Journal of Allergy and Clinical Immunology
9. Anaphylaxis
Section snippets
Pathogenesis
In many individuals with anaphylaxis, IgE plays a pivotal role. Synthesized in response to allergen exposure, it becomes fixed to FcɛRI on the surface membranes of mast cells and basophils. Aggregation of receptor-bound IgE molecules on re-exposure to the allergen results in cell activation, mediator release, and the immediate hypersensitivity response. IgE also contributes to the intensity of anaphylaxis through mechanisms that go beyond sensitizing, priming, activation, and mediator release;
Diagnosis
Diagnosis of anaphylaxis depends primarily on a meticulous clinical history: ascertaining exposure to potential triggering agents or events, time elapsed between exposure and symptom onset, and evolution of the episode over minutes or hours. Among individuals recognized as having anaphylaxis, target organs include skin (90% of episodes), respiratory tract (70%), gastrointestinal tract (30% to 45%), cardiovascular system (10% to 45%), and central nervous system (CNS; 10% to 15%; Fig 1, A).
Management
When anaphylaxis occurs in a healthcare facility, rapid assessment of airway, breathing, circulation, and orientation is mandatory; in addition, the skin should be examined and body weight (mass) should be estimated. This should be followed by prompt intramuscular injection of epinephrine, administration of supplemental oxygen, establishment of an airway, placing the individual in the supine position, and insertion of 1 or more large-bore intravenous lines for fluid replacement and infusion of
References (40)
- et al.
Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium
J Allergy Clin Immunol
(2006) - et al.
Risk assessment in anaphylaxis: current and future approaches
J Allergy Clin Immunol
(2007) - et al.
Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group
Ann Allergy Asthma Immunol
(2006) - et al.
ICD-9-CM coding of emergency department visits for food and insect sting allergy
Ann Epidemiol
(2006) - et al.
Further fatalities caused by anaphylactic reactions to food, 2001-2006
J Allergy Clin Immunol
(2007) - et al.
Further fatal allergic reactions to food in the United Kingdom, 1999-2006
J Allergy Clin Immunol
(2007) - et al.
Fatal anaphylaxis: postmortem findings and associated comorbid diseases
Ann Allergy Asthma Immunol
(2007) - et al.
5. IgE, mast cells, basophils, and eosinophils
J Allergy Clin Immunol
(2006) - et al.
Molecular regulation of mast cell activation
J Allergy Clin Immunol
(2006) - et al.
The sphingosine kinase-sphingosine-1-phosphate axis is a determinant of mast cell function and anaphylaxis
Immunity
(2007)
Identification of basophils by a mAb directed against pro-major basic protein 1
J Allergy Clin Immunol
Anti-IgE as a mast cell-stabilizing therapeutic agent
J Allergy Clin Immunol
Molecular mechanisms of anaphylaxis: lessons from studies with murine models
J Allergy Clin Immunol
Anaphylaxis, killer allergy: long-term management in the community
J Allergy Clin Immunol
Diagnostic value of tryptase in anaphylaxis and mastocytosis
Immunol Allergy Clin North Am
Insect sting allergy and venom immunotherapy: a model and a mystery
J Allergy Clin Immunol
Clinical and entomological factors influence the outcome of sting challenge studies
J Allergy Clin Immunol
Use of beta-blockers during immunotherapy for Hymenoptera venom allergy
J Allergy Clin Immunol
9. Food allergy
J Allergy Clin Immunol
Update on food allergy
J Allergy Clin Immunol
Cited by (0)
Disclosure of potential conflict of interest: The author has declared that she has no conflict of interest.