3
Diagnosis
Figure 1. Algorithm for Initial Evaluation and Management
of a Patient with a Previous Episode of Anaphylaxis
YES
Consider
consultation with allergist/
immunologist
YES
NO
Is the history consistent with a
previous episode of anaphylaxis?
Pursue other diagnoses or
make appropriate referral
NO
Consider idiopathic
anaphylaxis (See Box 10)
Are further diagnostic
tests indicated: allergy skin
tests or in vitro tests, challenge
tests?
Also at this point, consider obtaining lgE
anti-galactose-alpha-1,3-galactose
and mutation analysis for 816V
KIT mutation (See text)
YES
Is cause readily identified by history?
YES
YES
Diagnosis made for specific cause of anaphylaxis
YES
NO
• Diagnosis established
on basis of history
• Risk of testing
• Limitations of tests
• Patient refuses tests
• Other management
options available
• Management
(See Box 10)
NO
• Reconsider clinical diagnosis
• Reconsider idiopathic anaphylaxis
• Consider other triggers
• Consider further testing
• Management (See Box 10)
MANAGEMENT OF ANAPHYLAXIS
• General patient education
• Risk assessment
• Consider appropriate discontinuation of drugs which may worsen the event or
interfere with the treatment. These might include beta-adrenergic blockers,
angiotensin-converting enzyme inhibitors, monoamine oxidase inhibitors, etc.
• Medication: self-administered epinephrine
• Specific: Avoidance (e.g., food)
• All patients should be prescribed an automatic epinephrine injector and given an
anaphylaxis action plan
• lmmunot herapy (e.g., hymenoptera)
• Desensitization (e.g., penicillin)
• Graded challenge (e.g., local anesthetic)
• Premedication (e.g., radiocontrast)
Testing identifies specific
cause of anaphylaxis?
1
4
3
5
2
1A
6
7
8
9
10
