Anaphylaxis

Kirk H. Waibel

doi:10.1542/pir.29-8-255

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Kirk H. Waibel, MD*

^*Chief, Allergy/Immunology Service, Brooke Army Medical Center, Fort Sam Houston, Tex

Objectives

After completing this article, readers should be able to:

Delineate the diagnostic criteria for anaphylaxis.
List the most common causes of anaphylaxis.
Describe the different types of insect sting reactions.
Discuss the differences between acute and chronic urticaria.
List the appropriate laboratory tests for chronic urticaria.

Anaphylaxis

A 4-year-old boy is attending a friend's summer backyard party in south Texas. His mother finds him crying after two “ant bites.” Within minutes, the boy becomes diffusely flushed and has multiple raised erythematous lesions, facial edema, and audible wheezing.

Anaphylaxis is an immediate and potentially life-threatening reaction to an allergen. Although this review provides the practicing pediatrician a general overview of anaphylaxis, both the American Academy of Allergy, Asthma, and Immunology and the European Academy of Allergology and Clinical Immunology have published excellent practice parameters and position papers that address diagnosing, managing, and treating anaphylaxis. (1)(2)

Epidemiology

The term anaphylaxis, derived from the Greek “a” (contrary) and “phylaxis” (protection), was coined in 1902 by Portier and Richet. Their original experiments with sea anemone and dogs demonstrated that reintroduction of toxic venom in dogs who tolerated an initial dose resulted in unexpectedly severe symptoms, including itching, vomiting, diarrhea, and death. Over the past 100 years, multiple causative agents have been identified in children, the most common being foods, drugs, and insects. During the past 20 years, reported anaphylaxis cases and prescriptions for adrenaline have increased significantly. The prevalence of life-threatening anaphylaxis is estimated to be 5 to 15 per 100,000 persons, but most experts agree that anaphylaxis is both underrecognized and undertreated.

Pathogenesis and Clinical Criteria

Any child who presents with a suspected or known anaphylactic episode requires a complete evaluation to ascertain possible triggers. Although there are case reports of delayed reactions starting 2 or more hours after exposure, symptoms typically occur within minutes to …