Jerry R. Balentine, DO, FACEP
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Anaphylaxis facts
- Introduction to anaphylaxis
- What is the history of anaphylaxis?
- How common is anaphylaxis?
- What are common causes of anaphylaxis?
- What are the signs and symptoms of anaphylaxis?
- What happens after the symptoms begin?
- Are there any disorders that appear similar to anaphylaxis?
- How is anaphylaxis diagnosed?
- How do we manage anaphylaxis?
- What are emergency measures used in the treatment of anaphylaxis?
- Can anaphylaxis be prevented?
- Find a local Doctor in your town
How is anaphylaxis diagnosed?
Once you think that you might have had an anaphylactic reaction, the first order of business is to seek emergency care. Once the acute reaction has been treated you should follow up with your doctor who will probably recommend seeing an allergist. The allergist will assess whether or not the reaction was indeed allergic in nature. Usually, a careful and detailed medical history and selected blood or skin tests can identify the cause. Be prepared to recall your activities before the event, the food and medications you ingested, and whether or not you had any contact with rubber products.
Table 1: The Common Causes of Anaphylaxis
|Causes - IgE Mediated||Examples|
|Medications||Penicillin, cephalosporin, anesthetics, streptokinase, others|
|Insect stings||Hornet, wasp, yellow jacket, honey bee, fire ant|
|Foods||Peanuts, treenuts, fish, shellfish, eggs, milk, soy, wheat|
|Vaccines||Allergy shots, egg and gelatin-based vaccines|
|Hormones||Insulin, possibly progesterone|
|Animal/human proteins||Horse serum (used in some snake antivenoms)|
|Causes - Non IgE Mediated||Examples|
|Medication||Nonsteroidal anti-inflammatories (aspirin, Motrin, etc.), morphine, muscle relaxants (Robaxin, Norflex, and others), gamma globulin|
|Physical||Exercise, heat-induced urticaria (hives), cold- induced urticaria|
Two situations deserve special attention at this point since they are not covered elsewhere but are particularly interesting.
1. In the 1970s, it was noted that exercise could cause anaphylaxis. Exercise-induced anaphylaxis (EIA) usually occurs with prolonged, strenuous exercise. Conditioned athletes such as marathon runners are frequently affected. The reaction may occur while exercising shortly after eating a meal, after eating specific foods (for example, lettuce, shellfish, or celery), or after taking aspirin. It appears as though food or aspirin loads the gun and exercise pulls the trigger. Early symptoms are usually flushing and itching, which may progress to other typical symptoms of anaphylaxis if the exercise continues. Pre-medication with antihistamines or other drugs does not consistently prevent EIA. Exercise avoidance is the most effective treatment. If this is not feasible, exercising with a "buddy" and carrying emergency epinephrine kits is mandatory.
2. When no cause can be found for anaphylaxis, it is termed idiopathic. Recent reports suggest that 25% of all episodes of anaphylaxis are idiopathic. Many of those affected have underlying allergy or asthma conditions. Extensive allergy testing for foods may uncover an unusual food allergy that is responsible for these reactions. For frequent episodes of anaphylaxis, your physician may recommend a combination of antihistamine, cortisone, and a medication to widen the airways of the lungs (bronchial dilator) to help reduce the severity of attacks.
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