Anaphylaxis, Anaphylactic/Non-anaphylactic Food Reactions

Janet Beausoleil, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Erin McGintee, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Janet M. Beausoleil, MD, is an assistant professor of pediatrics at the University of Pennsylvania School of Medicine and attending physician at the Children's Hospital of Philadelphia. Here, she provides a definition of anaphylaxis, its mechanisms, and differential diagnosis, and describes its connection to food allergies.

Dr. Beausoleil wishes to disclosure that she has appeared as a speaker for GlaxoSmithKline and Merck. Dr. McGintee has no relationships with commercial interests related to the content of the presentation.

The author explains the incidence of anaphylaxis and its major causes – penicillin, hymenoptera stings, and food allergies, and notes that true anaphylaxis is an IgE-mediated reaction requiring initial exposure to an antigen. She points out that the diagnosis is by an appropriate history and sometimes by a serum tryptase. The chief mediator is histamine, causing vasodilation, vascular permeability, bronchoconstriction, and pruritus. She explains such clinical manifestations as tachycardia and hypotension, wheezing, cough, rhinitis, pruritus, angioedema and urticaria in anaphylaxis.

Dr. Beausoleil then compares anaphylaxis with anaphylactoid reactions that result from release of mediators from mast cells and basophils, and describes the risk factors for both, noting that fatal anaphylaxis is relatively rare. Drugs are a common cause of both anaphylaxis and anaphylactoid reactions, as are hymenoptera stings and latex allergies.

The lecture concludes with a discussion of foods commonly associated with allergy and anaphylaxis, including milk, nuts, and shellfish allergy, and the appropriate methods for diagnosis and treatment … the latter clearly being avoidance of the offending allergen. But there are pharmacologic interventions, including antihistamines and epinephrine, and the author warns that albuterol, sometimes used when epinephrine is ineffective, should not be used in place of epinephrine therapy.