Anaphylaxis - Diagnosis

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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 Mediated Examples
Medications Penicillin, cephalosporin, anesthetics, streptokinase, others
Insect stings Hornet, wasp, yellow jacket, honey bee, fire ant
Foods Peanuts, tree nuts, fish, shellfish, eggs, milk, soy, wheat
Vaccines Allergy shots, egg and gelatin-based vaccines
Hormones Insulin, possibly progesterone
Latex Rubber products
Animal/human proteins Horse serum (used in some snake antivenins)

Causes - Non IgE Mediated Example
Medication Nonsteroidal anti-inflammatories (aspirin, Motrin, etc.), morphine, muscle relaxants (Robaxin, Norflex, and others), gamma globulin
X-ray dye Data Cell
Preservatives Sulfites
Physical Exercise, heat-induced urticaria (hives), cold-induced urticaria
Idiopathic Unknown 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: Daisy123, 13-18 Female (Patient) Published: July 15

I am a Teen who has had a severe life threatening allergy to peanuts and all nuts my whole life- I have experienced an anaphylactic reaction 4 times in my life, all of them requiring hospitalization and multiple shots of the Epipen- it is very frightening to know that the allergy could take my life next time, but I try to be as careful as I possibly can.I almost always fall unconcious, and once, I even required CPR. I am just so thankful to my teachers and medical professionals that were there to take care of me!

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Comment from: mgt, 55-64 Female (Patient) Published: January 23

Through the years I've had a lot of pain with muscles and joints, having a heavy repetitive job, so I required inflammatory medication and always tried different ones but always went back off them as l was itchy. A few years ago l had an operation and the hospital put me on inflammatory medication and l was fine. I ran out of it over a few days and got more from my doctor. That night my body went into anaphylaxis, l was unconscious within seconds; l was in and out of consciousness. I split my head open (5 stitches) couldn't get my head off the floor, crawled to the door to get air, and couldn't breathe. I did not have a clue what was happening or where l was. I do remember l had severe abdominal pain. I couldn't talk, the dryness in my mouth was unbearable. I kept trying to say water but paramedics wouldn't give it to me because my head was split open. They couldn't understand why my blood pressure was so low and even said my face to them was swollen, they didn't know l was having anaphylactic reaction. It lasted around 3 hours. That was my second one. I didn't realize what the first one was till l had the second. It started with the same symptoms, itch in hands but in the first one l couldn't get my head off the floor but l wasn't unconscious. The conclusion was l went into shock second time on medication after being off them a few days. I'm lucky l know now so l have EpiPens and wear a medical bracelet. If you have one be careful as there are chances of having a second and it could be severe.

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