Recognising anaphylaxis

Patients with anaphylaxis may present clinically with varying degrees of angio-oedema, urticaria, dyspnoea and hypotension, although death from acute irreversible asthma or laryngeal oedema with few generalised manifestations is possible. Other

Table 13.1 Possible causes of anaphylaxis.

Insect stings, drugs, contrast media,

Most common causes of anaphylaxis

some foods (milk, eggs, fish and


Peanut and nut allergies

Recognised as particularly


Aspirin, non-steroidal anti-inflammatory

Notorious causes of anaphylaxis

agents, parenteral penicillins and



May increase the incidence and

severity of anaphylaxis and

antagonise the response to


symptoms include rhinitis, conjunctivitis, abdominal pain, vomiting, diarrhoea and a sense of impending doom. The skin colour often changes and the patient may appear either flushed or pale. Cardiovascular collapse is caused by vasodilation and loss of plasma from the blood compartment into the tissues. It is a common clinical manifestation, especially in response to intravenous drugs or stings. Any cardiac dysfunction is due principally to hypotension or, rarely, to an underlying disease or to intravenous administration of epinephrine.

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