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ACEP News: Vol 32 – No 03 – March 2013Introduction
Anaphylaxis is increasing in prevalence and has important health implications in the United States.
Although the exact incidence is unknown, anaphylactic reactions may involve up to 2% of the population.1 Moreover, the annual incidence of anaphylaxis and related conditions such as food allergy and asthma appears to be increasing.2-6
Evidence also suggests dramatic increases in emergency department visits, hospitalization, hospital outpatient visits and physician office visits as well.3,5 Despite the availability of diagnostic criteria and management guidelines, anaphylaxis is often under-recognized and/or under-treated in the United States.4,7-9
Further, the delayed administration of epinephrine is an important problem in anaphylaxis management that has been noted to contribute to fatalities.8,10-14 Given the potentially fatal consequences of anaphylaxis, health care professionals must not only be able to recognize and treat anaphylaxis promptly, but also to educate their patients on how to manage this life-threatening condition.
Food is the major cause of anaphylaxis in the United States, with recent data associating severe reactions, most commonly in children, with allergy to tree nuts, peanuts, shellfish, soy, etc.
What is Anaphylaxis?
In 2005, the National Institute of Allergy and Infection Disease (NIAID) and the Food Allergy and Anaphylaxis Network (FAAN) developed a consensus definition for anaphylaxis (Table 1).9 The symptoms of anaphylaxis are variable and can affect multiple organ systems, including the gastrointestinal tract and cardiovascular system.15-17
Skin signs such as flushing, itching, urticarial and rash occur in up to 90% of patients, while respiratory symptoms, including dyspnea, wheeze and upper angioedema, occur in up to 60% of patients.8
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