First Description of Anaphylaxis in the Medical Literature
Anaphylaxis was First Described in the Modern Medical Literature in 1902 in a Study Involving Protocols for Immunizing Dogs with Jellyfish Toxin
Injection of Small Amounts of Toxin in Some Dogs, Rather than Generating Protection, Precipitated the Rapid Onset of Fatal/Near-Fatal Symptoms [De L’action anaphylactique de certain venins. CR Soc Biol (Paris). 1902; 54:170]
The Authors Termed This Response “l’Anaphylaxie”, Derived from the Greek Words a- (“Against”) and Phylaxis (“Immunity” or “Protection”)
Historical Definitions
Anaphylaxis
Anaphylaxis is an Acute (Potentially Fatal), Multisystem Syndrome Resulting from the Sudden Release of Mast Cell and Basophil-Derived Mediators into the Circulation (J Allergy Clin Immunol, 2006) [MEDLINE]
Anaphylaxis Most Commonly is Associated with Food/Medication/Insect Sting Exposures
Mechanism of Anaphylaxis Involves IgE-Mediated Mast Cell Activation (Type I Hypersensitivity Reaction) in Most Cases
Systemic Mast Cell/Basophil Degranulation May Occur Via a Non-Immunologic Mechanism
Anaphylactoid Reaction
Mechanism of Anaphylactoid Reaction Involves IgE-Independent Events
However, Anaphylactoid Reaction is Clinically Indistinguishable from Anaphylaxis
Modern Definitions (J Allergy Clin Immunol, 2004) [MEDLINE]
Immunologic Anaphylaxis
IgE-Mediated Reactions
Immunoglobulin G (IgG)-Mediated Reactions (Observed in Animal Models Only)
Immune Complex/Complement-Mediated Reactions
Non-Immunologic Anaphylaxis
Agents/Events Which Induce Sudden, Massive Basophil/Mast Cell Degranulation in the Absence of Immunoglobulins (or Immune Complexes)
Epidemiology
Prevalence
In Industrialized Countries, the Estimated Lifetime Prevalence of Anaphylaxis from All Etiologies is between 0.05-2% in the General Population
In the United States, the Lifetime Prevalence of Anaphylaxis is at Least 1.6% (Based on Strict Clinical Diagnostic Criteria) (J Allergy Clin Immunol, 2014) [MEDLINE]
Etiology
Immunologic IgE-Mediated Mast Cell Activation (Type I Hypersensitivity) (see Immune Hypersensitivity)
Has Also Been Described with Lamb and Some Cuts of Pork
Health Care Practitioner Awareness of Alpha-Gal Syndrome is Lacking (MMWR Morb Mortal Wkly Rep, 2023) [MEDLINE]
42% of Surveyed Health Care Practitioners Had Never Heard of Alpha-Gal Syndrome (Among Those Who Had, <33% Knew How to Diagnose the Condition)
Physiology
Tick Acquires the Oligosaccharide, Galactose-Alpha-1,3-Galactose (Alpha-Gal), After Feasting on a Mammal, Retaining it in its Gastrointestinal Tract Until it Bites a Human
The Bite Provokes an IgE Response in the Human
Alpha-Gal is Found in Red Meats (as Well as Milk and Dairy Products)
Alpha-Gal is Also Found in Cetuximab (Erbitux) (see Cetuximab)
Alpha-Gal May Also Be Found in Porcine Products, Such as Heart Valves and Heparin
Clinical
Symptoms Range from Mild (Rash or Gastrointestinal Upset) to Severe (Anaphylaxis)
Alpha-Gal Related Meat Allergy is Unusual in that it Has a Delayed Onset, Occurring ≥2 hrs (Typically 4-6 hrs) After Meat Ingestion
Alpha-Gal Associated Cetuximab (Erbitux) Allergy (see Cetuximab): may occur on first exposure and may be severe, resulting in anaphylaxis
Allergy May Recede Over Months-Years if Red Meat is Avoided
Anaphylaxis (as Well as Liver Failure, Acute Kidney Injury, Hypotension, Acute Respiratory Distress Syndrome, Rhabdomyolysis, and Death) May Occur in Association with an Abacavir Hypersensivity Reaction
ACE Inhibitors are the Most Common Etiology of Drug-Induced Angioedema in the United States (Due to Their Frequent Use)
Anaphylactoid Reactions Have Been Reported to Occur When ACE Inhibitors are Used in Patients Treated with High-Flux Hemodialysis Using Polyacrylonitrile Dialyzers
Albiglutide (Tanzeum) (see Albiglutide): approved in 2014
Dulaglutide (Trulicity) (see Dulaglutide): approved in 2014
Exenatide (Byetta, Bydureon) (see Exenatide): approved in 2005/2012
Liraglutide (Victoza, Saxenda) (see Liraglutide): approved 2010[10]
Lixisenatide (Lyxumia in Europe, Adlyxin in the United States) (see Lixisenatide): approved in 2016
Semaglutide (Ozempic, Rybelsus, Wegovy) (see Semaglutide): approved in 2017
Epidemiology
Large Cohort Study of Risk of Anaphylaxis with GLP-1 Receptor Agonists (Diabetes Care, 2024) [MEDLINE]: n = 696,089 new users (with 456,612 person-years of exposure to GLP-1 Receptor Agonists
Anaphylaxis is Rare with GLP-1 Receptor Agonists
Lixisenatide is Unlikely to Confer Higher risk of anaphylaxis than other GLP-1 Receptor Agonists
Tick Bite-Associated Alpha-Galactosidase Sensitization Has Been Found to Be a Mechanism of Allergic Sensitization to Cetuximab and Red Meats (J Allergy Clin Immunol, 2015) [MEDLINE]
Risk of First-Exposure Anaphylaxis was 24 Per 100k Patients (JAMA, 2015) [MEDLINE]:
The Rates of Anaphylaxis were Very Low with All Intravenous Iron Products, But were 3 to 8-Fold Greater for Iron Dextran and Ferumoxytol than for Iron Sucrose (Ann Intern Med, 2022) [MEDLINE]
Iron Gluconate (Ferrous Gluconate, Fergon, Ferralet, Simron) (see Iron Gluconate)
Risk of First-Exposure Anaphylaxis was 24 Per 100k Patients (JAMA, 2015) [MEDLINE]
The Rates of Anaphylaxis were Very Low with All Intravenous Iron Products, But were 3 to 8-Fold Greater for Iron Dextran and Ferumoxytol than for Iron Sucrose (Ann Intern Med, 2022) [MEDLINE]
Intravenous Iron is Generally Well-Tolerated with Exceedingly Low Risk of Severe Reaction and Use of Premedication and Test Doses are Unnecessary,(JAMA Netw Open, 2022) [MEDLINE]
Risk of First-Exposure Anaphylaxis was 24 Per 100k Patients (JAMA, 2015) [MEDLINE]
Cumulative Risk of Anaphylaxis (Over 12 wk Period) [MEDLINE]: iron sucrose has lowest risk of all of the intravenous iron agents
The Rates of Anaphylaxis were Very Low with All Intravenous Iron Products, But were 3 to 8-Fold Greater for Iron Dextran and Ferumoxytol than for Iron Sucrose (Ann Intern Med, 2022) [MEDLINE]
Intravenous Iron is Generally Well-Tolerated with Exceedingly Low Risk of Severe Reaction and Use of Premedication and Test Doses are Unnecessary,(JAMA Netw Open, 2022) [MEDLINE]
Types of Radiographic Contrast Reactions (Note that Only Immediate Hypersensitivity Reactions are Considered Allergic)
Chemotoxic (“Physiologic”) Reactions (Transient Warmth/Flushing, Chills, Nausea/Vomiting, Metallic Taste, Isolated Pruritus, Chest Pain, Arrhythmias, Seizures, Hypertension, Vasovagal Hypotension and/or Bradycardia) Have All Been Reported
Immediate Hypersensitivity Reactions (Urticaria, Angioedema, Diffuse Erythroderma, Upper Airway Edema, Bronchospasm, Anaphylaxis) Have Been Reported
Epidemiology
Contrast-Specific IgE Antibodies Have Been Demonstrated in Several Studies (Allerg Immunol, 1993) [MEDLINE] (Am J Roentgenol, 2008) [MEDLINE]
Although Contrast-Associated IgE-Mediated Anaphylaxis was Once Considered Rare, Contrast-Specific IgE Antibodies Have Been Demonstrated in Some Cases (Am J Roentgenol, 2008) [MEDLINE] (Allerg Immunol, 1993) [MEDLINE]
Anaphylaxis Has Been Reported with Multiple Vaccines (JAMA, 2022) [MEDLINE]
Mechanism
Anaphylaxis is Usually Related to the Excipient (Such as Gelatin or Dextran) Rather than the Microbial Content Itself
Vitamin K (Phytonadione, Phytomenadione, Mephyton) (see Vitamin K)
Epidemiology
Hypersensitivity Reactions (Chest Pain, Anaphylaxis, Cyanosis, Diaphoresis, Dyspnea, Flushing, Shock, Cardiorespiratory Arrest, Tachycardia, etc) Have Been Reported
Anaphylaxis Has Historically Been Associated with the Receipt of Large Intravenous Doses Administered Rapidly Using Polyethoxylated (Polyoxyethylated) Castor Oil Formulations
Prevention
Maximum Rate of Intravenous Administration: 1 mg/min
Other
Aeroallergens
General Comments
Aeroallergens are Rarely Involved in Angioedema/Anaphylaxis
IgG-Dependent Anaphylaxis Has Been Demonstrated in Mouse/Pig/Dog Animal Models (But, with the Exceptions Noted Below, Does Not Clearly Exist in Humans)
Rare Cases of Anaphylaxis Have Been Reported in Patients Receiving Therapeutic Preparations of IgG Anti-IgE Antibodies (Omalizumab) (J Allergy Clin Immunol, 2007) [MEDLINE] (J Allergy Clin Immunol, 2007)[MEDLINE]
Omalizumab Blocks the Binding of IgE to Fc-Epsilon-RI Receptors and Does Not Bind Fc-Epsilon-RI-Associated IgE
These Anaphylactic Reactions Could Conceivably Be IgG-Mediated with the Patient’s IgE Acting as the Antigen and the IgG of the Drug Acting as the Causative Antibody (J Allergy Clin Immunol, 2007) [MEDLINE]
IgE-Independent Anaphylaxis Has Also Been Reported with the Monoclonal Antibody, Infliximab (Am J Gastroenterol, 2003) [MEDLINE] (Eur J Gastroenterol Hepatol, 2004) [MEDLINE]
Involvement of an IgG-Macrophage/Neutrophil-Mediated Pathway in Human Anaphylaxis Has Been Suggested by a Prospective, Multicenter Study of Patients (n = 86) Who Experienced Suspected IgE-Independent Anaphylaxis After Neuromuscular Blocking Agent Administration During General Anesthesia (Sci Transl Med, 2019) [MEDLINE]
Neuromuscular Blocking Agents are Low Molecular Weight Antigens Which are Intravenously Administered in Relatively High Concentrations, Which Might Predispose the Formation of Circulating Immune Complexes
Iron Dextran (Dexferrum, INFeD) (see Iron Dextran)
Risk of First-Exposure Anaphylaxis is 68 Per 100k Patients (JAMA, 2015) [MEDLINE]
There is a Cumulative Risk of Anaphylaxis (Over 12 wk Period) (JAMA, 2015) [MEDLINE]
Iron Dextrose Has the Highest Risk of All of the Intravenous Iron Preparations
The Rates of Anaphylaxis were Very Low with All Intravenous Iron Products, But were 3 to 8-Fold Greater for Iron Dextran and Ferumoxytol than for Iron Sucrose (Ann Intern Med, 2022) [MEDLINE]
Idiopathic Histaminergic Angioedema
Clinical
Recurrent Angioedema
Often Associated with Chronic Spontaneous Urticaria or Inducible (Physical) Urticaria
Relative Incidence (in Australian Study from 2002-2011): Rocuronium (56% of cases) > Succinylcholine (21% of cases) > Vecuronium (11% of Cases) (Br J Anaesth, 2013) [MEDLINE])
Cisatracurium Had the Lowest Prevalence of Cross-Reactivity in Patients with Known Anaphylaxis to Either Rocuronium or Vecuronium
Physiology
Involvement of an IgG-Macrophage/Neutrophil-Mediated Pathway in Human Anaphylaxis Has Been Suggested by a Prospective, Multicenter Study of Patients (n = 86) Who Experienced Suspected IgE-Independent Anaphylaxis After Neuromuscular Blocking Agent Administration During General Anesthesia (Sci Transl Med, 2019) [MEDLINE]
Neuromuscular Blocking Agents are Low Molecular Weight Antigens Which are Intravenously Administered in Relatively High Concentrations, Which Might Predispose the Formation of Circulating Immune Complexes
Rare Cases of Anaphylaxis Have Been Reported in Patients Receiving Therapeutic Preparations of IgG Anti-IgE Antibodies (Omalizumab) (J Allergy Clin Immunol, 2007) [MEDLINE] (J Allergy Clin Immunol, 2007)[MEDLINE]
Omalizumab Blocks the Binding of IgE to Fc-Epsilon-RI Receptors and Does Not Bind Fc-Epsilon-RI-Associated IgE
These Anaphylactic Reactions Could Conceivably Be IgG-Mediated with the Patient’s IgE Acting as the Antigen and the IgG of the Drug Acting as the Causative Antibody (J Allergy Clin Immunol, 2007) [MEDLINE]
Immune Complex Formation (Composed of Culprit Drug and IgG or Other Isotypes) with Complement Activation Has Been Proposed as a Mechanism (NEJM, 1989) [MEDLINE]
Contrast-Specific IgE Antibodies Have Been Demonstrated in Several Studies (Allerg Immunol, 1993) [MEDLINE] (Am J Roentgenol, 2008) [MEDLINE]
Although Contrast-Associated IgE-Mediated Anaphylaxis was Once Considered Rare, Contrast-Specific IgE Antibodies Have Been Demonstrated in Some Cases (Am J Roentgenol, 2008) [MEDLINE] (Allerg Immunol, 1993) [MEDLINE]
Physiology
IgE-Mediated (Some Cases)
Non-IgE-Mediated (Most Cases)
Activation of Coagulation/Kinin/Complement Cascades
interaction of Radiographic Contrast Molecules with the Fc Portions of IgE or IgG Already Bound to Basophil/Mast Cell Surface, Causing Cross-Linking and Activation
Inhibition of Cholinesterase
Inhibition of Platelet Aggregation with Increased Serotonin Release
Non-Immunologic Direct Mast Cell/Basophil Activation
These “Pseudoallergens” May Cause Urticaria (or Contact Urticaria) Via IgE-Mediated or Via Non-Immunologic Mechanisms, Especially in Children
Heparin Contaminated with Oversulfated Chondroitin Sulfate (see Heparin)
Epidemiology
Reports Occurred During a Worldwide Heparin Supply Contamination from 2007-2008
Physiology
Direct Activation of the Kinin-Kallikrein Pathway, Which Generates Bradykinin, C3a, and C5a
Some Human Mast Cells Express Receptors for the “Anaphylatoxins”, C3a and C5a, and Release Histamine in Response to Exposure to These Complement Fragments
Relative Incidence (in Australian Study from 2002-2011): Rocuronium (56% of cases) > Succinylcholine (21% of cases) > Vecuronium (11% of Cases) (Br J Anaesth, 2013) [MEDLINE])
Cisatracurium Had the Lowest Prevalence of Cross-Reactivity in Patients with Known Anaphylaxis to Either Rocuronium or Vecuronium
Mechanisms
Immunologic Non-IgE-Mediated Mechanism
Involvement of an IgG-Macrophage/Neutrophil-Mediated Pathway in Human Anaphylaxis Has Been Suggested by a Prospective, Multicenter Study of Patients (n = 86) Who Experienced Suspected IgE-Independent Anaphylaxis After Neuromuscular Blocking Agent Administration During General Anesthesia (Sci Transl Med, 2019) [MEDLINE]
Neuromuscular Blocking Agents are Low Molecular Weight Antigens Which are Intravenously Administered in Relatively High Concentrations, Which Might Predispose the Formation of Circulating Immune Complexes
Experimental Reduction of MRGPRX2 Receptor Expression in Sera Obtained from Patients with Prior History of Perioperative Anaphylaxis Results in Decreased Degranulation After In Vitro Exposure to Neuromuscular Junction Antagonists (Sci Rep, 2018) [MEDLINE]
Direct Mast Cell Degranulation with Histamine Release
Historically, Some Allergy Specialists Used Opioids as Positive Controls in Skin Testing Because These Agents Induce a Characteristic Wheal-and-Flare Response Due to the Direct Degranulation of Mast Cells in the Skin
Anaphylaxis Involving a Non-Immunologic Mechanism Has Been Reported with Older Paclitaxel Preparations Which Used the Diluent, Cremophor EL (Int Immunopharmacol, 2001) [MEDLINE]
Mechanism
Non-Immunologic Mechanism
Under Physiologic Conditions, Cremophor EL Can Form Large Micelles with Serum Lipids and Cholesterol, Stimulating Complement Activation (in the Absence of Immune Complex Formation)
Some Human Mast Cells Express Receptors for the “Anaphylatoxins”, C3a and C5a, Release Histamine in Response to Exposure to These Complement Fragments
Macrophages and Basophils Also have C3a Receptors and Can Produce Platelet Activating Factor (PAF) in Response to Their Activation
This Mechanism Has Been Implicated in Peanut-Induced Anaphylaxis in Mouse Models, Although the Significance of This in Human Anaphylaxis Has Not Been Demonstrated
Physical Factors
Factors
Cold
Cold Urticaria is Characterized by Rapid Onset of Erythema, Pruritus, and Edema After Exposure to Cold (Water, Air, Food/Beverage, or Other Source of Cold Temperature)
Can result in Massive Release of Histamine/Other Mediators, Resulting in Hypotension
While Some Episodes Involve the Presence of Abnormal Proteins (Such as Cryoglobulins or Cryofibrinogens), Which May Agglutinate or Precipitate at Lower Temperatures, Most Instances of Cold Urticaria/Anaphylaxis are Idiopathic and Lack Abnormal Circulating Proteins
Heat
Exercise: usually associated with a co-trigger (such as a food, NSAID, or exposure to cold air or water)
Anaphylaxis Involving a Non-Immunologic Mechanism Has Been Reported with Older Propofol Preparations Which Used the Diluent, Cremophor EL (Anesthesiology, 1992) [MEDLINE]
Mechanism
Non-Immunologic Mechanism
Under Physiologic Conditions, Cremophor EL Can Form Large Micelles with Serum Lipids and Cholesterol, Stimulating Complement Activation (in the Absence of Immune Complex Formation)
Some Human Mast Cells Express Receptors for the “Anaphylatoxins”, C3a and C5a, and Release Histamine in Response to Exposure to These Complement Fragments
Macrophages and Basophils Also have C3a Receptors and Can Produce Platelet Activating Factor (PAF) in Response to Their Activation
This Mechanism Has Been Implicated in Peanut-Induced Anaphylaxis in Mouse Models, Although the Significance of This in Human Anaphylaxis Has Not Been Demonstrated
Although Contrast-Associated IgE-Mediated Anaphylaxis was Once Considered Rare, Contrast-Specific IgE Antibodies Have Been Demonstrated in Some Cases (Am J Roentgenol, 2008) [MEDLINE] (Allerg Immunol, 1993) [MEDLINE]
Physiology
*IgE-Mediated (Some Cases)
Non-IgE-Mediated (Most Cases)
Activation of Coagulation/Kinin/Complement Cascades
interaction of Radiographic Contrast Molecules with the Fc Portions of IgE or IgG Already Bound to Basophil/Mast Cell Surface, Causing Cross-Linking and Activation
Inhibition of Cholinesterase
Inhibition of Platelet Aggregation with Increased Serotonin Release
Anaphylaxis-induced myocardial depression treated with amrinone. Lancet 1991; 337:682-683 [MEDLINE]
Anaphylaxis. N Engl J Med 1991; 324:1785-1786 [MEDLINE]
Histamine decreases left ventricular contractility in normal human subjects. J Appl Physiol 1992; 73:2530-2537 [MEDLINE]
Omapatrilat and enalapril in patients with hypertension: the Omapatrilat Cardiovascular Treatment vs. Enalapril (OCTAVE) trial. Am J Hypertens. 2004;17(2):103 [MEDLINE]
Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113(5):832 [MEDLINE]
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Anaphylaxis to iodinated contrast material: nonallergic hypersensitivity or IgE-mediated allergy? AJR Am J Roentgenol. 2008;190(3):666 [MEDLINE]
World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011 Feb;4(2):13-37. doi: 10.1097/WOX.0b013e318211496c [MEDLINE]
International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014; 7(1): 9 [MEDLINE]
Epidemiology
Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;327(6):380 [MEDLINE]
Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy. 2000;30(8):1144 [MEDLINE]
Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. 2001;107(1):191 [MEDLINE]
Fatal anaphylaxis in the UK, 1992-2001. Novartis Found Symp. 2004;257:116 [MEDLINE]
Should beta-blockers be given to patients with heart disease and peanut-induced anaphylaxis? A decision analysis. J Allergy Clin Immunol. 2004;113(5):977 [MEDLINE]
Anaphylaxis: can we tell who is at risk of a fatal reaction? Curr Opin Allergy Clin Immunol. 2004;4(4):285 [MEDLINE]
Cardiovascular aspects of anaphylaxis: implications for treatment and diagnosis. Curr Opin Allergy Clin Immunol. 2005;5(4):359 [MEDLINE]
[A case of anaphylactic shock in an elderly man following protamine sulfate administration during emergent off-pump coronary artery bypass grafting]. Masui. 2006;55(5):605 [MEDLINE]
Second symposium on the definition and management of anaphylaxis: summary report–Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391 [MEDLINE]
Fatal anaphylaxis: postmortem findings and associated comorbid diseases. Ann Allergy Asthma Immunol. 2007;98(3):252 [MEDLINE]
Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol. 2007;119(4):1016 [MEDLINE]
Further fatal allergic reactions to food in the United Kingdom, 1999-2006. J Allergy Clin Immunol. 2007;119(4):1018 [MEDLINE]
Fatal anaphylaxis: postmortem findings and associated comorbid diseases. Ann Allergy Asthma Immunol. 2007;98(3):252 [MEDLINE]
Factors predicting anaphylaxis to peanuts and tree nuts in patients referred to a specialist center. J Allergy Clin Immunol. 2008;121(3):632 [MEDLINE]
Allergy and the cardiovascular system. Clin Exp Immunol. 2008;153 Suppl 1:7 [MEDLINE]
Predictors of severe systemic anaphylactic reactions in patients with Hymenoptera venom allergy: importance of baseline serum tryptase-a study of the European Academy of Allergology and Clinical Immunology Interest Group on Insect Venom Hypersensitivity. J Allergy Clin Immunol. 2009;124(5):1047 [MEDLINE]
Anaphylactic deaths in Maryland (United States) and Shanghai (China): a review of forensic autopsy cases from 2004 to 2006. Forensic Sci Int. 2009;186(1-3):1 [MEDLINE]
Postmortem findings after anaphylactic reactions to drugs in Turkey. Am J Forensic Med Pathol. 2009;30(4):346 [MEDLINE]
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Asthma and the prospective risk of anaphylactic shock and other allergy diagnoses in a large integrated health care delivery system. Ann Allergy Asthma Immunol. 2010;104(5):371 [MEDLINE]
Risk of severe anaphylaxis for patients with Hymenoptera venom allergy: Are angiotensin-receptor blockers comparable to angiotensin-converting enzyme inhibitors? J Allergy Clin Immunol. 2010;125(5):1171; author reply 1171 [MEDLINE]
Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. J Allergy Clin Immunol. 2014;133(2):461 [MEDLINE]
Mast Cells, Mastocytosis, and Related Disorders. N Engl J Med. 2015;373(2):163 [MEDLINE]
Ramipril and metoprolol intake aggravate human and murine anaphylaxis: evidence for direct mast cell priming. J Allergy Clin Immunol. 2015;135(2):491 [MEDLINE]
Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012. J Allergy Clin Immunol. 2015 Apr;135(4):956-63.e1 [MEDLINE]
Increases in anaphylaxis fatalities in Australia from 1997 to 2013. Clin Exp Allergy. 2016;46(8):1099 [MEDLINE]
Increasing Emergency Department Visits for Anaphylaxis, 2005-2014. J Allergy Clin Immunol Pract. 2017;5(1):171 [MEDLINE]
The Epidemiology of Anaphylaxis. Clin Rev Allergy Immunol. 2018;54(3):366 [MEDLINE]
Trends in emergency care for anaphylaxis. J Allergy Clin Immunol Pract. 2020;8(2):767 [MEDLINE]
Association Between Severity of Anaphylaxis and Co-occurrence of Respiratory Diseases: A Systematic Review and Meta-analysis of Observational Studies. J Investig Allergol Clin Immunol. 2021;31(2):132 [MEDLINE]
Etiology
Anaphylaxis to meperidine. Anesth Analg. 1982;61(3):301 [MEDLINE]
Association of protamine IgE and IgG antibodies with life-threatening reactions to intravenous protamine. N Engl J Med. 1989;320(14):886 [MEDLINE]
Life-threatening anaphylactoid reactions to propofol (Diprivan). Anesthesiology. 1992;77(2):275 [MEDLINE]
Case report: recurrent anaphylactic shock to radiographic contrast media. Evidence supporting an exceptional IgE-mediated reaction. Allerg Immunol (Paris). 1993;25(10):425 [MEDLINE]
Anaphylaxis induced by horsefly bites: identification of a 69 kd IgE-binding salivary gland protein from Chrysops spp. (Diptera, Tabanidae) by western blot analysis. J Allergy Clin Immunol. 1998;101(1 Pt 1):134. [MEDLINE]
Formation of complement-activating particles in aqueous solutions of Taxol: possible role in hypersensitivity reactions. Int Immunopharmacol. 2001;1(4):721 [MEDLINE]
The incidence and management of infusion reactions to infliximab: a large center experience. Am J Gastroenterol. 2003;98(6):1315 [MEDLINE]
Severe anaphylactic reaction to infliximab: successful treatment with adalimumab – report of a case. Eur J Gastroenterol Hepatol. 2004;16(6):627 [MEDLINE]
Opioid-induced mast cell activation and vascular responses is not mediated by mu-opioid receptors: an in vivo microdialysis study in human skin. Anesth Analg. 2004;98(2):364 [MEDLINE]
Anaphylactic shock to Argas reflexus bite. Eur Ann Allergy Clin Immunol. 2005;37(2):66 [MEDLINE]
Allergy to pigeon tick (Argas reflexus) in Upper Silesia, Poland. Ann Agric Environ Med. 2006;13(1):107 [MEDLINE]
American Academy of Allergy, Asthma&Immunology/American College of Allergy, Asthma and Immunology Joint Task Force Report on omalizumab-associated anaphylaxis. J Allergy Clin Immunol. 2007;120(6):1373 [MEDLINE]
Anaphylactic shock to guar gum (food additive E412) contained in a meal substitute. Allergy. 2007 Jul;62(7):822. doi: 10.1111/j.1398-9995.2007.01369.x [MEDLINE]
Delayed onset and protracted progression of anaphylaxis after omalizumab administration in patients with asthma. J Allergy Clin Immunol. 2007;120(6):1378 [MEDLINE]
Anaphylaxis to paracetamol. J Paediatr Child Health. 2008;44(12):746-747. doi:10.1111/j.1440-1754.2008.01419.x [MEDLINE]
Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358(15):1547 [MEDLINE]
Anaphylactic reactions to bites of the pigeon tick Argas reflexus. Eur J Dermatol. 2010;20(2):244. [MEDLINE]
Probable acyclovir-induced angioedema in a patient with HIV infection and suspected varicella-zoster virus encephalitis. Am J Health Syst Pharm. 2011;68(23):2257-2260. doi: 10.2146/ajhp100639 [MEDLINE]
The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose. J Allergy Clin Immunol. 2011;127(5):1286 [MEDLINE]
Tick bites and red meat allergy. Curr Opin Allergy Clin Immunol. 2013 Aug;13(4):354-9. doi: 10.1097/ACI.0b013e3283624560 [MEDLINE]
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Identification of a mast-cell-specific receptor crucial for pseudo-allergic drug reactions. Nature. 2015;519(7542):237 [MEDLINE]
Comparative Risk of Anaphylactic Reactions Associated With Intravenous Iron Products. JAMA. 2015 Nov 17;314(19):2062-2068. doi: 10.1001/jama.2015.15572 [MEDLINE]
Anaphylaxis After Consumption of Guar Gum-Containing Food: A Report of Two Cases. Cureus. 2022 Aug 15;14(8):e28022. doi: 10.7759/cureus.28022 [MEDLINE]
Urticaria 12 Days After COVID-19 mRNA Booster Vaccination. JAMA. 2022 May 3;327(17):1702-1703. doi: 10.1001/jama.2022.5247 [MEDLINE]
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