Anaphylaxis

Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of the use of emergency medication on site.^[4][5] It typically causes more than one of the following: an itchy rash, throat closing due to swelling that can obstruct or stop breathing; severe tongue swelling that can also interfere with or stop breathing; shortness of breath, vomiting, lightheadedness, loss of consciousness, low blood pressure, and medical shock.^[6][1] These symptoms typically start in minutes to hours and then increase very rapidly to life-threatening levels.^[1] Urgent medical treatment is required to prevent serious harm and death, even if the patient has used an epipen or has taken other medications in response, and even if symptoms appear to be improving.^[6]

Common causes include allergies to insect bites and stings, allergies to foods – including nuts, milk, fish, shellfish, eggs and some fresh fruits or dried fruits; allergies to sulfites – a class of food preservatives and a byproduct in some fermented foods like vinegar; allergies to medications – including some antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin; allergy to general anaesthetic (used to make people sleep during surgery); allergy to contrast agents – dyes used in some medical tests to help certain areas of the body show up better on scans; allergy to latex – a type of rubber found in some rubber gloves and condoms.^[6][1] Other causes can include physical exercise, and cases may also occur in some people due to escalating reactions to simple throat irritation or may also occur without an obvious reason.^[6][1] The mechanism involves the release of inflammatory mediators in a rapidly escalating cascade from certain types of white blood cells triggered by either immunologic or non-immunologic mechanisms.^[7] Diagnosis is based on the presenting symptoms and signs after exposure to a potential allergen or irritant and in some cases, reaction to physical exercise.^[6][1]

The primary treatment of anaphylaxis is epinephrine injection into a muscle, intravenous fluids, then placing the person "in a reclining position with feet elevated to help restore normal blood flow".^[1][8] Additional doses of epinephrine may be required.^[1] Other measures, such as antihistamines and steroids, are complementary.^[1] Carrying an epinephrine autoinjector, commonly called an "epipen" and identification regarding the condition is recommended in people with a history of anaphylaxis.^[1] Immediately contacting ambulance / EMT services is always strongly recommended, regardless of any on site treatment.^[6] Getting to a doctor or hospital as soon as possible is absolutely required in all cases, even if it appears to be getting better.^[6]

Worldwide, 0.05–2% of the population is estimated to experience anaphylaxis at some point in life.^[3] Globally, as underreporting declined into the 2010s, the rate appeared to be increasing.^[3] It occurs most often in young people and females.^[8][9] About 99.7% of people hospitalized with anaphylaxis in the United States survive.^[10]