How is anaphylaxis recognized?
A. J. Apter and H. A. LaVallee
Department of Medicine, University of Connecticut Health Center, Farmington.
Prompt recognition of anaphylaxis may be lifesaving. Although its
presentation has been described, there are no criteria for making a rapid
diagnosis. A systematic review of the literature was performed to develop
objective clinical criteria aimed at improving the recognition of
anaphylaxis. A MEDLINE search of the word anaphylaxis over a 1-year period
identified all of the reports describing the initial manifestations. Of 160
reviewed articles, 116 contained a clinical description of anaphylaxis.
Eighty-nine (77%) of these 116 articles were case reports. Hypotension (84
reports [72%]) and urticaria and/or angioedema (70 reports [60%]) were the
most frequently described signs. Of the identified allergens, 73% were
diagnostic or therapeutic agents. In 72 of the 80 articles in which a
reaction time could be identified, the reaction occurred within 60 minutes.
As a result of this analysis, we conclude that anaphylaxis recognition may
be improved by the identification of one of the following criteria, which
describe the presentation in 82% of the analyzed reports: (1) exposure to
an allergen within 1 hour produces one or more systemic signs (hypotension,
upper or lower respiratory tract compromise, or increased gastrointestinal
tract motility), or (2) urticaria or angioedema accompanies at least one of
these systemic signs.
