Food allergy, dermatologic diseases, and anaphylaxisSymposium on the Definition and Management of Anaphylaxis: Summary report
Section snippets
Epidemiology and International Classification of Diseases coding
Study of the epidemiology of anaphylaxis has been hampered by lack of an agreed-on definition and a lack of required reporting of either fatal or serious events. A failure to agree on how severe a reaction must be to code it anaphylaxis as opposed to an allergic reaction and to appreciate the variable presentation of anaphylaxis contributes to the problem. Very few population-based studies have been attempted, so the actual incidence of anaphylaxis remains uncertain. Estimates of the incidence
Immunology of anaphylaxis
Aggregation of FcεRI by allergen-driven cross-linking of receptor-bound IgE activates mast cells and basophils to release mediators that induce the pathophysiologic features of the anaphylactic response.16 Initial sensitization occurs through a highly coordinated series of steps involving a variety of cell types and mediators,17 which is affected by environmental exposure and complex genetic factors. Consequently, even identical twins raised together may lack complete clinical concordance (eg,
Pathophysiology of anaphylaxis
Allergic reactions begin when an allergen crosses an epithelial and/or endothelial barrier and then interacts with cell-bound IgE antibodies. The integrity of natural barriers such as the skin or the gastrointestinal tract must be breached, and these allergens must then gain access to the reactive, sensitized cells in tissues (mast cells) or blood (basophils). The release of cellular mediators then leads to end-organ responses in the skin, respiratory tract, cardiovascular system, and/or
Anaphylaxis by major causative agents
Although the immunobiology and pathophysiology of anaphylaxis are basically the same regardless of the provoking factor, different allergens lead to subtle differences in the response.
Diagnosis and management
As demonstrated by the diverse organizations that participated in the NIAID/FAAN symposium, anaphylaxis is seen by different types of clinicians in a variety of clinical settings. This presents a formidable challenge to the creation of a disease definition that will fit all settings. Regardless of setting, however, epinephrine is the medication of choice for treating anaphylaxis.
Discussion
It is time to develop a universal and, ideally, international definition of anaphylaxis, because the current lack of agreement on what constitutes anaphylaxis has led to confusion on the part of first responders, emergency personnel, primary care physicians, and patients; has resulted in suboptimal diagnosis, treatment, and education of affected patients; and has hampered research efforts. It was apparent to those at the NIAID/FAAN symposium that the definition could not be mechanistically
References (59)
- et al.
Portier, Richet, and the discovery of anaphylaxis: a centennial
J Allergy Clin Immunol
(2002) - et al.
Emergency department anaphylaxis: a review of 142 patients in a single year
J Allergy Clin Immunol
(2001) - et al.
Epidemiology of anaphylaxis among children and adolescents enrolled in a health maintenance organization
J Allergy Clin Immunol
(2004) - et al.
Underreporting of anaphylaxis in a community emergency room
J Allergy Clin Immunol
(1995) - et al.
Discontinuing venom immunotherapy: extended observations
J Allergy Clin Immunol
(1998) - et al.
Epidemiology of anaphylaxis in Olmsted County: a population-based study
J Allergy Clin Immunol
(1999) - et al.
Multicenter study of emergency department visits for food allergies
J Allergy Clin Immunol
(2004) - et al.
Genetics of peanut allergy: a twin study
J Allergy Clin Immunol
(2000) - et al.
Relationship between food-specific IgE concentration and the risk of positive food challenges in children and adolescents
J Allergy Clin Immunol
(1997) - et al.
Studies on the relationship between the level of specific IgE antibodies and the clinical expression of allergy: definition of levels distinguishing patients with symptomatic from patients with asymptomatic allergy to common aeroallergens
J Allergy Clin Immunol
(1995)
A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy
J Allergy Clin Immunol
Histamine and tryptase levels in patients with acute allergic reactions: an emergency department-based study
J Allergy Clin Immunol
Fatalities due to anaphylactic reactions to foods
J Allergy Clin Immunol
Fatal posture in anaphylactic shock
J Allergy Clin Immunol
Drug allergy
J Allergy Clin Immunol
Weal and flare responses to intradermal rocuronium and cisatracurium in humans
Br J Anaesth
Studies of 400 Hymentoptera sting deaths in the United States
J Allergy Clin Immunol
Microarray immunoassay: association of clinical history, in vitro IgE function, and heterogeneity of allergenic peanut epitopes
J Allergy Clin Immunol
First aid anaphylaxis management in children who were prescribed an epinephrine autoinjector device (EpiPen)
J Allergy Clin Immunol
Food-dependent exercise-induced anaphylaxis
Immunol Allergy Clin North Am
Anaphylaxis in the prehospital setting
J Emerg Med
Emergency department anaphylaxis: a review of 142 patients in a single year
J Allergy Clin Immunol
Epinephrine absorption in children with a history of anaphylaxis
J Allergy Clin Immunol
Epinephrine absorption in adults: intramuscular versus subcutaneous injection
J Allergy Clin Immunol
Development of a questionnaire to measure quality of life in families with a child with food allergy
J Allergy Clin Immunol
Epinephrine absorption in adults: intramuscular versus subcutaneous injection
J Allergy Clin Immunol
First aid anaphylaxis management in children who were prescribed an epinephrine autoinjector device (EpiPen)
J Allergy Clin Immunol
De l'action anaphylactique de certains venins
C R Soc Biol (Paris)
The diagnosis and management of anaphylaxis
J Allergy Clin Immunol
Cited by (0)
Supported by the National Institute of Allergy and Infectious Diseases, National Institutes of Health.
Disclosure of potential conflicts of interest: A. Muñoz-Furlong is a member of the EpiPen Advisory Board for Dey. S. A. Bock has received consulting fees from Dey Pharmaceuticals, maker of EpiPen, and lecture fees from Astra Pharmaceuticals. D. B. K. Golden participates in a Speakers' Bureau for Dey and for ALK-Abelló Laboratories. F. E. Simons joined the EpiPen Advisory Board in mid 2004. C. A. Camargo, Jr, has consulted for and received research support from Dey Laboratories and has consulted for Alkermes. Remaining authors—none disclosed.