At a Glance - Acute anaphylaxis

Epidemiology 

- Acute anaphylaxis is rare but life-threatening.

- Incidence is increasing, with female preponderance.

Pathophysiology

- Usually type-1 IgE-mediated hypersensitivity.

Aetiology

- Foods: dairy products, nuts, seafood and fruits.

- Drugs: antibiotics, opioid analgesics and NSAIDs.

- Wasp or bee stings.

- Miscellaneous causes include latex and exercise, and it can also be idiopathic.

Clinical features

- Feeling of impending doom.

- Respiratory features include laryngeal oedema, stridor and bronchospasm.

- Cardiovascular features include palpitations, chest pain and loss of consciousness.

- Skin features include pruritus, urticaria and angio-oedema.

- Gastrointestinal features include lip and tongue swelling, nausea and vomiting, abdominal pain and diarrhoea.

- Rhino-conjunctivitis.

Investigations

- Mast cell tryptase is the only test indicated at the time of reaction to confirm the diagnosis.

- Subsequent investigations are directed at detecting the trigger agent.

Management

- Acute management involves adrenaline IM, oxygen, parenteral hydrocortisone and parenteral chlorpheniramine.

- Admit to hospital.

- Subsequent management involves identifying the trigger and advising on avoidance.

- Prescribe EpiPen and educate patient about how and when to use it.

- Recommend a Medic Alert bracelet/necklace.

Key features

- Death is common in the elderly and asthmatics.

Contributed by Dr Aziz Sheikh, professor of primary care research and development, Division of Community Health Sciences, GP Section, University of Edinburgh.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

Three people stabbed at East London GP practice

Three people stabbed at East London GP practice

Three people were stabbed at a GP practice in East London on Wednesday morning, police...

Practices face £50,000 pension cost hike under plan to raise employer contribution to 20.6%

Practices face £50,000 pension cost hike under plan to raise employer contribution to 20.6%

GP practices could face a five-figure hike in pension costs under plans to increase...

What medico-legal challenges will GPs face in 2019?

What medico-legal challenges will GPs face in 2019?

The MDU's head of advisory services, Dr Caroline Fryar, predicts which medico-legal...

GP practices providing online consultations doubled in 12 months, survey suggests

GP practices providing online consultations doubled in 12 months, survey suggests

The proportion of GP practices in England providing online consultations has almost...

Dr Nikita Kanani: Why peer support is the key to building a stronger general practice

Dr Nikita Kanani: Why peer support is the key to building a stronger general practice

NHS England's acting director of primary care Dr Nikita Kanani says connecting with...

Next-day GP appointments three times as likely to be missed as same-day bookings

Next-day GP appointments three times as likely to be missed as same-day bookings

Patients are nearly three times as likely to miss appointments booked with GP practices...