- An acute, widely distributed form of shock that occurs within minutes of exposure to antigen in a sensitized individual
- The overall rate of anaphylaxis appears to be increasing, especially in children
- An overall incidence rate of about 50 per 100,000 person-years is estimated from current data:
- Fortunately, case fatality rates are low for patients who make it to the ED (0.1–0.3%)
- Involves release of bioactive molecules such as histamine, leukotrienes, and prostaglandins from inflammatory cells:
- Mediator release results in increased vascular permeability, vasodilation, smooth-muscle contractions, and increased epithelial secretion
- Physiologically, this is manifested in a decrease in total peripheral resistance, venous return, and cardiac output, as well as intravascular volume depletion
- IgE mediated:
- Antibiotics, particularly penicillin family
- Venoms, esp bee and wasp
- Foodstuffs (shellfish, soybeans, peanuts, tree nuts, wheat, milk, eggs)
- Monoclonal antibody therapeutics
- Non-IgE mediated:
- Iodine contrast media
- Usually can be prevented by reducing rate of infusion
- Seminal fluid
In children, foods are an important trigger for IgE-mediated anaphylaxis:
- The most common foods to cause anaphylactic events are peanuts, tree nuts, fish, shellfish, milk, and egg, but any food can produce a reaction
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Schaider, Jeffrey J., et al., editors. "Anaphylaxis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307031/all/Anaphylaxis.
Anaphylaxis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307031/all/Anaphylaxis. Accessed May 28, 2023.
Anaphylaxis. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307031/all/Anaphylaxis
Anaphylaxis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 May 28]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307031/all/Anaphylaxis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Anaphylaxis ID - 307031 ED - Barkin,Adam Z, ED - Shayne,Philip, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307031/all/Anaphylaxis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -