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PubMed2001

Anaphylaxis in the United States: an investigation into its epidemiology.

BACKGROUND: Anaphylaxis is a severe, life-threatening allergic reaction that affects both children and adults in the United States. However, data regarding the incidence and prevalence of anaphylaxis and the number of deaths caused by it are limited. OBJECTIVE: To provide a better understanding of the magnitude of the problem of anaphylaxis in the United States. METHODS: A thorough review of the current medical literature was conducted to obtain prevalence estimates on each of the 4 major subtypes of anaphylaxis (food, drugs, latex, and insect stings). We calculated an overall estimate of the risk of anaphylaxis by using only estimates that are specifically derived from epidemiologic studies measuring anaphylaxis in the general population. RESULTS: Known rates or cases of anaphylaxis were 0.0004% for food, 0.7% to 10% for penicillin, 0. 22% to 1% for radiocontrast media, and 0.5% to 5% after insect stings. There were 220 cases after latex exposure. Considering the 1999 US population of 272 million, the population at risk for anaphylaxis from food is 1099, from penicillin is 1.9 million to 27. 2 million, from radiocontrast media is 22 000 to 100 000, from latex is 220, and from insect stings is 1.36 million to 13.6 million. These calculations yield a total of 3.29 million to 40.9 million individuals at risk of anaphylaxis. CONCLUSION: The occurrence of anaphylaxis in the US is not as rare as is generally believed. On the basis of our figures, the problem of anaphylaxis may, in fact, affect 1.21% to 15.04% of the US population.

Anaphylaxis↗
PubMed2004

Should beta-blockers be given to patients with heart disease and peanut-induced anaphylaxis? A decision analysis.

BACKGROUND: Beta-blocker therapy postmyocardial infarction is generally recommended because it reduces mortality. However, beta-blockers may increase anaphylaxis mortality in the growing population of patients with peanut-induced anaphylaxis. OBJECTIVE: We sought to assess the risks and benefits of beta-blocker therapy among patients with peanut allergy and heart disease. METHODS: We created a Markov model for patients with heart disease at risk for peanut-induced anaphylaxis to compare life expectancy with the following strategies: (1) beta-blocker and (2) no beta-blocker. Meta-analysis and a literature review were used to estimate model parameters. We performed sensitivity analysis to explore parameter uncertainty. RESULTS: For peanut-allergic patients who are postmyocardial infarction or who have congestive heart failure, the heart disease benefit of beta-blockers outweighs the increased likelihood of dying from anaphylaxis, increasing life expectancy by 9.4 and 17.4 months, respectively. Beta-blocker was preferred unless (1) the annual rate of moderate to severe anaphylaxis exceeded 6.0% for postmyocardial infarction and 15% for congestive heart failure patients; (2) beta-blocker therapy increased the incidence of moderate to severe anaphylaxis >2.5-fold for postmyocardial infarction and >5.8-fold for congestive heart failure patients; (3) anaphylaxis case fatality exceeded 6.5% postmyocardial infarction; or (4) beta-blocker therapy increased anaphylaxis case fatality >25-fold postmyocardial infarction. CONCLUSION: Our results suggest that for patients postmyocardial infarction or with congestive heart failure who are at risk for peanut-induced anaphylaxis, beta-blocker use should still improve survival. However, the epidemiology of anaphylaxis and effects of beta-blocker therapy on anaphylaxis incidence and mortality require further study.

Adrenergic beta-Antagonists↗
PubMed1996

Idiopathic anaphylaxis: a series of 335 cases.

BACKGROUND: Idiopathic anaphylaxis is anaphylaxis with no definable etiology and no trigger by exogenous allergens. Initially described in 1978, idiopathic anaphylaxis has been subsequently characterized and treatment protocols have been established. OBJECTIVE: The demographics and course of 335 patients (225 previously reported) treated with prednisone, hydroxyzine, and albuterol are now reported. RESULTS: Ages ranged from 5 to 83 years. There were nine new pediatric patients in this series totaling 14 (4.2%). Atopy was common (48%) with 34 new patients with asthma. The duration of symptoms prior to presentation ranged from three days to 27 years. One hundred thirty-two patients with idiopathic anaphylaxis were available for follow-up. Twenty of these are currently receiving prednisone for control of idiopathic anaphylaxis, seven of them as part of their initial therapy, and ten for control of recurrence of symptoms. Three patients required continuous alternate day prednisone for control of symptoms (corticosteroid-dependent idiopathic anaphylaxis). Of the 335 patients, there were no longer any patients with the diagnosis of malignant idiopathic anaphylaxis defined as requiring prednisone, 20 mg daily, or 60 mg every other day, for control of idiopathic anaphylaxis. Of the six patients previously diagnosed with malignant idiopathic anaphylaxis, five no longer required prednisone and one has a decreased prednisone requirement of 20 mg on alternate days. Hospital visits were significantly reduced by the management regimens. There were no fatalities from idiopathic anaphylaxis in this series. CONCLUSIONS: The incidence of idiopathic anaphylaxis is increasing in our practice with more patients being evaluated each year. During 1104 patient years of observation (the longest period of single patient observation being 24 years), no inciting agent has been found responsible for the anaphylactic symptoms. Prognosis continues to remain good with the majority of patients achieving remission with pharmacotherapy.

Adolescent↗
PubMed2001

Emergency department anaphylaxis: A review of 142 patients in a single year.

BACKGROUND: There are few data on the incidence, clinical features, and management of patients with acute anaphylaxis presenting to the emergency department. We investigated all presentations to one department during the course of a year to improve current awareness of this medical emergency. OBJECTIVE: The purpose of the study was to describe the clinical features, management, and outcome of anaphylaxis presentations to a single Australian adult emergency department in a single year, 1998-1999. METHODS: This was a retrospective, case-based study of adult patients (>or=13 years of age) attending a single emergency department in Brisbane, Australia, during the year 1998-1999. The medical records of 304 patients satisfying the relevant discharge diagnostic codes were studied. We determined incidence, sex ratio, age, clinical features, management, disposal, asthma prevalence, and causes in patients presenting with acute allergic reactions and anaphylaxis. RESULTS: In all, 162 emergency department patients with acute allergic reactions and 142 emergency department patients with anaphylaxis, including 60 whose anaphylaxis was severe, were seen during the year, for an anaphylaxis presentation incidence of 1 in 439. One patient died; this gave a case fatality rate of 0.70%. Cutaneous features were present in 94% of the patients with anaphylaxis. Of those with severe anaphylaxis, 35% had dizziness/syncope before hospital presentation, 25% laryngeal edema, and 21.7% systolic hypotension on hospital presentation. A cause was recognized in 73% of the anaphylaxis cases; most commonly, the causative agent was a drug, insect venom, or food. Adrenaline was used in 57% of the severe cases before hospital presentation or in the hospital. The emergency department alone definitively cared for 94% of all patients, though only 43% severe anaphylaxis cases were referred for follow-up. CONCLUSION: The emergency department anaphylaxis presentation incidence of 1 in 439 cases is greater than previously recognized, though death remains rare. In three fourths of cases, a precipitant was identified, a fact that emphasizes the need for a detailed initial history. Definitive management in the emergency department alone is possible in most cases, provided that the appropriate use of adrenaline and the need for allergy clinic follow-up are appreciated.

Adolescent↗
PubMed2002

Histamine and antihistamines in anaphylaxis.

Anaphylaxis and anaphylactoid reactions are potentially fatal. These disorders are sometimes iatrogenic, and increase with increased exposure to drugs, synthetic substances, and medical procedures. Non-IgE-mediated anaphylactoid reactions are common in medical settings and are clinically indistinguishable from anaphylaxis. These reactions may be unrecognized if a rigid classic definition of anaphylaxis is used. Histamine is a primary mediator of anaphylaxis and signs and symptoms of anaphylaxis can be reproduced by histamine infusion. Histamine triggers a cascade of inflammatory mediators and modulates its own release. H1-antihistamines are adjunctive treatment therapy for acute anaphylaxis and anaphylactoid reactions, in which many mediators of inflammation are involved. Compared with epinephrine, the first-response medication of choice, antihistamines have a slow onset of action, and they cannot block events that occur subsequent to histamine binding to its receptors. Antihistamines are an important component of regimens for the prevention of anaphylaxis and anaphylactoid reactions in patients at risk, and may eventually have more widespread application in the perioperative setting. In some instances, such as with exercise-induced anaphylaxis and reactions to latex in sensitized individuals, prophylaxis regimens are not always effective. H2-antagonists are not detrimental in the therapy of anaphylaxis and many studies show a favorable outcome when combining H1- and H2-antagonist therapy for prophylaxis. They should be added to therapy at the discretion of the treating physician. Because of decreased antimuscarinic and central nervous system side effects, the newer antihistamines can be given in high doses, allowing more complete blockade of histamine receptors. These agents should lead to a reevaluation of the usefulness of antihistamines in both the treatment of acute anaphylaxis and in prophylactic regimens. The unavailability of parenterally administered second-generation H1-antagonists limits their usefulness in acute anaphylaxis and perioperative prophylaxis.

Anaphylaxis↗
PubMed2005

IL-9 promotes but is not necessary for systemic anaphylaxis.

Anaphylaxis represents an extreme form of allergic reaction, consisting of a sensitization phase during which allergen-specific IgE are produced and an acute effector phase triggered by allergen-induced degranulation of mast cells. We studied the role of IL-9, a Th2 cytokine implicated in asthma, in different models of murine anaphylaxis. Using a passive model of systemic anaphylaxis, in which anti-DNP IgE Abs were administered before challenge with DNP-BSA, we found that IL-9-transgenic mice or wild-type mice treated with IL-9 for 5 days were highly sensitive to fatal anaphylaxis. This effect was reproduced in both anaphylaxis-susceptible and -resistant backgrounds (FVB/N or [FVB/N x BALB/c] F(1) mice, respectively) and correlated with increased serum concentrations of mouse mast cell protease-1 level, a protein released upon mast cells degranulation. By contrast, IL-9 did not increase the susceptibility to passive cutaneous anaphylaxis. IL-9 expression also increased the susceptibility to fatal anaphylaxis when mice were sensitized by immunization against OVA before challenge with the same Ag. In this model, serum from sensitized, IL-9-transgenic mice was more potent in transferring susceptibility to OVA challenge into naive mice, indicating that IL-9 also promotes the sensitization stage. Finally, using IL-9R-deficient mice, we found that despite its anaphylaxis-promoting activity, IL-9 is dispensable for development of both passive and active anaphylaxis, at least in the C57BL/6 mouse background. Taken together, the data reported in this study indicate that IL-9 promotes systemic anaphylaxis reactions, acting at both the sensitization and effector stages, but is not absolutely required for this process.

Anaphylaxis↗
PubMed2002

The incidence of anaphylaxis following intravenous phytonadione (vitamin K1): a 5-year retrospective review.

BACKGROUND: Phytonadione (vitamin K1) administered intravenously (i.v.) has been associated with anaphylaxis, although the incidence is not known. The anaphylaxis is thought to be attributable to the solubilizing vehicle, polyethoxylated castor oil (Cremophor EL, BASF AG, Ludwingshafen, Germany). OBJECTIVE: To estimate the incidence of anaphylaxis after i.v. administration of phytonadione. METHODS: A retrospective review of anaphylaxis after i.v. phytonadione over a 58-month period at a large academic center was performed. During the period of the study a protocol for the administration of i.v. phytonadione was in place. A review of computerized records and survey of staff identified cases of anaphylaxis meeting predefined inclusion criteria. In addition, a literature review was performed for articles concerning anaphylaxis after i.v. phytonadione. RESULTS: Over the 58 months of the study, a total of 6,572 doses of i.v. phytonadione were administered. Two cases of anaphylaxis after i.v. phytonadione were identified. The incidence of anaphylaxis was 3 per 10,000 doses with 95% confidence intervals of 0.04 to 11 per 10,000 doses. The literature review identified 14 cases meeting inclusion criteria with no reviews of the literature or estimates of incidence. CONCLUSIONS: The incidence of anaphylaxis after i.v. phytonadione is overall comparable or slightly less than other drugs known to cause anaphylaxis. We do not recommend routine pretreatment with antihistamines or corticosteroids before administration of phytonadione.

Adult↗
PubMed1997

A case of idiopathic anaphylaxis associated with respiratory infections.

BACKGROUND: Anaphylaxis is associated with IgE-mediated reactions to foods, drugs, and other allergens. Exercise-induced anaphylaxis and food plus exercise-induced anaphylaxis have been reported. Anaphylactoid reactions with no mechanisms determined have been described with radiographic contrast media. Idiopathic anaphylaxis by definition is anaphylaxis with no identifiable external allergen or stimulus. In our series of more than 350 patients with idiopathic anaphylaxis, extensive evaluation has failed to identify a cause for the anaphylaxis. OBJECTIVE: To report a first case of idiopathic anaphylaxis associated with coryzal symptoms. METHODS: A patient was evaluated for idiopathic anaphylaxis. Appropriate therapy was initiated. RESULTS: The patient's anaphylactic episodes are related to the occurrence of coryzal symptoms but no clear IgE-mediated mechanism was identified. CONCLUSION: This is the first reported association of anaphylaxis with an inciting factor of infection.

Anaphylaxis↗
PubMed2001

Age, sex, geographical and socio-economic variations in admissions for anaphylaxis: analysis of four years of English hospital data.

BACKGROUND: Although the most severe of the allergic disorders, the epidemiology of anaphylaxis remains poorly described. Hospital admissions for anaphylaxis in England more than doubled during the 1990s. OBJECTIVE: To provide baseline data for assessing future trends, and to assess whether there is sufficient regional variation in incidence to allow efficient testing of aetiological hypotheses, we sought to identify any age, sex, geographical and socio-economic variations in hospital inpatient admissions for anaphylaxis. METHODS: We studied all emergency admissions for anaphylaxis to English NHS hospitals between 1991 and 1995. Poisson regression modelling was used to calculate rates of anaphylaxis admission per 100 000 emergency admissions by age, sex, deprivation and by residence in urban/rural, North/South and East/West England. RESULTS: Of the 13.5 million emergency inpatient admissions, 2323 patients had a primary diagnosis of anaphylaxis. Poisson regression analyses showed significant age, gender, geographical and socio-economic variations in emergency admissions for anaphylaxis: adjusted Female rate ratio 1.19 (95% CI 1.09-1.29), South rate ratio 1.35 (95% CI 1.25-1.47), Rural rate ratio 1.35 (95% CI 1.17, 1.59), and Non-deprived rate ratio 1.32 (95% CI 1.19, 1.46). CONCLUSION: This study identifies striking national age, sex, geographical and socio-economic variations in the incidence of inpatient admissions for anaphylaxis in England, affording important opportunities to generate and test aetiological hypotheses. Risk of anaphylaxis admission is considerably increased in females of child-bearing age and those residing in southern, rural, and affluent areas are independent risk factors for anaphylaxis admission.

Adolescent↗
PubMed1998

IgG-mediated anaphylaxis via Fc gamma receptor in CD40-deficient mice.

Anaphylaxis denotes an immediate hypersensitivity reaction to allergen, exclusively mediated by IgE antibodies. However, IgE antibodies do not explain all the syndromes that are encountered. We investigated potent IgG-mediated anaphylaxis in CD40-deficient mice that lack the immunoglobulin class switching for T cell-dependent antigens. Immunization with ovalbumin did not induce either humoral responses of IgG, IgA, and IgE, or systemic anaphylaxis in CD40-deficient mice. Although systemic anaphylaxis by active immunization was not observed in CD40-deficient mice, both passive cutaneous anaphylaxis (PCA) and passive systemic anaphylaxis assessed by mouse blood pressure monitoring with cervical artery catheterization did take place when antigen-specific IgG was transferred and then antigen challenge given. Further, to investigate the inflammatory pathway of IgG-mediated immediate hypersensitivity reactions, we focused on the Fc gamma receptor (Fc gammaR) function. Pretreatment of the mice with the anti-Fc gammaRII/Fc gammaRIII MoAb clearly blocked the response of PCA and passive systemic anaphylaxis, suggesting that they were initiated through Fc gammaR. In conclusion, we directly demonstrate the IgG-mediated anaphylaxis and its triggering mechanism through Fc gammaR in in vivo conditions. In addition to IgE-mediated anaphylaxis, IgG-mediated anaphylaxis should be considered and the blocking of Fc gammaR would provide one of the therapeutic targets for the control of IgG-mediated hypersensitivity diseases.

Anaphylaxis↗
PubMed2000

Parent reported allergy and anaphylaxis in 4173 South Australian children.

OBJECTIVES: To determine the prevalence of parent reported allergy and anaphylaxis in a sample of children and to investigate the first aid management of anaphylaxis in the schools and preschools that these children attend. METHODS: The study sample comprised 4173 South Australian children aged 3-17 years. Information was collected regarding parent-reported allergy and anaphylaxis. All children with known anaphylaxis were contacted and an attempt was made to contact those with reports of allergy to ascertain if these children had anaphylaxis. A telephone questionnaire was used to verify reports of anaphylaxis and determine the cause, severity and school first aid management of anaphylaxis. RESULTS: The rate of parent reported allergy and anaphylaxis was 7.3 and 0.59 per 100 children, respectively. Two-thirds of children with anaphylaxis did not have emergency medication available at school, an emergency action plan, or a teacher on site able to administer adrenaline for first aid use. CONCLUSIONS: Children attending preschool or school may have had a past history of anaphylaxis. Arrangements for first aid management of these children while in this environment are often inadequate.

Adolescent↗
PubMed1993

A population based case-cohort study of drug-induced anaphylaxis.

1. In order to determine the risk of anaphylaxis as an adverse reaction to drugs, a case-cohort study was performed. Cases consisted of all admissions in 1987 and 1988 to all Dutch hospitals with anaphylaxis as the principal diagnosis, and a random sample of admissions with related symptoms. Hospital discharge summaries were classified according to probability to anaphylaxis by a blinded Audit Committee. Of admissions classified as probable or possible anaphylaxis, the causative agent was assessed. The reference cohort consisted of all persons in the catchment area of a sample of pharmacies in The Netherlands, in the period between January 1, 1987 and December 31, 1988. 2. Out of 934 admissions, discharge summaries on 811 admissions were received, of which 727 contained enough clinical details. Out of 727, 391 were classified as probable or possible anaphylaxis. In 336 of these 391, anaphylaxis was reason for admission. This group consisted of 158 men and 178 women. Drug-induced anaphylaxis occurred in 107 patients. 3. Drug-induced anaphylaxis was most frequently caused by penicillins, analgesics and non-steroidal antiinflammatory drugs (NSAID) with the highest point estimate of the risk relative to all other drugs of 10.7, 6.9 and 3.7 respectively. 4. In the cases of probable anaphylaxis, the risk of anaphylaxis to glafenine relative to all other drugs was 167.7 in 1987 (95%-CI: 63.0-446.4) and 128.6 in 1988 (95%-CI: 50.4-328.5), to amoxycillin 15.2 in 1987 (95%-CI: 5.0-46.0) and 4.4 in 1988 (95%-CI: 1.03-18.9) and to diclofenac 6.1 in 1988 (95%-CI: 1.4-26.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Diagnosis and management of food-induced anaphylaxis: a national survey of pediatricians.

BACKGROUND: Food allergy is a common pediatric problem, affecting as many as 6% of young children, yet it is unclear whether pediatricians are well prepared to manage food-induced anaphylaxis. OBJECTIVE: The purpose of this work was to assess pediatricians' knowledge of diagnosis and management of children with food-induced anaphylaxis. METHODS: A survey designed to assess food allergy diagnosis and management was mailed to a US national random sample of 1130 pediatricians. Survey questions were based on a clinical scenario involving a child having an anaphylactic reaction after ingesting peanut. Primary outcome measures included correct responses to the 11 questions about anaphylaxis. RESULTS: A total of 468 pediatricians (41%) responded to the survey. The majority of the respondents were women (58%), spent > 50% of their time in a clinical setting (78%), and reported providing care for food allergy patients (86%). Overall, 70% of the pediatricians agreed that the clinical scenario was consistent with anaphylaxis, and 72% chose to administer epinephrine. However, only 56% of respondents agreed with both the diagnosis of anaphylaxis and treating with epinephrine. Most pediatricians (70%) did not recognize that a 30-minute observation period after anaphylaxis was too short. Pediatricians who reported providing care for food allergy patients were more likely to agree with the diagnosis of anaphylaxis (73% vs 59%), with treating the reaction with epinephrine (73% vs 64%), and with prescribing self-injectable epinephrine (83% vs 66%) than pediatricians who did not care for food allergy patients. The more certain that pediatricians were that the child was having an anaphylactic reaction, the more likely they were to agree with treating the reaction with epinephrine. In general, recent continuing medical education was not predictive of improved knowledge. CONCLUSION: Although the majority of pediatricians seem to have some knowledge of food-induced anaphylaxis, a substantial proportion has knowledge deficits that may hinder their ability to provide optimal care to children with food-induced anaphylaxis. Pediatricians who provide health care for patients with food allergy may be better equipped to manage food-induced anaphylaxis than those who do not. Because continuing medical education was not a significant predictor of increased knowledge, ensuring that pediatric residents develop experience managing patients with food allergies may be a better strategy to educate primary care pediatricians about food allergy.

Anaphylaxis↗
PubMed2006

Fluoroquinolone-associated anaphylaxis in spontaneous adverse drug reaction reports in Germany: differences in reporting rates between individual fluoroquinolones and occurrence after first-ever use.

BACKGROUND: The frequency of fluoroquinolone-associated anaphylaxis has been estimated to be 1.8-23 per 10 million days of treatment based on spontaneous reports. It is unknown whether there are differences between the reporting rates of anaphylaxis with individual fluoroquinolones. According to pathophysiology, anaphylaxis may be immune mediated (anaphylactic) or not (anaphylactoid). The latter may occur after first-ever intake since no sensitisation phase is necessary. OBJECTIVE: To analyse spontaneous reports of fluoroquinolone-associated anaphylaxis contained in the spontaneous adverse drug reaction database of the Federal Institute for Drugs and Medical Devices in Germany with regard to differences in reporting rates between various fluoroquinolones, the previous intake and the time to onset of the reaction. METHODS: All fluoroquinolone-associated cases of anaphylaxis, anaphylactic shock, and anaphylactic/anaphylactoid reaction spontaneously reported to the Federal Institute for Drugs and Medical Devices between 1 January 1993 and 31 December 2004 were identified and assessed with regard to the correctness of the diagnosis of anaphylaxis, the causal relationship with the drug, the previous intake of fluoroquinolones and the time to onset of the reaction. RESULTS: In 166 of 204 cases identified, the diagnosis of anaphylaxis and a causal relationship with the drug were considered at least possible. Moxifloxacin, levofloxacin, ciprofloxacin and ofloxacin accounted for 90 (54%), 25 (15%), 21 (13%) and 16 (10%) of the 166 cases, respectively. The corresponding reporting rates per 1 million defined daily doses based on crude estimates of exposure were 3.3, 0.6, 0.2 and 0.2 for moxifloxacin, levofloxacin, ciprofloxacin and ofloxacin, respectively. The occurrence of anaphylaxis after the first dose or within the first three days was reported in 71 of 166 (43%) cases, but no information on prior exposure with this or any other fluoroquinolone was provided with these reports. In 21 of 166 (13%) cases, the reaction occurred within the first 3 days and it was stated that the particular fluoroquinolone had never been taken before. CONCLUSIONS: Anaphylaxis appears to be associated with the fluoroquinolone class of antibacterials. Observed differences in reporting rates should be further investigated. Fluoroquinolone-associated anaphylaxis may occur after first-ever intake of the agent.

Adult↗
PubMed1995

Recurrent anaphylaxis due to unrecognized latex hypersensitivity in two healthcare professionals.

BACKGROUND: Anaphylaxis is a potentially fatal immediate-type reaction and intense effort may be required to identify the allergen responsible. In some cases, a "hidden" allergen may be responsible that is not apparent in spite of careful clinical assessment. OBJECTIVES: This report describes the assessment of two cases of anaphylaxis in which a search for an allergen was initially not conclusive and the diagnosis of idiopathic anaphylaxis was considered. METHODS: Two patients were evaluated by various physicians for anaphylaxis with no clear indication of a responsible allergen. Persistence in evaluation led to the identification of the allergen responsible. RESULTS: In two health care workers latex was identified as the "hidden" cause of anaphylaxis. This allergen had not been considered in either case in initial evaluations. Neither patient has had a recurrence of anaphylaxis since latex was identified as the cause of anaphylaxis. CONCLUSIONS: Although latex is widely recognized as a cause of anaphylaxis, it can still be unrecognized in some cases of recurrent anaphylaxis. Latex must be considered as a "hidden" cause of anaphylaxis, particularly in health care workers.

Adult↗
PubMed1994

Clinical course of idiopathic anaphylaxis.

BACKGROUND: Only a few groups have reported on idiopathic anaphylaxis. We analyzed our experience with idiopathic anaphylaxis, especially in regards to prognosis. METHODS: Thirty-seven patients with the diagnosis of idiopathic anaphylaxis were retrospectively identified by a medical records search from 1989-1992. Thirty-five patients were evaluable and a telephone questionnaire was conducted to determine the current treatment and course of their idiopathic anaphylaxis since their initial evaluation. RESULTS: Patient ages ranged from 26 to 71 years (mean 48), 72% were women, and 43% were atopic. Frequent episodes of idiopathic anaphylaxis (> 5/year) occurred in 31%. At follow-up (mean 2.5 years), 21 patients (60%) had resolution of idiopathic anaphylaxis, and the frequency of anaphylaxis was decreased in nine, increased in two, and the same in three patients. Only three patients were still having frequent episodes and two required chronic glucocorticoids. Patients with frequent idiopathic anaphylaxis treated with only antihistamines and adrenergics underwent remission or improvement as frequently as those treated with chronic glucocorticoids. CONCLUSIONS: These results are similar to other reports of idiopathic anaphylaxis and indicate a generally favorable prognosis. Some patients with frequent idiopathic anaphylaxis improved without the need for glucocorticoids. Well controlled studies may be required to analyze the role of glucocorticoids in this disease.

Adrenergic Agents↗
PubMed1995

Anaphylaxis. A review of 266 cases.

BACKGROUND: A presentation of findings from a large population of anaphylaxis cases. METHODS: Retrospective chart review and follow-up questionnaire provided data on 266 subjects (113 males and 153 females) aged 12 to 75 years (mean age, 38 years) who were referred to a university-affiliated private allergy-immunology practice in Memphis, Tenn, for evaluation and management of anaphylaxis from January 1978 through March 1992. RESULTS: Of 266 subjects, 162 (61%) had three or more anaphylactic episodes, 41 (15%) had two episodes, and 63 (24%) had one episode. Atopy was present in 98 individuals (37%). Physicians thought foods, spices, and food additives caused anaphylaxis in 89 individuals (34%); crustaceans and peanut accounted for about half of these cases. Medications were thought to have caused the anaphylactic episodes in 52 individuals (20%); nonsteroidal anti-inflammatory drugs in about half of these cases. Other probable causes included exercise (n = 19), latex (n = 2), hormonal changes (n = 2), and insect bites (n = 4). A suspected cause could not be determined in 98 individuals (37%). These subjects were diagnosed as having idiopathic anaphylaxis. Of the 266 subjects, 102 responded to a follow-up survey; 68 (67%) of the 102 were thought to have identifiable causes of anaphylaxis (32 of whom [47%] failed to carry epinephrine syringes for self-administration despite instructions to do so). In contrast, of 34 subjects with idiopathic anaphylaxis who responded to the survey, only three (9%) did not carry epinephrine. CONCLUSIONS: (1) Atopy is common in subjects who experience anaphylaxis, regardless of its origin; (2) crustaceans and nonsteroidal anti-inflammatory drugs are the most common food and medication groups, respectively, thought to cause anaphylaxis; (3) causative agents can be identified for two thirds of the subjects, and recurrent attacks are the rule; and (4) subjects with idiopathic anaphylaxis are more likely to carry epinephrine for self-administration than those with identifiable causes.

Adolescent↗
PubMed2005

Molecular mechanisms of anaphylaxis: lessons from studies with murine models.

Studies with murine models demonstrate 2 pathways of systemic anaphylaxis: one mediated by IgE, Fc epsilonRI, mast cells, histamine, and platelet-activating factor (PAF), and the other mediated by IgG, Fc gammaRIII, macrophages, and PAF. The former pathway requires much less antibody and antigen than the latter. As a result, IgG antibody can block IgE-mediated anaphylaxis induced by small quantities of antigen without mediating Fc gammaRIII-dependent anaphylaxis. The IgE pathway is most likely responsible for most human anaphylaxis, which generally involves small amounts of antibody and antigen; similarities in the murine and human immune systems suggest that the IgG pathway might mediate disease in persons repeatedly exposed to large quantities of antigen. Mice, like human subjects, can experience IgE/Fc epsilonRI/mast cell-mediated gastrointestinal and systemic anaphylaxis in response to ingested antigen. Gastrointestinal symptoms depend on serotonin and PAF; mediator dependence of systemic symptoms has not been determined. Both local and systemic anaphylaxis induced by ingested antigens might be blocked by IgA and IgG antibodies. IL-4 and IL-13 signaling through the IL-4 receptor alpha chain, in addition to promoting the mastocytosis and IgE antibody production that mediate most human anaphylaxis, exacerbates the effector phase of anaphylaxis by increasing target cell responsiveness to vasoactive mediators. As a result, IL-4 receptor alpha chain antagonists might be particularly effective suppressors of anaphylaxis.

Anaphylaxis↗