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Anaphylaxis is an acute and potentially lethal multisystem allergic reaction that occurs in a variety of clinical scenarios and is almost unavoidable. Immunologic reactions to medications, foods, and insect stings cause most episodes, but virtually any substance capable of inducing systemic degranulation of mast cells and basophils can produce anaphylaxis. All health care professionals must be able to recognize anaphylaxis promptly, be prepared to treat it appropriately, and be able to provide preventive recommendations. Similarly, at-risk individuals must be prepared to self-treat anaphylaxis promptly if prevention fails., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose of Review: This review aims to provide an evidence-based overview of several pharmacotherapeutic options available for refractory anaphylaxis when intramuscular epinephrine, the drug of choice, fails to provide resolution of signs and symptoms., Recent Findings: The evidence base for the therapy of anaphylaxis is comparatively weak and is largely based on consensus expert recommendations and case reports. There is an increasing recognition that this is problematic. The level of evidence for epinephrine use in anaphylaxis is higher than for other agents. Recent systematic reviews have confirmed the lack of high-grade evidence to support use of antihistamines and corticosteroids in anaphylaxis, both of which statistically continue to be used more frequently than epinephrine. Newer pharmacotherapeutic agents have been proffered, but none has been evaluated with scientific rigor., Summary: Some anaphylactic reactions are so severe that treatment is unsuccessful despite rapid recognition and treatment. Improving the evidence base for the various treatment modalities may further help minimize fatalities once anaphylaxis is recognized. Consensus expert recommendations and case reports suggest a number of pharmacotherapeutic agents that are worthy of high-quality scrutiny through randomized controlled studies in which both treatment and placebo arms receive intramuscular epinephrine injections.

Purpose of Review: This review aims to provide an overview of the evolving understanding of the pathophysiology of anaphylaxis., Recent Findings: Immunopathologic mechanisms of anaphylaxis have traditionally focused on the IgE-dependent and IgE-independent release of mediators from mast cells and basophils. There are accumulating data supporting the significance of alternative pathways of anaphylaxis. Increasing attention has also focused on the internal compensatory mechanisms activated in response to anaphylaxis., Summary: Recent advances will enhance understanding of the pathophysiology of anaphylaxis and might have future implications for diagnosis and management.

These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "The Diagnosis and Management of Anaphylaxis Practice Parameter: 2010 Update." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, or the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion., (Copyright (c) 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.)

Anaphylaxis may recur 1 to 72 hours after initial signs and symptoms apparently resolve. Reported incidence of biphasic anaphylaxis varies from 1% to 23%. Late-phase severity varies from mild to severe (rarely fatal). No evidence or expert consensus presently identifies distinguishing characteristics in the initial phase that predict a late phase. However, reports propose potential risk factors, including initial phase severity, delayed or suboptimal doses of epinephrine during initial treatment, laryngeal edema or hypotension during initial phase, delayed symptomatic onset after antigen exposure, or history of biphasic anaphylaxis. It is unclear whether systemic corticosteroids administered in the initial phase can prevent or weaken late-phase reactions. Based on available evidence, observation periods after complete resolution of uniphasic anaphylaxis should be individualized, particularly because there are no reliable predictors of biphasic anaphylaxis. A 10-hour observation period appears sufficient, but some investigators recommend 24 hours.

Anaphylaxis, an acute and potentially lethal multisystem allergic reaction, is almost unavoidable in medical practice. Physicians must be able to recognize anaphylaxis, treat it promptly and appropriately, and provide preventive recommendations. Epinephrine, which should be administered immediately, is the drug of choice for acute anaphylaxis.

Anaphylaxis, an acute and potentially lethal multisystem allergic reaction, is almost unavoidable in medical practice. Health care professionals must be able to recognize the signs of anaphylaxis, treat an episode promptly and appropriately, and be able to provide preventive recommendations. Epinephrine, which should be administered immediately, is the drug of choice for acute anaphylaxis.

Anaphylaxis is a life-threatening syndrome resulting from the sudden release of mast cell- and basophil-derived mediators into the circulation. Foods and medications cause most anaphylaxis for which a cause can be identified, but virtually any agent capable of directly or indirectly activating mast cells or basophils can cause this syndrome. This review discusses the pathophysiologic mechanisms of anaphylaxis, its causes, and its treatment.

Anaphylaxis, an acute and potentially lethal multi-system clinical syndrome resulting from the sudden, systemic degranulation of mast cells and basophils, occurs in a variety of clinical scenarios and is almost unavoidable inmedical practice. Healthcare professionalsmust be able to recognize its features, treat an episode promptly and appropriately, and be able to provide recommendations to prevent future episodes. Epinephrine, administered immediately, is the drug of choice for acute anaphylaxis. The discussion provides an overview of one set of evidence-based and consensus parameters for the diagnosis and management of anaphylaxis.

Discusses drug allergies, adverse reactions resulting from immunologic responses to drugs or their metabolites. Epidemiology and incidence of drug reactions; Classification of adverse drug reactions; Risk factors for adverse drug reactions; Allergic reaction to specific drugs; Approach to the patient experiencing a drug reaction while taking multiple drugs; Management of anaphylaxis and anaphylactoid reactions.

Presents a retrospective study of 266 cases of anaphylaxis treatment and management in Memphis, Tennessee. Description of subjects included in the study; Identifiable causative factors; Idiopathic anaphylaxis; Clinical signs and symptoms; Crustaceans and non-steroidal anti-inflammatory drugs as the most common food and medication groups thought to cause anaphylaxis.