Document Detail


Anaphylaxis: Recent advances in assessment and treatment.
MedLine Citation:
PMID:  19815109     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The incidence rate of anaphylaxis is increasing, particularly during the first 2 decades of life. Common triggers include foods, medications, and insect stings. Clinical diagnosis is based on a meticulous history of an exposure or event preceding characteristic symptoms and signs, sometimes but not always supported by a laboratory test such as an elevated serum total tryptase level. Physician-initiated investigation of patients with anaphylaxis whose symptoms and signs are atypical sometimes leads to important insights into previously unrecognized triggers and mechanisms. In idiopathic anaphylaxis, in which no trigger can be confirmed by means of skin testing or measurement of specific IgE, the possibility of mastocytosis or a clonal mast cell disorder must be considered in addition to the possibility of a previously unrecognized trigger. Long-term risk reduction in patients with anaphylaxis focuses on optimal management of relevant comorbidities such as asthma and other respiratory diseases, cardiovascular disease, and mastocytosis or a clonal mast cell disorder; avoidance of the relevant confirmed allergen trigger; and relevant immunomodulation such as medication desensitization, venom immunotherapy, and possibly in the future, immunotherapy with food. Emergency preparedness for recurrence of anaphylaxis in community settings includes having epinephrine (adrenaline) autoinjectors available, knowing when and how to use them, and having a written, personalized anaphylaxis emergency action plan and up-to-date medical identification. Randomized controlled trials of the pharmacologic interventions used in an acute anaphylaxis episode are needed.
Authors:
F Estelle R Simons
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Journal of allergy and clinical immunology     Volume:  124     ISSN:  1097-6825     ISO Abbreviation:  J. Allergy Clin. Immunol.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-09     Completed Date:  2009-11-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1275002     Medline TA:  J Allergy Clin Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  625-36; quiz 637-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. lmcniven@hsc.mb.ca
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MeSH Terms
Descriptor/Qualifier:
Allergens / immunology*
Anaphylatoxins / immunology*,  metabolism
Anaphylaxis / diagnosis*,  epidemiology,  therapy*
Animals
Anti-Allergic Agents / therapeutic use
Antigen-Antibody Complex / immunology
Cytokines / blood
Humans
Immunoglobulin E / blood
Mast Cells / immunology*,  metabolism
Risk Factors
Chemical
Reg. No./Substance:
0/Allergens; 0/Anaphylatoxins; 0/Anti-Allergic Agents; 0/Antigen-Antibody Complex; 0/Cytokines; 37341-29-0/Immunoglobulin E

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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