Contemporary Reviews in Critical Care Medicine: Anaphylaxis.
Chest. 2017 Aug 08;:
Authors: LoVerde D, Iweala OI, Eginli A, Krishnaswamy G
Anaphylaxis is a systemic, life threatening disorder triggered by mediators released by mast cells and basophils activated via allergic (IgE-mediated) or non-allergic (non-IgE-mediated) mechanisms. It is a rapidly evolving, multisystem process involving the integumentary, pulmonary, gastrointestinal and cardiovascular systems. Anaphylaxis and angioedema are serious disorders that can lead to fatal airway obstruction and culminate in cardiorespiratory arrest resulting in hypoxemia and/or shock. 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 emergency department and in some cases, hospitalization and management in an intensive care unit (ICU). Recent reports suggest that underdiagnosis and undertreatment of anaphylaxis are common. 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. Conditions such as postural orthostatic tachycardia syndrome (POTS), Carcinoid syndrome, Munchausen's stridor and factitious anaphylaxis can present similarly and need to be included in the differential diagnosis. 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. The sine qua non of treatment is avoidance of any known triggers and epinephrine, which should never be delayed if this disorder is suspected. Secondary treatments include fluids, bronchodilators, antihistamines and glucocorticoids. Patients with cardiopulmonary arrest, airway or vascular compromise require mechanical ventilation, vasopressors and other advanced life support in the ICU.
PMID: 28800865 [PubMed - as supplied by publisher]