![]() 21 Wood and colleagues 21 conducted two nationwide, cross-sectional random-digit-dial surveys to estimate lifetime prevalence of anaphylaxis in the United States: 7.7% of the 1,000 adults included in the public survey reported prior anaphylactic reactions and were classified as “possible” anaphylaxis. 20 Multiple studies support the notion that the prevalence of anaphylaxis is increasing, especially in industrialized nations. 20 Children and adolescents made up the largest number of cases based on prescription information of epinephrine autoinjectors. 4, 19 In 2006, the American College of Allergy Asthma and Immunology Epidemiology of Anaphylaxis Working Group estimated a 0.05% to 2% lifetime prevalence of anaphylaxis. 11Įpidemiology: Prevalence, Hospitalization, and Anaphylactic Shockĭetermining the prevalence of anaphylaxis is challenging because it is underdiagnosed, 18 and estimates are based on studies with variable study designs that are not always comparable. Anaphylactic reactions result from release of mediators by mast cells and basophils activated either by IgE, termed “immunologic,” or by direct activation of these cells by certain agents, termed “nonimmunologic anaphylaxis.” 1, 7, 8, 9, 10 Although the term “anaphylactoid” was previously used to describe non-IgE-mediated anaphylaxis, this terminology is no longer recommended. This results in multiple clinical effects leading to the diagnosis ( Table 1). 5 e-Table 1 provides a historical perspective of events leading to our current understanding of anaphylaxis.Īnaphylaxis has been defined as a systemic, immediate hypersensitivity reaction mediated by IgE and resulting in mast cell and basophil mediator release. Richet termed the condition “anaphylaxis” as opposed to prophylaxis and was awarded the Nobel Prize in Medicine for this work in 1913. Within minutes of the second injection, Neptune began to gasp, wheeze, and collapsed with bloody emesis, only to die within 25 min. 6 An important series of experiments were conducted on the dog, Neptune, wherein an initial injection of toxin was followed by a second injection 22 days later. ![]() 5 In the early 20th century, the French physiologist, Charles Richet, along with Paul Portier, undertook a study of hypnotoxin, an urticaria-inducing toxin and other toxins derived from Physalia (Portuguese man of war or “floating terror” found in the Atlantic, Indian, and Pacific oceans) extracts. 4 Anaphylaxis is presumably an ancient disease, although several developments in the past century have led to enormous insights and treatment advances. 1, 2, 3 Reports suggest that underdiagnosis and undertreatment of anaphylaxis are common. Patients with cardiopulmonary arrest or airway or vascular compromise require mechanical ventilation, vasopressors, and other advanced life support in the ICU.Īnaphylaxis and angioedema are serious disorders that can lead to fatal airway obstruction and culminate in cardiorespiratory arrest, resulting in hypoxemia and/or shock, requiring management in an ICU setting. Secondary treatments include fluids, bronchodilators, antihistamines, and glucocorticoids. The sine qua non of treatment is avoidance of any known triggers and epinephrine, which should never be delayed if this disorder is suspected. Anaphylaxis is a clinical diagnosis, but plasma tryptase and urinary histamine levels are often elevated, allowing diagnostic confirmation however, diagnostic testing should not delay treatment as results may not be immediately available. Conditions such as postural orthostatic tachycardia syndrome, carcinoid syndrome, Munchausen stridor, and factitious anaphylaxis can present similarly and need to be included in the differential diagnosis. Several new syndromes have been described recently including bird-egg, pork-cat, delayed allergy to mammalian meat and a diverse group of mast cell activation disorders. Reports suggest that underdiagnosis and undertreatment of anaphylaxis are common. Often, these disorders can be appropriately managed in an outpatient setting however, these conditions can be severe enough to warrant evaluation of the patient in the ED and in some cases, hospitalization, and management in an ICU. Anaphylaxis and angioedema are serious disorders that can lead to fatal airway obstruction and culminate in cardiorespiratory arrest, resulting in hypoxemia and/or shock. It is a rapidly evolving, multisystem process involving the integumentary, pulmonary, gastrointestinal, and cardiovascular systems. Anaphylaxis is a systemic, life-threatening disorder triggered by mediators released by mast cells and basophils activated via allergic (IgE-mediated) or nonallergic (non-IgE-mediated) mechanisms.
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