Anaphylaxis is an acute systemic event which can be rapidly progressive and fatal. Most cases are mediated by IgE related mechanisms. However, episodes of anaphylaxis can occur through other immunologic and non-immunologic pathways. Therefore it is defined by its clinical manifestations. Those manifestations can be protean highly variable. Four systems can be involved. These are the skin and subcutaneous tissue, the respiratory tract, the gastrointestinal tract, and the blood vessels throughout the body.
The most common system involved is the skin. Cutaneous manifestations occur in approximately 90 percent or more of episodes. The next most frequent system involved is the respiratory tract, followed by the gastrointestinal tract. In some cases, patients manifest only symptoms caused by involvement of the systemic vasculature, thus presenting as shock.
In spite of the mechanism involved or the manifestations of the event, the initial treatment of choice is the same. Epinephrine is the initial drug of choice for all episodes. Numerous conditions must be considered in the differential diagnosis. Perhaps the most common of these is the vasodepressor (vasovagal) response.
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Lieberman, P. (2009). Clinical Aspects and Diagnosis of Anaphylaxis. In: Pawankar, R., Holgate, S.T., Rosenwasser, L.J. (eds) Allergy Frontiers: Diagnosis and Health Economics. Allergy Frontiers, vol 4. Springer, Tokyo. https://doi.org/10.1007/978-4-431-98349-1_18
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