Anaphylaxis - Diagnosis

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Discuss the events that led to a diagnosis of anaphylaxis. Did you end up in the ER?

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How is anaphylaxis diagnosed?

If someone thinks he or she is having an anaphylactic reaction, the first order of business is to seek emergency care. Once the acute reaction has been treated, one should follow up with a 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 any activities that preceded the event, the food and medications ingested, and whether or not one had any contact with rubber products.

Table 1: The Common Causes of Anaphylaxis

Causes - IgE MediatedExamples
MedicationsPenicillin, cephalosporin, anesthetics, streptokinase, others
Insect stingsHornet, wasp, yellow jacket, honey bee, fire ant
FoodsPeanuts, tree nuts, fish, shellfish, eggs, milk, soy, wheat
VaccinesAllergy shots, egg and gelatin-based vaccines
HormonesInsulin, possibly progesterone
LatexRubber products
Animal/human proteinsHorse serum (used in some snake antivenins)

Causes - Non IgE MediatedExample
MedicationNonsteroidal anti-inflammatories (aspirin, Motrin, etc.), morphine, muscle relaxants (Robaxin, Norflex, and others), gamma globulin
X-ray dye
PhysicalExercise, heat-induced urticaria (hives), cold-induced urticaria
IdiopathicUnknown 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 can be 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. Premedication 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, a 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.
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See what others are saying

Comment from: momonamisson, 45-54 Female (Patient) Published: September 17

After repeated episodes of needing to go to the emergency room (ER) for nonstop nausea/vomiting, I realized how badly I was feeling and there was more to the picture, like chest tightness, lungs burning, skin burning, etc. This last trip to the ER gave me the definitive diagnosis that I was having an anaphylactic reaction because during one visit I was pretreated with IV Benadryl for a test and it made my symptoms so much better. I began to put together the picture of being exposed to something toxic in my home and now we have found that exposure to mold and possibly other allergens has been the source of my problems all along. I have been in a constant state of anaphylaxis and never knew it! Now to solve the mystery of why.

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Comment from: anna, 19-24 Female (Patient) Published: October 13

On February 28, 2014, in the morning I was stung by an insect. I was sleepy so couldn't identify the insect. Within 15 minutes I had breathing difficulty, dizziness, nausea, black spots, and very low blood pressure. I had seen some movies where a character suffers anaphylaxis so knew I had to get emergency medical treatment and somehow reached the hostel warden. The hospital never had a patient with such a case of allergic reaction. The treatment was a blur as I was in and out of consciousness. Even two months after the attack I was weak with severe asthma and several new allergies, nausea, dizziness, swellings, etc. The allergy specialist told me Ayurveda can be an effective treatment. To go through the Ayurvedic treatment for venom (visha chikitsa) was really difficult but within two weeks, the after effects disappeared. I always keep EpiPen with me and avoid situations that can lead to an insect bite.

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