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

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Emergency Central

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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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Rosen, Peter, 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: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307031/all/Anaphylaxis. Accessed April 22, 2019.
Anaphylaxis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307031/all/Anaphylaxis
Anaphylaxis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 22]. 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 - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, 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 -