Anaphylaxis - Diagnosis

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How is anaphylaxis diagnosed?

Anaphylaxis is a clinical diagnosis and is usually diagnosed by the patterns of symptoms listed above. If someone thinks he or she is having an anaphylactic reaction, the first and most important step is to treat with self-injectable epinephrine and/or seek emergency care. Once the acute reaction has been treated with epinephrine, one must seek urgent medical care to monitor for the risk of a biphasic reaction. Referral to an allergist is also typically recommended. The allergist will assess whether or not the reaction was indeed allergic in nature. Sometimes, a careful and detailed medical history and selected blood or skin tests can identify the trigger. The medical history focuses on exposures such as foods, medications, and stings preceding the anaphylactic reaction. In rare cases, exercise or alcohol may be a factor in anaphylaxis.

Table 1: The Common Triggers of Anaphylaxis
Causes - IgE MediatedExamples
MedicationsAntibiotics (penicillin, cephalosporins), muscle paralytics used in anesthesia, NSAIDs, platinum-based chemotherapy, others
Insect stingsHornet, wasp, yellow jacket, honey bee, fire ant
FoodsPeanuts, tree nuts, fish, shellfish, eggs, milk, soy, wheat, sesame
VaccinesAllergy shots
HormonesInsulin, possibly progesterone
LatexRubber products
Causes - Non-IgE-MediatedExamples
MedicationNSAIDS, morphine, IV iron, gamma globulin, IV iron
PreservativesSulfites

Exercise-induced anaphylaxis: Exercise-induced anaphylaxis is a rare condition that presents with the same symptoms as anaphylaxis but is triggered by exercise. Exercise-induced anaphylaxis can be food-dependent in which symptoms occur with exercise only after consuming specific foods, such as celery, wheat, alcohol, or shellfish. 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. Warming up slowly, avoiding eating two to four hours before exercise, exercising with a partner, and carrying emergency epinephrine kits is mandatory for those at risk for exercise-induced anaphylaxis. If symptoms occur despite these measures, then exercise avoidance may be recommended.

When no cause can be found for anaphylaxis, it is termed idiopathic. Recent reports suggest that 25% of all episodes of anaphylaxis are idiopathic. For frequent episodes of anaphylaxis, a physician may recommend a combination of antihistamine, leukotriene inhibitors, or oral steroids to reduce the severity of attacks. There is also some evidence that a biologic medication, omalizumab (Xolair), which binds IgE, may help with idiopathic anaphylaxis.

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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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