How to recognize anaphylaxis

When is it anaphylaxis?

Anaphylaxis is highly likely when any ONE of the three following criteria are met:

  1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (generalized hives, itching or flushing, swollen lips/tongue/uvula AND AT LEAST ONE OF THE FOLLOWING:
  • Respiratory compromise (difficulty breathing, wheezing, bronchospasm, stridor, reduced PEF, low oxygenation of the blood)
  • Reduced blood pressure or associated symptoms of end organ dysfunction (low blood pressure, collapse, fainting, incontinence)

 

  1. Two or more of the following that occur rapidly after exposure to a LIKELY allergen for that patient (minutes to several hours)
  • Involvement of skin, mucosal tissue (hives, itching, flushing, swollen lips, tongue, uvula)
  • Respiratory compromise (difficulty breathing, wheezing, bronchospasm, stridor, reduced PEF, low oxygenation of the blood)
  • Reduced blood pressure or associated symptoms of end organ dysfunction (low blood pressure, collapse, fainting, incontinence)
  • Persistent GI symptoms (crampy abdominal pain, vomiting)

 

  1. Reduced BP after exposure to KNOWN allergen for that patient (minutes to several hours)
  • Infants and children: low systolic blood pressure (age dependent) or greater than 30% decreased in systolic BP
  • Adults: systolic BP of less than 90 mm Hg or greater than 30% decrease from that person’s baseline

Note: low systolic blood pressure for children is defined as less than 70 mm Hg from 1 month to 1 year, less than (70 mm Hg + [2 x age]) from 1 to 10 years, and less than 90 mm Hg from 11 to 17 years.

“When a patient fulfills any of the three criteria of anaphylaxis outlined above, the patient should receive epinephrine immediately because epinephrine is the treatment of choice in anaphylaxis. There undoubtedly will be patients who present with symptoms not yet fulfilling the criteria of anaphylaxis yet in whom it would be appropriate to initiate therapy with epinephrine, such as a patient with a history of near-fatal anaphylaxis to peanut who ingested peanut and within minutes is experiencing urticaria and generalized flushing.”

Reference: Sampson HA et al. J Allergy Clin Immunol 2006; 117:391-7

 

How can I recognize anaphylaxis in someone else  (including children or non-verbal persons?)

Symptoms that can be recognized without self reporting:

Skin and mucus membranes: sudden onset hives, angioedema (swelling of the face, tongue, mouth and throat)

Respiratory: rapid onset of coughing, choking, stridor (high pitched breath sound), wheezing, difficulty breathing, cessation of breathing, turning blue

GI: sudden, profuse vomiting

Cardiovascular: weak pulse, irregular heartbeat, sweating, clamminess, paleness, fainting, loss of consciousness

Central nervous system: sudden unresponsiveness, low muscle tone, lethargy, seizures

Reference: Simons FER. J Allergy Clin Immunol 2007; 120: 537-40.

4 Responses

  1. Larry Herring April 13, 2015 / 10:24 pm

    Thank goodness for this website! I was just diagnosed with a sever case of MCAD by The Mayo Clinic. 10 days of testing. Being treated 4x a day. Feel like crap and am extremly worried. I wish there was a support group.

    • Lisa Klimas April 13, 2015 / 11:50 pm

      There are several support groups! Are you on Facebook? There is a MastAttack group and we would love to have you.

      • Larry Herring April 14, 2015 / 2:14 am

        TY!! I will Join immediately as I am part of the Dyautonomia page as well.

        Larry

        • Sean-Michael August 3, 2015 / 5:17 am

          Welcome Larry. Sorry you have to deal with MCAS but glad you found this site. I also listed several other Facebook support groups on my Mast Cell Aware on blogspot.com in the resource section because I felt so alone at first but we with MCAS are actually more prevalent than doctors recognized. I hope you find what you need.

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