Anaphylaxis (cont.)

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
Latex	Rubber products
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
X-ray dye
Preservatives	Sulfites
Physical	Exercise, heat-induced urticaria (hives), cold- induced urticaria
Idiopathic	Unknown cause

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.

Source: MedicineNet.com
http://www.medicinenet.com/anaphylaxis/article.htm