Anaphylaxis – A must know for all

Abstract

Anaphylaxis is a severe, acute, and potentially fatal multi-organ reaction caused by exposure to an allergen. The most involved organ systems are skin, pulmonary, cardiovascular, and gastrointestinal systems, with cutaneous system involvement witnessed in up to 90% of cases. Three commonest reported triggers are food, medicine, and insect venom. It is characterized clinically by wheals and/or angioedema in association with dyspnea, tachypnea, wheezing, tachycardia, vomiting , abdominal pain, diarrhea, clammy skin, confusion, and anxiety. According to the available data, the likelihood of experiencing an episode of anaphylaxis during a lifetime can be expected in up to 2% of population. The incidence of anaphylaxis has been increasing because of the globalization, which has resulted in increased migration of inherent population to distant areas of the world, wider distribution of food and medicines. Furthermore, because of the climate change brought about by industrialization and automation, there has been a noticeable change in the local insect species. People manifesting with any of the three clinical presentations of atopic diathesis (namely, asthma, eczema, and allergic rhinitis) generally have higher chances of experiencing anaphylaxis, and the three most common incriminating triggers include food item, latex rubber, and radio contrast agents. Depending on the patho-physiological mechanism involved, anaphylaxis can be either immunologic, non-immunologic, or idiopathic. The diagnosis of anaphylaxis can largely be made based purely on the presenting sign and symptoms. However, in some rare cases, when it is not possible to make the diagnosis clinically, laboratory investigations are used to supplement or to exclude a specific entity. The standard protocol for managing a case of anaphylaxis includes removal of the trigger, initiation of epinephrine therapy at an earliest, appropriate positioning of the patient to maintain free airway, and hemodynamic balance and call for help for multidisciplinary approach. It is often misdiagnosed owning to the markedly varying clinical presentations, and absence of specific diagnostic laboratory test. Thus, in the present review we have given a comprehensive update to freshen up the knowledge of the physician, to enable them to easily diagnose and manage a suspected case of anaphylaxis, to avoid potential complications and fatalities, and even prevent repeated attacks in some of the cases.