Anaphylaxis history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
The hallmark of anaphylaxis is to find a possible causative allergen. Often the history may rely on friends and family who can help with the temporal relationship between symptoms and the inciting event. <ref name="pmidhttps://doi.org/10.1016/S0091-6749(18)30572-4">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/S0091-6749(18)30572-4 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> | The hallmark of [[anaphylaxis]] is to find a possible causative [[allergen]]. Often the history may rely on friends and family who can help with the temporal relationship between [[Symptom|symptoms]] and the inciting event. <ref name="pmidhttps://doi.org/10.1016/S0091-6749(18)30572-4">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/S0091-6749(18)30572-4 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> | ||
The diagnosis is likely when any one of the following criteria is met: <ref name="pmid21293765">{{cite journal| author=Bjornsson HM, Graffeo CS| title=Improving diagnostic accuracy of anaphylaxis in the acute care setting. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 5 | pages= 456-61 | pmid=21293765 | doi= | pmc=3027438 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21293765 }} </ref> | The [[diagnosis]] is likely when any one of the following [[criteria]] is met: <ref name="pmid21293765">{{cite journal| author=Bjornsson HM, Graffeo CS| title=Improving diagnostic accuracy of anaphylaxis in the acute care setting. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 5 | pages= 456-61 | pmid=21293765 | doi= | pmc=3027438 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21293765 }} </ref> | ||
*1. Acute onset with involvement of mucosal tissue, skin, or both and one of the following: | |||
** Respiratory compromise | *1. [[Acute (medicine)|Acute]] onset with involvement of [[Mucous membrane|mucosal]] tissue, [[skin]], or both and one of the following: | ||
** Reduced blood pressure or evidence of end-organ dysfunction | **[[Respiratory Physiology|Respiratory]] compromise | ||
*2. Exposure to a likely antigen for the patient followed by two of the following: | **[[Hypotension|Reduced blood pressure]] or evidence of [[end-organ dysfunction]] | ||
** Skin involvement | *2. Exposure to a likely [[antigen]] for the patient followed by two of the following: | ||
** Respiratory compromise | **[[Skin]] involvement | ||
** Reduced blood pressure | **[[Respiratory]] compromise | ||
** Gastrointestinal symptoms | **[[Hypotension|Reduced blood pressure]] | ||
*3. Exposure to a known allergen to the patient followed by reduced blood pressure | **[[Gastrointestinal tract|Gastrointestinal]] symptoms | ||
*3. Exposure to a known [[allergen]] to the patient followed by [[Hypotension|reduced blood pressure]] | |||
==History and Symptoms== | ==History and Symptoms== | ||
Symptoms of anaphylaxis are related to the | Symptoms of [[anaphylaxis]] are related to the [[histamine]] release from [[mast cell]]s ([[degranulation]]). [[Histamine]] induces [[vasodilation]] of [[arterioles]] and [[constriction]] of [[bronchioles]] in the [[lungs]]. <ref name="pmid28800865">{{cite journal| author=LoVerde D, Iweala OI, Eginli A, Krishnaswamy G| title=Anaphylaxis. | journal=Chest | year= 2018 | volume= 153 | issue= 2 | pages= 528-543 | pmid=28800865 | doi=10.1016/j.chest.2017.07.033 | pmc=6026262 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28800865 }} </ref> | ||
===History=== | ===History=== | ||
Patients with anaphylaxis may have a positive history of: <ref name="pmidhttps://doi.org/10.1542/peds.2016-4006">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1542/peds.2016-4006 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> <ref name="pmid28372711">{{cite journal| author=Commins SP| title=Outpatient Emergencies: Anaphylaxis. | journal=Med Clin North Am | year= 2017 | volume= 101 | issue= 3 | pages= 521-536 | pmid=28372711 | doi=10.1016/j.mcna.2016.12.003 | pmc=5381731 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28372711 }} </ref> | Patients with [[anaphylaxis]] may have a positive history of: <ref name="pmidhttps://doi.org/10.1542/peds.2016-4006">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1542/peds.2016-4006 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> <ref name="pmid28372711">{{cite journal| author=Commins SP| title=Outpatient Emergencies: Anaphylaxis. | journal=Med Clin North Am | year= 2017 | volume= 101 | issue= 3 | pages= 521-536 | pmid=28372711 | doi=10.1016/j.mcna.2016.12.003 | pmc=5381731 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28372711 }} </ref> | ||
* Ingestion of certain foods, drinks or medications within 8 hours before the event | |||
* Exposure to heat or cold before the event | *[[Ingestion]] of certain foods, drinks or [[medications]] within 8 hours before the event | ||
* Sting or bite prior to the event | *Exposure to [[heat]] or [[cold]] before the event | ||
* Recurrence of symptoms following initial resolution | *[[Sting (biology)|Sting]] or [[bite]] prior to the event | ||
* Recent infection or illness | *Recurrence of symptoms following initial resolution | ||
* Recent relevant exposure or travel history | *Recent [[infection]] or [[illness]] | ||
* Prior similar episodes | *Recent relevant exposure or travel history | ||
*Prior similar episodes | |||
===Common Symptoms=== | ===Common Symptoms=== | ||
Common symptoms of anaphylaxis include: | Common [[Symptom|symptoms]] of [[anaphylaxis]] include: | ||
*[[Urticaria]] (hives) | *[[Urticaria]] (hives) | ||
* [[Respiratory distress]] | *[[Respiratory distress]] | ||
* Upper Airway edema | *Upper Airway [[edema]] | ||
* [[Itch]]ing | *[[Itch]]ing | ||
* [[Nasal congestion]] | *[[Nasal congestion]] | ||
* Flushed appearance | *[[Flushed]] appearance | ||
* [[Hypotension]] (low blood pressure) | *[[Hypotension]] (low blood pressure) | ||
* Stridor | *[[Stridor]] | ||
* Rhinitis | *[[Rhinitis]] | ||
* Dizziness | *[[Dizziness]] | ||
* Confusion | *[[Confusion]] | ||
* Headache | *[[Headache]] | ||
* [[Abdominal pain]] | *[[Abdominal pain]] | ||
* [[Cough]] | *[[Cough]] | ||
* [[Diarrhea]] | *[[Diarrhea]] | ||
* [[Palpitations]] | *[[Palpitations]] | ||
* [[Vomiting]] | *[[Vomiting]] | ||
===Less Common Symptoms=== | ===Less Common Symptoms=== | ||
Less common symptoms of anaphylaxis include: | Less common symptoms of anaphylaxis include: | ||
The time between ingestion of the allergen and anaphylaxis symptoms can vary for some patients depending on the amount of allergen consumed and their reaction time. Symptoms can appear immediately or can be delayed by half an hour to several hours after ingestion. However, symptoms of anaphylaxis usually appear very quickly once they do begin. | *[[Chest pain]] | ||
*[[Polyuria]] | |||
*[[Dysarthria|Slurred speech]] | |||
*[[Tears]] (due to [[angioedema]] and stress) | |||
*[[Unconsciousness]] | |||
*[[Encephalitis]] | |||
*[[Fainting]] | |||
*[[Angioedema]] (swelling of the [[lips]], [[face]], [[neck]] and [[throat]]) | |||
*[[Anxiety]] | |||
The time between ingestion of the [[allergen]] and [[anaphylaxis]] [[Symptom|symptoms]] can vary for some [[patients]] depending on the amount of [[allergen]] consumed and their reaction time. [[Symptoms]] can appear immediately or can be delayed by half an hour to several hours after [[ingestion]]. However, [[symptoms]] of [[anaphylaxis]] usually appear very quickly once they do begin. | |||
==References== | ==References== | ||
Latest revision as of 22:01, 14 April 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Dushka Riaz, MD
Overview
The hallmark of anaphylaxis is to find a possible causative allergen. Often the history may rely on friends and family who can help with the temporal relationship between symptoms and the inciting event. [1]
The diagnosis is likely when any one of the following criteria is met: [2]
- 1. Acute onset with involvement of mucosal tissue, skin, or both and one of the following:
- Respiratory compromise
- Reduced blood pressure or evidence of end-organ dysfunction
- 2. Exposure to a likely antigen for the patient followed by two of the following:
- Skin involvement
- Respiratory compromise
- Reduced blood pressure
- Gastrointestinal symptoms
- 3. Exposure to a known allergen to the patient followed by reduced blood pressure
History and Symptoms
Symptoms of anaphylaxis are related to the histamine release from mast cells (degranulation). Histamine induces vasodilation of arterioles and constriction of bronchioles in the lungs. [3]
History
Patients with anaphylaxis may have a positive history of: [4] [5]
- Ingestion of certain foods, drinks or medications within 8 hours before the event
- Exposure to heat or cold before the event
- Sting or bite prior to the event
- Recurrence of symptoms following initial resolution
- Recent infection or illness
- Recent relevant exposure or travel history
- Prior similar episodes
Common Symptoms
Common symptoms of anaphylaxis include:
- Urticaria (hives)
- Respiratory distress
- Upper Airway edema
- Itching
- Nasal congestion
- Flushed appearance
- Hypotension (low blood pressure)
- Stridor
- Rhinitis
- Dizziness
- Confusion
- Headache
- Abdominal pain
- Cough
- Diarrhea
- Palpitations
- Vomiting
Less Common Symptoms
Less common symptoms of anaphylaxis include:
- Chest pain
- Polyuria
- Slurred speech
- Tears (due to angioedema and stress)
- Unconsciousness
- Encephalitis
- Fainting
- Angioedema (swelling of the lips, face, neck and throat)
- Anxiety
The time between ingestion of the allergen and anaphylaxis symptoms can vary for some patients depending on the amount of allergen consumed and their reaction time. Symptoms can appear immediately or can be delayed by half an hour to several hours after ingestion. However, symptoms of anaphylaxis usually appear very quickly once they do begin.
References
- ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1016/S0091-6749(18)30572-4 Check
|pmid=value (help). - ↑ Bjornsson HM, Graffeo CS (2010). "Improving diagnostic accuracy of anaphylaxis in the acute care setting". West J Emerg Med. 11 (5): 456–61. PMC 3027438. PMID 21293765.
- ↑ LoVerde D, Iweala OI, Eginli A, Krishnaswamy G (2018). "Anaphylaxis". Chest. 153 (2): 528–543. doi:10.1016/j.chest.2017.07.033. PMC 6026262. PMID 28800865.
- ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1542/peds.2016-4006 Check
|pmid=value (help). - ↑ Commins SP (2017). "Outpatient Emergencies: Anaphylaxis". Med Clin North Am. 101 (3): 521–536. doi:10.1016/j.mcna.2016.12.003. PMC 5381731. PMID 28372711.