Anaphylaxis is a topic covered in the 5-Minute Emergency Consult.

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  • An acute, widely distributed form of shock that occurs within minutes of exposure to antigen in a sensitized individual
  • ∼500–1,000 deaths are attributed annually in the US to anaphylaxis. There are ∼10,000 ER visits per month for anaphylaxis in the US
  • 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, especially bee and wasp
    • Latex
    • Vaccines
    • Foodstuffs (shellfish, soybeans, peanuts, tree nuts, wheat, milk, eggs, nitrates/nitrites)
    • Monoclonal antibody therapeutics
  • Non-IgE mediated:
    • Iodine contrast media
    • Opiates
    • Vancomycin

Pediatric Considerations
In children, foods are an important trigger for IgE-mediated anaphylaxis:
  • Milk, egg, wheat, and soy (MEWS) are the most common food allergens.
  • Peanut allergies are increasingly common and can be more potent; children can develop anaphylaxis from residual peanut in a candy bar.

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