Document Detail


History and classification of anaphylaxis.
MedLine Citation:
PMID:  15025389     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Anaphylaxis is the maximal variant of an acute allergic reaction involving several organ systems. The phenomenon itself is old, but it was recognized and named at the beginning of the 20th century by Richet and Portier. The clinical symptoms of anaphylaxis affect various organs, most commonly starting in the skin and proceeding to the respiratory tract, to gastrointestinal involvement and to cardiovascular symptoms, and finally to cardiac and/or respiratory arrest. Anaphylaxis stricto sensu is an immunological reaction, mostly mediated by IgE antibodies, but also by IgG or IgM antibodies (immune complex anaphylaxis). There are cases with similar clinical symptomatology without detectable immunological sensitization which are called pseudo-allergic or anaphylactoid reactions. In the newer nomenclature, some authors tend to include these under the heading of 'anaphylaxis' which has then to be defined as an acute systemic hypersensitivity reaction. The most common elicitors of anaphylaxis include drugs, foods, additives, but also other allergens as well as physical factors (cold, heat, UV radiation). The clinical outcome--the intensity of the reaction--is not only influenced by the degree of sensitization, but also by concomitant other factors: sometimes, individuals only develop anaphylaxis after simultaneous exposure to the allergen and an infection, physical exercise, psychological stress or concomitant medication (e.g. beta blockers). The term 'summation anaphylaxis' has been proposed for this phenomenon which probably underlies many cases of so-called idiopathic anaphylaxis. In patients with insect venom anaphylaxis, decreased levels of plasma angiotensin have been measured in inverse correlation to the severity of the reaction. Certain differential diagnoses have to be distinguished from anaphylaxis. Every patient with a history of anaphylaxis should undergo allergy diagnosis with the aim to detect the eliciting agent, characterize the relevant pathomechanism (e.g. IgE-mediated reaction) and to offer a tolerable alternative (in food or drug allergy). In clear-cut IgE-mediated anaphylaxis, allergen-specific immunotherapy (hyposensitization) is the effective causal treatment, with success rates of 90% in insect venom anaphylaxis.
Authors:
Johannes Ring; Knut Brockow; Heidrun Behrendt
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Publication Detail:
Type:  Historical Article; Journal Article    
Journal Detail:
Title:  Novartis Foundation symposium     Volume:  257     ISSN:  1528-2511     ISO Abbreviation:  Novartis Found. Symp.     Publication Date:  2004  
Date Detail:
Created Date:  2004-03-17     Completed Date:  2004-05-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9807767     Medline TA:  Novartis Found Symp     Country:  England    
Other Details:
Languages:  eng     Pagination:  6-16; discussion 16-24, 45-50, 276-85     Citation Subset:  IM    
Affiliation:
Division Environmental Dermatology and Allergology GSF/TUM, Department of Dermatology and Allergy Biederstein, Technical University Munich, Biedersteiner Strasse 29, D-80802 Munich, Germany.
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MeSH Terms
Descriptor/Qualifier:
Allergens / immunology
Anaphylaxis* / classification,  epidemiology,  history,  physiopathology
Animals
Diagnosis, Differential
History, 20th Century
History, 21st Century
History, Ancient
Humans
Immunoglobulin E / immunology
Chemical
Reg. No./Substance:
0/Allergens; 37341-29-0/Immunoglobulin E

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


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