Diagnosis and Assessment
Fig 1. Initial Evaluation and Management of a Patient with a History of a Previous Episode of Anaphylaxis
Is the history consistent with a previous episode of anaphylaxis?
YES
Consider consultation with allergist/immunologist
YES Is cause readily identified by history? YES Are further diagnostic tests indicated: allergy skin
tests or in vitro tests, challenge tests?
YES
Testing identifies specific cause of anaphylaxis?
YES
Diagnosis made for specific cause of anaphylaxis
YES
Management of anaphylaxis: • General: Patient education > Risk assessment > Consider appropriate discontinuation of ACE inhibitors and b-blockers > Medication: self-administered epinephrine
10
• Specific: Avoidance (eg, food) > Immunotherapy (eg, hymenoptera) > Desensitization (eg, penicillin) > Graded challenge (eg, local anesthetic) > Premedication (eg, radiocontrast)
8 NO
> Reconsider clinical diagnosis > Reconsider idiopathic anaphylaxis
> Consider other triggers > Consider further testing > Management (See Box 10)
NO
> Diagnosis established on basis of history
> Risk of testing > Limitaions of tests > Patients refuses tests > Other management options available
> Management (See Box 10) NO
Consider idiopathic anaphylaxis (See Box 10)
NO
Pursue other diagnoses or make appropriate referral
