Skip to main content
SpringerLink
Log in

Anaphylaxis in Pregnancy

  • Chapter
  • First Online:
Book cover Asthma, Allergic and Immunologic Diseases During Pregnancy

  • 602 Accesses

Abstract

Anaphylaxis during pregnancy is a relatively rare but potentially life-threatening event that can be devastating to the mother and the infant. Etiologies during the first three trimesters are similar to anaphylaxis in nonpregnant individuals and include foods, medications, insect stings, latex, and exercise. Etiologies during labor and delivery include most commonly antibiotics (beta-lactams) used for infection prophylaxis, oxytocin, and perioperative agents. In addition to typical cutaneous, respiratory, and gastrointestinal symptoms of anaphylaxis, unique signs and symptoms of anaphylaxis during pregnancy include intense vulvar and vaginal itching, low back pain, uterine cramps, fetal distress, and preterm labor.

Prevention of anaphylaxis can be achieved by doing a prepregnancy risk assessment for anaphylaxis in all women of childbearing age and implementing risk reduction strategies. This includes performing appropriate skin testing, challenge tests, and implementing immunotherapy prior to pregnancy. It also includes confirming the etiology of prior systemic reactions/anaphylaxis. A personalized anaphylaxis emergency action plan should be developed, medical alert jewelry/identification should be worn, and injectable epinephrine should be prescribed and be available at all times. During pregnancy, skin testing, challenge tests, and initiation of immunotherapy are almost always deferred to avoid iatrogenic risk. Patients on maintenance immunotherapy may continue after risk communication, though doses should generally not be increased during pregnancy.

Management of anaphylaxis during pregnancy includes injecting intramuscular epinephrine promptly, positioning the mother on her left side to improve venous return to the heart, providing high-flow supplemental oxygen, continuous monitoring, and maintaining systolic blood pressure at 90 mm Hg or higher to maintain perfusion of the placenta. Cardiopulmonary resuscitation and emergency cesarean delivery should be performed when indicated.

Prospective studies of anaphylaxis during pregnancy and following women at higher risk for anaphylaxis (i.e., such as those on immunotherapy or with known food, drug, or insect sting allergies) are needed to help advance optimal management strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Simons FE, Ardusso LRF, Bilo MB, El-Gamal YM, Ledford DK, et al. World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011;2(3):13–36. February 24, 2011.

    Article  Google Scholar 

  2. Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF, Bock SA, et al. 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;117:391–7.

    Article  Google Scholar 

  3. Lieberman P, Camargo CA Jr, Bohlke K, et al. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol. 2006;97:596–602.

    Article  Google Scholar 

  4. Wood RA, Camargo CA Jr, Lieberman P, Sampson HA, Schwartz LB, Zitt M, et al. Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. J Allergy Clin Immunol. 2014;133:461–7.

    Article  Google Scholar 

  5. Ma L, Danoff TM, Borsish L. Case fatality and population mortality associated with anaphylaxis in the United States. J Allergy Clin Immunol. 2014;133:1075–83.

    Article  Google Scholar 

  6. Turner PJ, Gowland MH, Sharma V, Ierodiakonou D, Harper N, Garcez T, et al. 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;135:956–63.

    Article  Google Scholar 

  7. Jerschow E, Lin RY, Scaperotti MM, McGinn AP. Fatal anaphylaxis in the United States, 1999–2010: temporal patterns and demographic associations. J Allergy Clin Immunol. 2014;134:1318–28.

    Article  Google Scholar 

  8. Centers for Disease Control. Accessed 13 Jan 2018. https://www.cdc.gov/nchs/fastats/births.htm.

  9. Mulla ZD, Ebrahim MS, Gonzalez JL. Anaphylaxis in the obstetric patient: analysis of a statewide hospital discharge database. Ann Allergy Asthma Immunol. 2010;104:55–9.

    Article  Google Scholar 

  10. Steinke JW, Platts-Mills T, Commins S. The alpha-gal story: lessons learned from connecting the dots. J Allergy Clin Immunol. 2015;135:589–96.

    Article  CAS  Google Scholar 

  11. Lei D, Akin C, Kovalszki A. Management of mastocytosis in pregnancy: a review. J Allergy Clin Immunol Pract. 2017;5:2117–23.

    Article  Google Scholar 

  12. Meggs WJ, Pescovitz OH, Metcalfe D, Loriaux D, Cutler G, Kaliner M. Progesterone sensitivity as a cause of recurrent anaphylaxis. N Engl J Med. 1984;311:1236–49.

    Article  CAS  Google Scholar 

  13. Chaudhuri K, Gonzales J, Jesurun CA, Ambat MT, Mandal-Chaudhuri S. Anaphylactic shock in pregnancy: a case study and review of the literature. Int J Obstet Anesth. 2008;17:350–7.

    Article  CAS  Google Scholar 

  14. Heinly TL, Lieberman P. Anaphylaxis in pregnancy. Immunol Allergy Clin N Am. 2000;20:83–8.

    Google Scholar 

  15. Macy E. Penicillin skin testing in pregnant women with a history of penicillin allergy and group B streptococcus colonization. Ann Allergy Asthma Immunol. 2006;97:164–8.

    Article  Google Scholar 

  16. Sheikh J. Intrapartum anaphylaxis to penicillin in a woman with rheumatoid arthritis who had no prior penicillin allergy. Ann Allergy Asthma Immunol. 2007;99:287–9.

    Article  CAS  Google Scholar 

  17. Philipson EH, Lang DM, Gordon SJ, Burlingame JM, Emery SP, Arroliga ME. Management of group B Streptococcus in pregnant women with penicillin allergy. J Reprod Med. 2007;52:480–4.

    PubMed  Google Scholar 

  18. Sengupta A, Kohli JK. Antibiotic prophylaxis in cesarean section causing anaphylaxis and intrauterine fetal death. J Obstet Gynaecol Res. 2008;34:252–4.

    Article  Google Scholar 

  19. Khan R, Anastasakis E, Kadir RA. Anaphylactic reaction to ceftriaxone in labour. An emerging complication. J Obstet Gynaecol. 2008;28:751–3.

    Article  Google Scholar 

  20. Stoll BJ, Hansen NI, Sanchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues. Pediatrics. 2011;127:817–26.

    Article  Google Scholar 

  21. Smaill FM, Gyte GM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev. 2010;1:CD007482.

    Google Scholar 

  22. Jensen-Jarolim E, Reider N, Fritsch R, Breiteneder H. Fatal outcome of anaphylaxis to chamomile-containing enema during labor: a case study. J Allergy Clin Immunol. 1998;102:1041–2.

    Article  CAS  Google Scholar 

  23. Porter BJ, Acharya U, Ormerod AD, Herriot R. Latex/chlorhexidine-induced anaphylaxis in pregnancy. Allergy. 1998;53:455–7.

    Article  CAS  Google Scholar 

  24. Draisci G, Nucera E, Pollastrini E, Forte E, Zanfini B, Pinto R, et al. Anaphylactic reactions during cesarean section. Int J Obstet Anesth. 2007;16:63–7.

    Article  CAS  Google Scholar 

  25. Draisci G, Zanfini BA, Nucera E, Catarci S, Sangregorio R, Schiavino D, et al. Latex sensitization: a special risk for the obstetric population? Anesthesiology. 2011;114:565–9.

    Article  Google Scholar 

  26. Turillazzi E, Greco P, Neri M, Pomara C, Riezzo I, Fineschi V. Anaphylactic latex reaction during anaesthesia: the silent culprit in a fatal case. Forensic Sci Int. 2008;179:e5–8.

    Article  CAS  Google Scholar 

  27. Matsuo K, Lynch MA, Kopelman JN, Atlas RO. Anaphylactoid syndrome of pregnancy immediately after intrauterine pressure catheter placement. Am J Obstet Gynecol. 2008;198:e8–9.

    Article  Google Scholar 

  28. Ogata J, Minami K. Synthetic oxytocin and latex allergy. Br J Anesth. 2007;98:845–6.

    Article  CAS  Google Scholar 

  29. Pant D, Vohra VK, Pandey SS, Sood J. Pulseless electrical activity during caesarean delivery under spinal anaesthesia: a case report of severe anaphylactic reaction to Syntocinon. Int J Obstet Anesth. 2009;18:85–8.

    Article  CAS  Google Scholar 

  30. Lin MC, Hseih TK, Liu CA, Chu CC, Chen JY, Wang JJ, et al. Anaphylactoid shock induced by oxytocin administration – a case report. Acta Anaesthesiol Taiwan. 2007;45:233–6.

    PubMed  Google Scholar 

  31. Coppola A, Maruotti GM, Feola G, Catalano A, Quaglia F, Tomaiuolo M, et al. Management of patients with factor V deficiency: open issues from the challenging history of a woman with anaphylactic transfusion reactions. Haemophilia. 2010;16:560–3.

    Article  CAS  Google Scholar 

  32. Smith HS, Hare MJ, Hoggarth CE, Assem ES. Delivery as a cause of exercise-induced anaphylactoid reaction: case report. Br J Obstet Gynaecol. 1985;92:1196–8.

    Article  CAS  Google Scholar 

  33. Villalta D, Martelli P. A case of breastfeeding anaphylaxis. Eur Ann Allergy Clin Immunol. 2007;39:26–7.

    CAS  PubMed  Google Scholar 

  34. McKinney KK, Scranton SE. A case report of breastfeeding anaphylaxis: successful prophylaxis with oral antihistamines. Allergy. 2011;66:435–6.

    Article  CAS  Google Scholar 

  35. Shank JJ, Olney SC, Lin FL, McNamara MF. Recurrent postpartum anaphylaxis with breast-feeding. Obstet Gynecol. 2009;114:415–6.

    Article  Google Scholar 

  36. Simons FE. Anaphylaxis: recent advances in assessment and treatment. J Allergy Clin Immunol. 2009;124:625–36.

    Article  CAS  Google Scholar 

  37. Simons FE, Schatz M. Anaphylaxis during pregnancy. J Allergy Clin Immunol. 2012;130:597–606.

    Article  CAS  Google Scholar 

  38. Fong A, Chau CT, Pan D, et al. Amniotic fluid embolism: antepartum, intrapartum and demographic factors. J Matern Fetal Neonatal Med. 2015;28(7):793–8.

    Article  Google Scholar 

  39. Conde-Augdelo A, Romero R. Amniotic fluid embolism: an evidence-based review. Am J Obstet Gynecol. 2009;201:445. E1–13.

    Article  Google Scholar 

  40. Braveman RF. Pregnancy-associated diseases. In: Hines RL, Marshall KE, editors. Stoelting’s anesthesia and coexisting diseases. 5th ed. Philadelphia: Churchill Livingstone; 2008. p. 557–80.

    Chapter  Google Scholar 

  41. Gonzalez-Perez A, Aponte Z, Vidaurre CF, Rodriguez LAG. Anaphylaxis epidemiology in patients with and patients without asthma: a United Kingdom database review. J Allergy Clin Immunol. 2010;125:1098–104.

    Article  Google Scholar 

  42. Mueller UR. Cardiovascular disease and anaphylaxis. Curr Opin Allergy Clin Immunol. 2007;7:337–41.

    Article  Google Scholar 

  43. Brockow K, Jofer C, Behrendt H, Ring J. Anaphylaxis in patients with mastocytosis: a study on history, clinical features and risk factors in 120 patients. Allergy. 2008;63:226–32.

    Article  CAS  Google Scholar 

  44. Rueff F, Przybilla B, Bilo MB, Muller U, Scheipl F, Aberer W, et al. Predictors of severe systemic anaphylactic reactions in patients with Hymenoptera venom allergy: importance of baseline serum tryptase-a study of the European Academy Allergology and Clinical Immunology Interest Group on Insect Venom Hypersensitivity. J Allergy Clin Immunol. 2009;124:1047–54.

    Article  CAS  Google Scholar 

  45. Vadas P, Gold M, Perelman B, Liss GM, Lack G, Blyth T, et al. Platelet-activating factor, PAF acetylhydrolase, and severe anaphylaxis. N Engl J Med. 2008;358:28–35.

    Article  CAS  Google Scholar 

  46. Muraro A, Lemanske RF Jr, Castells M, Torres MJ, Khan D, Simon HU, et al. Precision medicine in allergic disease—food allergy, drug allergy, and anaphylaxis—PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology. Allergy. 2017;72:1006–21.

    Article  CAS  Google Scholar 

  47. Castells M. Diagnosis and management of anaphylaxis in precision medicine. J Allergy Clin Immunol. 2017;140:321–33.

    Article  Google Scholar 

  48. Schmidt AP, Taswell HF, Gleich GJ. Anaphylactic transfusion reactions associated with anti-IgA antibody. N Engl J Med. 1969;280:188–93.

    Article  CAS  Google Scholar 

  49. Steenholdt C, Svenson M, Bendtzen K, Thomsen OO, Brynskov J, Ainsworth MA. Acute and delayed hypersensitivity reactions to infliximab and adalimumab in a patient with Crohn’s disease. J Crohns Colitis. 2012;6:108–11.

    Article  Google Scholar 

  50. Bergamaschini L, Mannucci PM, Federici AB, Coppola R, Guzzoni S, Agostoni A. Posttransfusion anaphylactic reactions in a patient with severe von Willebrand disease: role of complement and alloantibodies to von Willebrand factor. J Lab Clin Med. 1995;125:348–55.

    CAS  PubMed  Google Scholar 

  51. Heden H, Richter W, Messmer K, Renck H, Ljungstrom KG, Laubenthal H. Incidence, pathomechanism and prevention of dextran-induced anaphylactoid/anaphylactic reactions in man. Dev Biol Stand. 1980;48:179–89.

    Google Scholar 

  52. Umeda Y, Fukumoto Y, Miyauchi T, Imaizumi M, Shimabukuro K, Mori Y, et al. Anaphylactic shock related to aprotinin induced by anti-aprotinin immunoglobulin G antibody alone; report of a case. Kyobu Geka. 2007;60:69–71.

    CAS  PubMed  Google Scholar 

  53. Kishimoto TK, Viswanathan K, Ganguly T, et al. Contaminated heparin associated with adverse clinical events and activation of the contact system. N Engl J Med. 2008;258:2457–67.

    Article  Google Scholar 

  54. Vadas P, Perelman B, Liss G. Platelet-activating factor, histamine, and tryptase levels in human anaphylaxis. J Allergy Clin Immunol. 2013;131:144–9.

    Article  CAS  Google Scholar 

  55. Cousins L. Fetal oxygenation, assessment of fetal well-being and obstetric management of the pregnant patient with asthma. J Allergy Clin Immunol. 1999;103(suppl):S343–9.

    Article  CAS  Google Scholar 

  56. Brown SG, Stone SF, Fatovich DM, et al. Anaphylaxis: clinical patterns, mediator release, and severity. J Allergy Clin Immunol. 2013;132(5):1141–1149.e5.

    Article  CAS  Google Scholar 

  57. Simons FE, Frew AJ, Ansotegui IJ, et al. Risk assessment in anaphylaxis: current and future approaches. J Allergy Clin Immunol. 2007;120(1 Suppl):S2–24.

    Article  CAS  Google Scholar 

  58. Farrar SC, Gherman RB. Serum tryptase analysis in a woman with amniotic fluid embolism. A case report. J Reprod Med. 2001;46(10):926–8.

    CAS  PubMed  Google Scholar 

  59. Kaur K, Bhardwaj M, Kumar P, et al. Amniotic fluid embolism. J Anaesthesiol Clin Pharmacol. 2016;32(2):153–9.

    Article  CAS  Google Scholar 

  60. Schatz M, Dombrowski MP. Clinical practice. Asthma in pregnancy. N Engl J Med. 2009;360(18):1862–9.

    Article  CAS  Google Scholar 

  61. Stephan V1, Zimmermann A, Kühr J, et al. Determination of N-methylhistamine in urine as an indicator of histamine release in immediate allergic reactions. J Allergy Clin Immunol. 1990;86(6 Pt 1):862–8.

    Article  CAS  Google Scholar 

  62. Ono E, Taniguchi M, Mita H, et al. Increased production of cysteinyl leukotrienes and prostaglandin D2 during human anaphylaxis. Clin Exp Allergy. 2009;39(1):72–80.

    Article  CAS  Google Scholar 

  63. Hepner DL, Castells M, Mouton-Faivre C, et al. Anaphylaxis in the clinical setting of obstetric anesthesia: a literature review. Anesth Analg. 2013;117(6):1357–67.

    Article  CAS  Google Scholar 

  64. Gei AF, Pacheco LD, Vanhook JW, et al. The use of a continuous infusion of epinephrine for anaphylactic shock during labor. Obstet Gynecol. 2003;102(6):1332–5.

    CAS  PubMed  Google Scholar 

  65. Cunningham LM, Mattu A, O'Connor RE, et al. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation. Am J Emerg Med. 2012;30(8):1630–8.

    Article  Google Scholar 

  66. NEW, Jagdis A, Vadas P. Omalizumab effectively prevents recurrent refractory anaphylaxis in a patient with monoclonal mast cell activation syndrome. Ann Allergy Asthma Immunol. 2014;113:115–6.

    Article  Google Scholar 

  67. Bernstein IL, Li JT, Bernstein DI, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008;100(3 Suppl 3):S1–148.

    CAS  PubMed  Google Scholar 

  68. Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011;127(1 Suppl):S1–55.

    Article  Google Scholar 

  69. Oykhman P, Kim HL, Ellis AK. Allergen immunotherapy in pregnancy. Allergy Asthma Clin Immunol. 2015;11:31.

    Article  Google Scholar 

  70. Shaikh WA, Shaikh SW. A prospective study on the safety of sublingual immunotherapy in pregnancy. Allergy. 2012;67(6):741–3.

    Article  CAS  Google Scholar 

  71. Hjortlund J, Mortz CG, Skov PS, et al. Diagnosis of penicillin allergy revisited: the value of case history, skin testing, specific IgE and prolonged challenge. Allergy. 2013;68(8):1057–64.

    Article  CAS  Google Scholar 

  72. Verani JR, McGee L, Schrag SJ, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease – revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010;59(RR-10):1–36.

    PubMed  Google Scholar 

  73. Brown RH, McAllister MA, Gundlach AM. The final steps in converting a health care organization to a latex-safe environment. Jt Comm J Qual Patient Saf. 2009;35(4):224–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dilley Allergy and Asthma Specialists, San Antonio, TX, USA

    Christopher W. Calabria

  2. Department of Allergy and Immunology, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA

    Christopher A. Coop

Authors
  1. Christopher W. Calabria
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher A. Coop
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, CA, USA

    Jennifer A. Namazy

  2. Department of Allergy, Kaiser Permanente Medical Center, San Diego, CA, USA

    Michael Schatz

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Calabria, C.W., Coop, C.A. (2019). Anaphylaxis in Pregnancy. In: Namazy, J., Schatz, M. (eds) Asthma, Allergic and Immunologic Diseases During Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-030-03395-8_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-03395-8_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-03394-1

  • Online ISBN: 978-3-030-03395-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation