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Anaphylaxis Update

By Bobby Quentin Lanier, M.D. | on March 1, 2013 | 2 Comments
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ACEP News: Vol 32 – No 03 – March 2013

Definition of Anaphylaxis

Acute onset of illness with cutaneous and/or mucosal involvement AND 1 or more of the following:

  • Respiratory compromise (dyspnea, bronchospasm, stridor, hypoxia)
  • Cardiovascular compromise (hypotension, collapse)

Two or more of the following occur rapidly after exposure to a likely allergen (minutes to several hours):

  • Involvement of skin or mucosa (generalized hives, itch, flushing, swelling)
  • Respiratory compromise
  • Cardiovascular compromise
  • Or persistent gastrointestinal symptoms (crampy abdominal pain, vomiting)
  • Hypotension after exposure to known allergen for that patient (minutes to several hours): age-specific low blood pressure* or greater than 30% decline from baseline (or less than 90 mm Hg for adults)

*Low systolic blood pressure for children is defined as less than 70 mm Hg from 1 month to 1 year, less than 70 mm Hg + (2 times age) from 1 to 10 years, and less than 90 mm Hg from 11 to 17 years


(Adapted from Ann. Emerg. Med.47:373-80, Copyright 2006, with permission from Elsevier.)

Introduction

Anaphylaxis is increasing in prevalence and has important health implications in the United States.

Although the exact incidence is unknown, anaphylactic reactions may involve up to 2% of the population.1 Moreover, the annual incidence of anaphylaxis and related conditions such as food allergy and asthma appears to be increasing.2-6

Evidence also suggests dramatic increases in emergency department visits, hospitalization, hospital outpatient visits and physician office visits as well.3,5 Despite the availability of diagnostic criteria and management guidelines, anaphylaxis is often under-recognized and/or under-treated in the United States.4,7-9

Further, the delayed administration of epinephrine is an important problem in anaphylaxis management that has been noted to contribute to fatalities.8,10-14 Given the potentially fatal consequences of anaphylaxis, health care professionals must not only be able to recognize and treat anaphylaxis promptly, but also to educate their patients on how to manage this life-threatening condition.

Food is the major cause of anaphylaxis in the United States, with recent data associating severe reactions, most commonly in children, with allergy to tree nuts, peanuts, shellfish, soy, etc.

What is Anaphylaxis?

In 2005, the National Institute of Allergy and Infection Disease (NIAID) and the Food Allergy and Anaphylaxis Network (FAAN) developed a consensus definition for anaphylaxis (Table 1).9 The symptoms of anaphylaxis are variable and can affect multiple organ systems, including the gastrointestinal tract and cardiovascular system.15-17

Skin signs such as flushing, itching, urticarial and rash occur in up to 90% of patients, while respiratory symptoms, including dyspnea, wheeze and upper angioedema, occur in up to 60% of patients.8

Pages: 1 2 3 4 | Single Page

Topics: AllergyCardiovascularClinical GuidelineCritical CareDiagnosisEmergency MedicineEmergency PhysicianImmune SystemPatient Safety

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2 Responses to “Anaphylaxis Update”

  1. July 22, 2014

    Articles on anaphylaxis and diagnosis thereof | Mastopedia Research Feed Reply

    […] https://www.acepnow.com/article/anaphylaxis-update/ […]

  2. March 26, 2015

    Anaphylaxis Update | Mastopedia Research Feed Reply

    […] https://www.acepnow.com/article/anaphylaxis-update/ […]

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