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Pathophysiology and management of anaphylaxis in the critically ill 

Pathophysiology and management of anaphylaxis in the critically ill
Pathophysiology and management of anaphylaxis in the critically ill

James Keegan

and Charles D. Deakin

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date: 23 May 2022

Anaphylaxis is a severe life-threatening systemic hypersensitivity reaction, which occurs in approximately 10–20 per 100,000 population per annum, and accounts for 0.3% of adult critical care admissions. Anaphylaxis most commonly results from an exaggerated immune reaction to foreign antigens, prompting release of vasoactive substances from mast cells. A broad range of agents including foods, insect stings, latex, and drugs can trigger anaphylaxis. Common food allergens include nuts, shellfish, milk, and eggs. The most frequently implicated drugs include neuromuscular blocking agents (NMBAs) and antibiotics. The clinical features of anaphylaxis are variable and may occur together or in isolation. Epinephrine is the primary treatment for anaphylaxis, administered via the intramuscular route. Measurement of mast cell tryptase is essential for the diagnosis of anaphylaxis. Samples should be taken immediately, at 1–2 hours, and at 24 hours after the onset of symptoms. Investigations should be directed at identification of the trigger agent, and patients should be provided with information to enable them to avoid probable triggers and recognize future episodes.

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