Anaphylactoid reaction

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See also: Anaphylaxis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vidit Bhargava, M.B.B.S [2]

Synonyms and keywords:

Overview

Definition

Anaphylactoid reaction or pseudo allergic reaction is defined as a condition presenting with symptoms similar to an allergic reaction but without detectable immunological sensitization, as found in classical allergic reactions. (Raised IgE levels in blood)

Diagnosis

Symptoms

The clinical features are quite similar to anaphylaxis, however the presentation is almost always milder. Most commonly the syndrome begins with involvement of the skin, usually as pruritus, flush, urticaria or angioedema. Paresthesia's, itching of pharynx and genital area, and feeling of anxiety are common symptoms. Almost all organ systems may be involved as explained below:

Respiratory

• Sneezing or rhinorrhea is the earliest manifestation.

• Hoarseness or throat tightness

• Cough and wheezing
• Change of voice (dysphonia)
• Dyspnea due to laryngeal obstruction
• Cyanosis or even respiratory arrest may occur

Gastrointestinal

• Nausea and cramping
• vomiting and diarrhea
• Micturition and defecation

Cardiovascular

• Tachycardia
• Hypotension
• Arrythmia
• Shock
• Cardiac arrest

The following system of grading is sometimes used to grade the severity of reactions:

Symptoms	Skin	Abdomen	Respiratory	Cardiovascular
Grade I	Pruritus, flush, urticaria, angioedema	-	-	-
Grade II	Pruritus, flush, urticaria, angioedema	Nausea, cramping	Rhinorrhea, hoarseness, dyspnea	Tachycardia, arrhythmia
Grade III	Pruritus, flush, urticaria, angioedema	Vomiting, defecation, diarrhea	Laryngeal edema, bronchospasm, cyanosis	Shock
Grade IV	Pruritus, flush, urticaria, angioedema	Vomiting, defecation, diarrhea	Respiratoy arrest	Cardiac arrest

Adapted from Ring and Mesmer