylaxis?srsltid=AfmBOorh7q69qc79SKHxU-ZApWfTEdHml8o5nfWJG4HUJXCb__h8T_1J

  How Is Anaphylaxis Diagnosed? […] Diagnosing anaphylaxis starts with a physical exam to determine the severity of the reaction and its potential causes. Your doctor will ask you questions about your medical history, including any existing allergies or pre-existing conditions to narrow down the scope of what’s going on. […] Testing for anaphylaxis may also include provocation tests, which involve exposing a patient to small amounts of potential allergens in a controlled environment. This helps to identify if the patient is indeed experiencing anaphylaxis and can also help pinpoint which allergen is causing the reaction. […] Once anaphylaxis is properly diagnosed, your doctor can develop a comprehensive treatment plan to help manage the reaction and keep it from happening in the future.

• #54 Anaphylaxis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468

  Anaphylaxis requires an injection of epinephrine and a follow-up trip to an emergency room. If you don’t have epinephrine, you need to go to an emergency room immediately. If anaphylaxis isn’t treated right away, it can be fatal. […] The diagnosis and long-term management of anaphylaxis are complicated, so you’ll probably need to see a doctor who specializes in allergies and immunology. […] If you don’t know what triggers an allergy attack, certain tests can help identify the allergen. In some cases, the cause of anaphylaxis is not identified (idiopathic anaphylaxis). […] An anaphylactic reaction can be life-threatening it can stop your breathing or your heartbeat.

• #55 Anaphylaxis Unknown? Put On Your Detective Cap – Allergy & Asthma Network

  https://allergyasthmanetwork.org/news/anaphylaxis-unknown-put-your-detective-cap/

  Anaphylaxis is a severe allergic reaction that comes on swiftly and can turn deadly in minutes. […] When there is no obvious or apparent cause of a reaction, it is termed idiopathic anaphylaxis. […] Any time a person experiences anaphylaxis, they should consult with a board-certified allergist for an in-depth evaluation. When the cause of the allergic reaction is not obvious, the process will likely take several visits, extensive discussion and allergy testing. […] The allergist will likely want to do extensive testing for a wide range of food and other allergens. This could include testing specific foods that the patient will be asked to supply, such as spices used, packaged food, or even leftover restaurant food. Both skin tests and blood tests might be ordered. […] If after an exhaustive evaluation no cause is determined, the diagnosis is idiopathic anaphylaxis.

• #56 Idiopathic Anaphylaxis | Anaphylaxis UK

  https://www.anaphylaxis.org.uk/fact-sheet/idiopathic-anaphylaxis/

  Anaphylaxis (pronounced ana-fil-ax-is) is a severe and potentially life-threatening allergic reaction. […] If after medical testing and investigation the cause of the reaction is not found, the reaction is then labelled as idiopathic anaphylaxis (which means cause unknown). […] A diagnosis of idiopathic anaphylaxis should only be made after an extensive medical investigation. This should include a review of all hospitalisation and AE records.

• #57 Idiopathic Anaphylaxis | Free Anaphylaxis & Epinephrine Auto-Injector Online Training Video | ProAnaphylaxisicon-log-invimeo-iconicon-social-facebookicon-social-youtubeicon-social-linkedinicon-social-twitter

  https://www.proanaphylaxis.com/training/video/idiopathic-anaphylaxis-diagnosis

  Sometimes, people are diagnosed as having what the doctor may call idiopathic anaphylaxis. This special type of anaphylaxis means that the cause for the anaphylactic reaction is unknown. During idiopathic anaphylaxis, the reaction is normally exactly the same and the signs and symptoms are typical. If the doctor diagnoses this, they will advise you to stay away from all of the most common allergens like shellfish, peanuts and eggs. This is because it could be that there may be more than one thing you are allergic to. Sometimes, the doctor will diagnose the condition as idiopathic, but then later on you may realise that you only get anaphylactic reactions after eating certain foods or after being stung by something. The doctor may also ask you to undertake allergy testing and physical examinations. In cases of idiopathic anaphylaxis, it is essential that you always carry around your prescribed auto-injector, as you cannot always stay away from allergens. Many people with idiopathic anaphylaxis see a decrease in reactions as their life goes on, again however, it is unclear why this is.

• #58 Anaphylaxis Unknown? Put On Your Detective Cap – Allergy & Asthma Network

  https://allergyasthmanetwork.org/news/anaphylaxis-unknown-put-your-detective-cap/

  Anaphylaxis is a severe allergic reaction that comes on swiftly and can turn deadly in minutes. […] When there is no obvious or apparent cause of a reaction, it is termed idiopathic anaphylaxis. […] Any time a person experiences anaphylaxis, they should consult with a board-certified allergist for an in-depth evaluation. When the cause of the allergic reaction is not obvious, the process will likely take several visits, extensive discussion and allergy testing. […] The allergist will likely want to do extensive testing for a wide range of food and other allergens. This could include testing specific foods that the patient will be asked to supply, such as spices used, packaged food, or even leftover restaurant food. Both skin tests and blood tests might be ordered. […] If after an exhaustive evaluation no cause is determined, the diagnosis is idiopathic anaphylaxis.

• #59 Idiopathic Anaphylaxis | Free Anaphylaxis & Epinephrine Auto-Injector Online Training Video | ProAnaphylaxisicon-log-invimeo-iconicon-social-facebookicon-social-youtubeicon-social-linkedinicon-social-twitter

  https://www.proanaphylaxis.com/training/video/idiopathic-anaphylaxis-diagnosis

  Sometimes, people are diagnosed as having what the doctor may call idiopathic anaphylaxis. This special type of anaphylaxis means that the cause for the anaphylactic reaction is unknown. During idiopathic anaphylaxis, the reaction is normally exactly the same and the signs and symptoms are typical. If the doctor diagnoses this, they will advise you to stay away from all of the most common allergens like shellfish, peanuts and eggs. This is because it could be that there may be more than one thing you are allergic to. Sometimes, the doctor will diagnose the condition as idiopathic, but then later on you may realise that you only get anaphylactic reactions after eating certain foods or after being stung by something. The doctor may also ask you to undertake allergy testing and physical examinations. In cases of idiopathic anaphylaxis, it is essential that you always carry around your prescribed auto-injector, as you cannot always stay away from allergens. Many people with idiopathic anaphylaxis see a decrease in reactions as their life goes on, again however, it is unclear why this is.

• #60

  https://www.wyndly.com/blogs/learn/exercise-induced-anaphylaxis?srsltid=AfmBOorDUZkrNWNaV4ztfy-Anqu8DD0T3pqAvZGJWlpFThQKhatS-gDG

  Yes, anaphylaxis can be triggered by exercise. This condition, known as exercise-induced anaphylaxis, causes severe reactions like hives, difficulty breathing, and low blood pressure during or after physical activity. Certain foods or medications can exacerbate these symptoms when consumed pre-exercise. […] Exercise-induced anaphylaxis is a rare but severe allergic reaction that occurs in conjunction with physical activity. It can be life-threatening and requires immediate medical attention. The exact cause is not well understood, but it appears to involve an interaction between allergens and exercise. […] Diagnosing exercise-induced anaphylaxis can be challenging due to its sporadic nature. It requires a detailed medical history, physical examination, and specific diagnostic tests. The key is to identify the correlation between physical activity and the onset of symptoms.

• #61

  https://www.wyndly.com/blogs/learn/exercise-induced-anaphylaxis?srsltid=AfmBOorDUZkrNWNaV4ztfy-Anqu8DD0T3pqAvZGJWlpFThQKhatS-gDG

  Further diagnostic tests may include skin tests or blood tests to identify specific allergens. In some cases, a controlled exercise challenge might be conducted under medical supervision to confirm the diagnosis. This test involves the patient exercising in a controlled environment to replicate the conditions that typically cause symptoms. […] An allergist or immunologist can provide a definitive diagnosis and develop a customized treatment plan, which may include allergy exposure therapy. […] The treatment for exercise-induced anaphylaxis primarily focuses on preventing episodes, managing symptoms, and preparing for potential allergic reactions. […] Exercise-induced anaphylaxis is diagnosed if you experience symptoms such as hives, difficulty breathing, nausea, faintness, or a rapid heartbeat within a few hours after exercising.

• #62

  https://www.wyndly.com/blogs/learn/exercise-induced-anaphylaxis?srsltid=AfmBOorDUZkrNWNaV4ztfy-Anqu8DD0T3pqAvZGJWlpFThQKhatS-gDG

  Exercise-induced anaphylaxis is diagnosed through a combination of patient history and physical examination. Doctors may also conduct an exercise challenge test, where the patient exercises under supervision to trigger symptoms. Blood tests for specific antibodies might be done too, to confirm the diagnosis. […] The incidence of exercise-induced anaphylaxis is relatively low, affecting approximately 2% of the population. This condition is characterized by severe, sometimes life-threatening allergic reactions triggered by physical activity. It’s important to note that the severity and triggers can vary from person to person.

• #63 Diagnosis and management of anaphylaxis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11250555/

  A detailed clinical history is crucial in diagnosing anaphylaxis. […] The use of these criteria to diagnose anaphylaxis was found to have a positive predictive value of 68.6% and a negative predictive value of 98.4%. […] The diagnosis of -gal syndrome is based on a history of delayed allergic reactions to mammalian meat and the blood test for immunoglobulin E to the oligosaccharide -gal. […] Anaphylaxis in infants typically involves the skin in 98%, the respiratory system in 59%, and the gastrointestinal system in 56%, whereas cardiovascular symptoms are rarely reported. […] The administration of epinephrine at a dose of 0.01 mg/kg (1:1000) intramuscularly (maximum single dose, 0.5 mg) is the first-line treatment for anaphylaxis. […] After treatment of the acute episode and presenting symptoms, monitoring of patients in an appropriately equipped health care facility is essential.

• #64 Food Allergy Anaphylaxis in Infants and Toddlers | AAFA.org

  https://aafa.org/asthma-allergy-research/our-research/food-allergy-anaphylaxis-in-infants/

  Anaphylaxis is a severe allergic reaction that can be life-threatening if not treated quickly and properly. […] The most common causes of anaphylaxis are food, latex, insect stings and bites, and medicines. Food is the most common cause of anaphylaxis in young children. […] Anaphylaxis can be hard to recognize in infants and toddlers. Its important for parents and caregivers to know the signs and symptoms in young children and when to give epinephrine. […] The ITA study identified signs and symptoms of anaphylaxis that are specific to infants and toddlers and recognized by parents/caregivers. The most common symptoms of anaphylaxis in infants and toddlers were skin reactions, swelling, vomiting, and diarrhea. […] The ITA study also found that parents/caregivers recognized signs that they later realized were due to an allergic reaction. More education is needed on allergic reaction symptoms in babies.

• #65 Food Allergy Anaphylaxis in Infants and Toddlers | AAFA.org

  https://aafa.org/asthma-allergy-research/our-research/food-allergy-anaphylaxis-in-infants/

  Anaphylaxis is a severe allergic reaction that can be life-threatening if not treated quickly and properly. […] The most common causes of anaphylaxis are food, latex, insect stings and bites, and medicines. Food is the most common cause of anaphylaxis in young children. […] Anaphylaxis can be hard to recognize in infants and toddlers. Its important for parents and caregivers to know the signs and symptoms in young children and when to give epinephrine. […] The ITA study identified signs and symptoms of anaphylaxis that are specific to infants and toddlers and recognized by parents/caregivers. The most common symptoms of anaphylaxis in infants and toddlers were skin reactions, swelling, vomiting, and diarrhea. […] The ITA study also found that parents/caregivers recognized signs that they later realized were due to an allergic reaction. More education is needed on allergic reaction symptoms in babies.

• #66 Anaphylaxis in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/a/anaphylaxis-in-children.html

  Anaphylaxis is a medical emergency. […] A healthcare provider can often diagnose anaphylaxis based on a health history alone. The healthcare provider will look at the following to make a diagnosis: […] The symptoms of anaphylaxis may look like other health problems. Always talk with your child’s healthcare provider for a diagnosis. […] Anaphylaxis is a medical emergency that needs to be treated right away. […] Treatment will likely include a shot of epinephrine. […] If your child has had anaphylaxis, you may be prescribed an epinephrine autoinjector.

• #67 Anaphylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482124/

  Anaphylaxis is an acute, life-threatening hypersensitivity disorder defined as a generalized, rapidly evolving, multi-systemic allergic reaction. […] This activity describes the evaluation and treatment of anaphylaxis and explains the role of the interprofessional team in managing patients with this condition. […] Evaluate the clinical criteria used in the evaluation of anaphylaxis. […] Diagnosing anaphylaxis is clinical; thus, laboratory studies or other diagnostics are unnecessary. […] A consensus criterion has been constructed to improve clinical recognition to prevent delayed treatment, as this poses a great risk to patients. […] Clinical presentation often begins as a mild allergic reaction. […] Rapid treatment should be initiated with intramuscular epinephrine if any of these symptoms are present.

• #68 Anaphylaxis | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-024-00926-3

  Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and potentially life-threatening. […] Prompt recognition and treatment with intramuscular epinephrine is the most effective means at reducing fatalities from anaphylaxis. […] However, anaphylaxis is often under-recognized and treated inadequately. […] There is no single test to diagnose anaphylaxis in routine clinical practice. […] Immediate intramuscular administration of epinephrine into the anterolateral thigh is the first-line therapy for anaphylaxis, and is always safe, even if the diagnosis is uncertain.

• #69 Anaphylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482124/

  Anaphylaxis is an acute, life-threatening hypersensitivity disorder defined as a generalized, rapidly evolving, multi-systemic allergic reaction. […] This activity describes the evaluation and treatment of anaphylaxis and explains the role of the interprofessional team in managing patients with this condition. […] Evaluate the clinical criteria used in the evaluation of anaphylaxis. […] Diagnosing anaphylaxis is clinical; thus, laboratory studies or other diagnostics are unnecessary. […] A consensus criterion has been constructed to improve clinical recognition to prevent delayed treatment, as this poses a great risk to patients. […] Clinical presentation often begins as a mild allergic reaction. […] Rapid treatment should be initiated with intramuscular epinephrine if any of these symptoms are present.

• #70 Management of Anaphylaxis at COVID-19 Vaccination Sites | CDC

  https://www.cdc.gov/vaccines/covid-19/clinical-considerations/managing-anaphylaxis.html

  If anaphylaxis is suspected, administer epinephrine as soon as possible, contact emergency medical services, and transfer patients to a higher level of medical care. […] Epinephrine (1 mg/ml aqueous solution [1:1000 dilution]) is the first-line treatment for anaphylaxis and should be administered immediately, as an intramuscular injection. […] Because of the acute, life-threatening nature of anaphylaxis, there are no contraindications to epinephrine administration. […] Monitoring in a medical facility for several hours is advised, even after complete resolution of symptoms and signs. […] There are no contraindications to the administration of epinephrine for the treatment of anaphylaxis. […] Pregnant women with anaphylaxis should be managed in the same manner as non-pregnant women.

• #71 ASCIA Guidelines Acute management of anaphylaxis – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/hp/papers/acute-management-of-anaphylaxis-guidelines

  Anaphylaxis indicated by any one of the following signs: Difficult or noisy breathing, Swelling of tongue, Swelling or tightness in throat, Difficulty talking or hoarse voice, Wheeze or persistent cough – unlike the cough in asthma, the onset of coughing during anaphylaxis is usually sudden, Persistent dizziness or collapse, Pale and floppy (young children), Abdominal pain, vomiting – for insect stings or injected drug (medication) allergy. […] Adrenaline (epinephrine) is the first line treatment for anaphylaxis. […] Adrenaline should be the first line treatment for anaphylaxis in pregnancy, and prompt administration of adrenaline (1:1,000 IM adrenaline 0.01mg per kg up to 0.5mg per dose) should not be withheld due to a fear of causing reduced placental perfusion. […] Adrenaline is the first line treatment for anaphylaxis and acts to reduce airway mucosal oedema, induce bronchodilation, induce vasoconstriction and increase strength of cardiac contraction.

• #72 Anaphylaxis & Angioedema: Practical Approach to Diagnosis and Management in Emergency Department | RECAPEM

  https://recapem.com/anaphylaxis-angioedema-practical-approach-to-diagnosis-and-management-in-emergency-department-2/

  When in doubt, its generally wise to treat empirically for anaphylaxis while continuing to investigate other diagnostic possibilities. There will be some patients who do not neatly fit any of these criteria, but for whom epinephrine administration is appropriate. As an example, it would be appropriate to administer epinephrine to a patient with a history of severe anaphylaxis to peanut or bee sting who presents with urticaria and flushing that developed within minutes of a known or suspected ingestion of peanut.

• #73 Anaphylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482124/

  Anaphylaxis is a rapidly evolving presentation, usually within 1 hour of exposure. […] The first hour after the initial symptom onset is the most crucial for treatment. […] Early recognition and aggressive treatment greatly reduce the risk of adverse outcomes. […] Diagnosing anaphylaxis is clinical; thus, laboratory studies or other diagnostics are unnecessary. […] Angioedema can also mimic these symptoms. […] There is no absolute contraindication to treatment with epinephrine in anaphylaxis. […] Patients should always be provided with an epinephrine auto-injector and instructed on how to use it. […] Patients should also be given outpatient follow-up with an allergist and immunologist to assist in the determination of inciting agents and prevention of future reoccurrences.

• #74 Anaphylaxis | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-024-00926-3

  Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and potentially life-threatening. […] Prompt recognition and treatment with intramuscular epinephrine is the most effective means at reducing fatalities from anaphylaxis. […] However, anaphylaxis is often under-recognized and treated inadequately. […] There is no single test to diagnose anaphylaxis in routine clinical practice. […] Immediate intramuscular administration of epinephrine into the anterolateral thigh is the first-line therapy for anaphylaxis, and is always safe, even if the diagnosis is uncertain.

• #75 Anaphylaxis: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0915/p355.html

  Antihistamines and corticosteroids are not effective first-line treatments for anaphylaxis. […] Patients should be transported to the hospital for continued therapy and monitoring, especially those with an initial presentation of significant respiratory or circulatory compromise, and patients with refractory anaphylaxis. […] Biphasic reactions occur in less than 5% of patients diagnosed with anaphylaxis and are defined as the recurrence of anaphylaxis within 72 hours of the initial reaction without reexposure to the allergen. […] All patients at risk of anaphylaxis should be provided with an action plan instructing them on how to manage an episode of anaphylaxis, including the proper administration of epinephrine. […] Guidelines recommend that all patients diagnosed with an anaphylactic reaction be prescribed an auto-injector. […] Referral to an allergist is appropriate if a clinician feels inadequately trained to provide education or if the patient presents after the reaction and the offending agent cannot be confirmed.

• #76 Anaphylaxis – Diagnosis & Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/anaphylaxis-diagnosis-treatment/

  Anaphylaxis is a potentially life-threatening emergency that requires immediate diagnosis and treatment. […] Anaphylaxis is a clinical diagnosis and is highly likely when any one of the following three criteria is filled: […] Sudden onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (ie. generalized hives, itching or flushing, swollen lips-tongue-uvula) and at least one of the following: […] Two or more of the following occurring rapidly (minutes to several hours) after exposure to a likely allergen or other trigger for that patient: […] Reduced BP after exposure to a known allergen for that patient (minutes to several hours): […] All patients with suspected anaphylaxis should be closely monitored as above. […] Admission or observation is recommended for patients who do not respond promptly to IM epinephrine, require >1 dose of epinephrine, or received epinephrine only after a significant delay (>60 minutes), as these features may be risk factors for a biphasic response.

• #77 Anaphylaxis – Diagnosis & Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/anaphylaxis-diagnosis-treatment/

  Anaphylaxis is a potentially life-threatening emergency that requires immediate diagnosis and treatment. […] Anaphylaxis is a clinical diagnosis and is highly likely when any one of the following three criteria is filled: […] Sudden onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (ie. generalized hives, itching or flushing, swollen lips-tongue-uvula) and at least one of the following: […] Two or more of the following occurring rapidly (minutes to several hours) after exposure to a likely allergen or other trigger for that patient: […] Reduced BP after exposure to a known allergen for that patient (minutes to several hours): […] All patients with suspected anaphylaxis should be closely monitored as above. […] Admission or observation is recommended for patients who do not respond promptly to IM epinephrine, require >1 dose of epinephrine, or received epinephrine only after a significant delay (>60 minutes), as these features may be risk factors for a biphasic response.

• #78 Anaphylaxis: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0915/p355.html

  Antihistamines and corticosteroids are not effective first-line treatments for anaphylaxis. […] Patients should be transported to the hospital for continued therapy and monitoring, especially those with an initial presentation of significant respiratory or circulatory compromise, and patients with refractory anaphylaxis. […] Biphasic reactions occur in less than 5% of patients diagnosed with anaphylaxis and are defined as the recurrence of anaphylaxis within 72 hours of the initial reaction without reexposure to the allergen. […] All patients at risk of anaphylaxis should be provided with an action plan instructing them on how to manage an episode of anaphylaxis, including the proper administration of epinephrine. […] Guidelines recommend that all patients diagnosed with an anaphylactic reaction be prescribed an auto-injector. […] Referral to an allergist is appropriate if a clinician feels inadequately trained to provide education or if the patient presents after the reaction and the offending agent cannot be confirmed.

• #79 ASCIA Guidelines Acute management of anaphylaxis – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/hp/papers/acute-management-of-anaphylaxis-guidelines

  If there is a risk of re-exposure to allergens such as stings or foods, or if the cause of anaphylaxis is unknown (idiopathic) then prescribe and if possible dispense an adrenaline injector before discharge, pending specialist review. […] It is important that ALL patients who present with anaphylaxis are referred to a clinical immunology/allergy specialist who will: Identify/confirm cause, Educate about avoidance/prevention strategies and management of comorbidities, Provide ASCIA Action Plan for Anaphylaxis – preparation for future reactions.

• #80 Anaphylaxis | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0283-4

  Epinephrine is the drug of choice for anaphylaxis and should be given immediately, even if the diagnosis is uncertain; intramuscular administration into the anterolateral thigh is recommended. […] There are no absolute contraindications to the use of epinephrine. […] The mainstays of long-term treatment include: specialist assessment, avoidance measures, the provision of an epinephrine auto-injector and an individualized anaphylaxis action plan.

• #81 Anaphylaxis | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0283-4

  Epinephrine is the drug of choice for anaphylaxis and should be given immediately, even if the diagnosis is uncertain; intramuscular administration into the anterolateral thigh is recommended. […] There are no absolute contraindications to the use of epinephrine. […] The mainstays of long-term treatment include: specialist assessment, avoidance measures, the provision of an epinephrine auto-injector and an individualized anaphylaxis action plan.

• #82 ASCIA Guidelines Acute management of anaphylaxis – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/hp/papers/acute-management-of-anaphylaxis-guidelines

  If there is a risk of re-exposure to allergens such as stings or foods, or if the cause of anaphylaxis is unknown (idiopathic) then prescribe and if possible dispense an adrenaline injector before discharge, pending specialist review. […] It is important that ALL patients who present with anaphylaxis are referred to a clinical immunology/allergy specialist who will: Identify/confirm cause, Educate about avoidance/prevention strategies and management of comorbidities, Provide ASCIA Action Plan for Anaphylaxis – preparation for future reactions.

• #83 Anaphylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482124/

  Anaphylaxis is a rapidly evolving presentation, usually within 1 hour of exposure. […] The first hour after the initial symptom onset is the most crucial for treatment. […] Early recognition and aggressive treatment greatly reduce the risk of adverse outcomes. […] Diagnosing anaphylaxis is clinical; thus, laboratory studies or other diagnostics are unnecessary. […] Angioedema can also mimic these symptoms. […] There is no absolute contraindication to treatment with epinephrine in anaphylaxis. […] Patients should always be provided with an epinephrine auto-injector and instructed on how to use it. […] Patients should also be given outpatient follow-up with an allergist and immunologist to assist in the determination of inciting agents and prevention of future reoccurrences.

• #84 Anaphylaxis: Causes, Symptoms, and Treatment

  https://patient.info/doctor/anaphylaxis-and-its-treatment

  Serum mast-cell tryptase can be measured in cases of anaphylaxis, particularly to clarify diagnosis where ambiguity exists. […] Elevated serum tryptase levels imply either massive mast-cell degranulation, as occurs in anaphylaxis, or a condition such as mastocytosis. […] Guidance from the National Institute for Health and Care Excellence (NICE) advises measurement of mast-cell tryptase:7 […] Observe patients for a period of 6-12 hours from the onset of symptoms, depending on their response to emergency treatment.7 […] When time allows: […] In the long term […] Refer to an allergist or allergy clinic to try to identify the allergen, so that it can be avoided in future. […] Organise self-use of pre-loaded pen injections for future attacks (eg, EpiPen; containing 0.3 mL of 1 in 1000 strength (that is, 300 micrograms) for adults; and for children 0.3 mL of 1 in 2000 (150 micrograms)). […] Give a written self-management plan, information about anaphylaxis and biphasic reactions, and details of the possible signs and symptoms of a severe allergic reaction.

• #85 Diagnosis and management of anaphylaxis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11250555/

  In summary, anaphylaxis is a severe life-threatening systemic allergic reaction, which constitutes a clinical emergency. […] The diagnosis of anaphylaxis is based on clinical criteria; use of laboratory tests, e.g., for tryptase, may only be used to support the clinical diagnosis because they are not specific for anaphylaxis. […] Epinephrine is the first-line treatment for anaphylaxis, and there are no absolute contraindications to its use. […] Potential risk factors for life-threatening allergic reactions include asthma, peanuts and/or tree nuts, and delayed epinephrine use. […] After treatment of patients with anaphylaxis, they should be observed until full symptom resolution; all patients must be educated on avoiding their triggers, identifying symptoms of anaphylaxis, and treating their allergic reactions appropriately.

• #86 Signs & Symptoms of Anaphylaxis | Anaphylaxis UK

  https://www.anaphylaxis.org.uk/fact-sheet/anaphylaxis-signs-and-symptoms/

  You must carry two AAIs with you at all times, as you may need to use a second one if your symptoms don’t improve after five minutes or get worse. […] If you think you might have an allergy, see your GP. […] If you are prescribed adrenaline auto-injectors, carry two with you at all times. […] Use your adrenaline auto-injectors as soon as you notice any signs of anaphylaxis know the ABC symptoms so you can act quickly.

• #87 Anaphylaxis – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/patients/about-allergy/anaphylaxis

  Anaphylaxis requires immediate treatment with adrenaline (epinephrine), which is injected into the outer mid-thigh muscle. Delayed treatment can result in fatal anaphylaxis. […] For people diagnosed as being at risk of anaphylaxis, identifying the cause (also known as a trigger) is a very important step in learning how to manage the condition: […] Allergy testing may be recommended if the doctor suspects an allergy is the cause of anaphylaxis. This will usually include a blood test for allergen specific immunoglobulin E (IgE) or skin prick testing (SPT), to help confirm or rule out allergy triggers. […] Effective management of anaphylaxis saves lives. People at risk of anaphylaxis need ongoing management by a doctor. […] Identification of the trigger/s of anaphylaxis will include a detailed medical history and clinical examination followed by interpretation of allergy test results. […] Adrenaline rapidly reverses the effects of anaphylaxis by reducing throat swelling, opening the airways, and maintaining heart function and blood pressure.

• #88 Diagnosis and management of anaphylaxis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11250555/

  In summary, anaphylaxis is a severe life-threatening systemic allergic reaction, which constitutes a clinical emergency. […] The diagnosis of anaphylaxis is based on clinical criteria; use of laboratory tests, e.g., for tryptase, may only be used to support the clinical diagnosis because they are not specific for anaphylaxis. […] Epinephrine is the first-line treatment for anaphylaxis, and there are no absolute contraindications to its use. […] Potential risk factors for life-threatening allergic reactions include asthma, peanuts and/or tree nuts, and delayed epinephrine use. […] After treatment of patients with anaphylaxis, they should be observed until full symptom resolution; all patients must be educated on avoiding their triggers, identifying symptoms of anaphylaxis, and treating their allergic reactions appropriately.

• #89 Anaphylaxis | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-024-00926-3

  Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and potentially life-threatening. […] Prompt recognition and treatment with intramuscular epinephrine is the most effective means at reducing fatalities from anaphylaxis. […] However, anaphylaxis is often under-recognized and treated inadequately. […] There is no single test to diagnose anaphylaxis in routine clinical practice. […] Immediate intramuscular administration of epinephrine into the anterolateral thigh is the first-line therapy for anaphylaxis, and is always safe, even if the diagnosis is uncertain.

• #90 Diagnosis and management of anaphylaxis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11250555/

  In summary, anaphylaxis is a severe life-threatening systemic allergic reaction, which constitutes a clinical emergency. […] The diagnosis of anaphylaxis is based on clinical criteria; use of laboratory tests, e.g., for tryptase, may only be used to support the clinical diagnosis because they are not specific for anaphylaxis. […] Epinephrine is the first-line treatment for anaphylaxis, and there are no absolute contraindications to its use. […] Potential risk factors for life-threatening allergic reactions include asthma, peanuts and/or tree nuts, and delayed epinephrine use. […] After treatment of patients with anaphylaxis, they should be observed until full symptom resolution; all patients must be educated on avoiding their triggers, identifying symptoms of anaphylaxis, and treating their allergic reactions appropriately.

• #91 Diagnosis and management of anaphylaxis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11250555/

  In summary, anaphylaxis is a severe life-threatening systemic allergic reaction, which constitutes a clinical emergency. […] The diagnosis of anaphylaxis is based on clinical criteria; use of laboratory tests, e.g., for tryptase, may only be used to support the clinical diagnosis because they are not specific for anaphylaxis. […] Epinephrine is the first-line treatment for anaphylaxis, and there are no absolute contraindications to its use. […] Potential risk factors for life-threatening allergic reactions include asthma, peanuts and/or tree nuts, and delayed epinephrine use. […] After treatment of patients with anaphylaxis, they should be observed until full symptom resolution; all patients must be educated on avoiding their triggers, identifying symptoms of anaphylaxis, and treating their allergic reactions appropriately.

• #92 Anaphylaxis | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-024-00926-3

  Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and potentially life-threatening. […] Prompt recognition and treatment with intramuscular epinephrine is the most effective means at reducing fatalities from anaphylaxis. […] However, anaphylaxis is often under-recognized and treated inadequately. […] There is no single test to diagnose anaphylaxis in routine clinical practice. […] Immediate intramuscular administration of epinephrine into the anterolateral thigh is the first-line therapy for anaphylaxis, and is always safe, even if the diagnosis is uncertain.

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