Diagnosis and Assessment Anaphylaxis to Foods
ÎFood is the most common cause of anaphylaxis in the outpatient setting, and food allergens account for 30% of fatal cases of anaphylaxis. (D)
ÎThe most commonly implicated foods responsible for food-induced anaphylaxis include: peanuts, tree nuts, fish, shellfish, cow's milk, soy and egg. In addition, sesame seed has recently been identified as a significant cause of food-induced anaphylaxis. (C)
ÎCommon themes associated with fatal food anaphylaxis include: reactions commonly involve peanuts and tree nuts; cutaneous and respiratory symptoms are frequently observed; victims are typically teenagers and young adults; patients often have a prior history of food allergy and asthma; and there is a failure to promptly administer epinephrine. (C)
ÎAs is the case of anaphylaxis following other agents, asthma is a risk factor for more severe food-induced anaphylaxis. (C)
ÎBiphasic anaphylactic reactions can occur in up to 20% of fatal and near-fatal food reactions. (C)
ÎSerum tryptase measurements may not be elevated in cases of food- induced anaphylaxis. (C)
ÎThe rapid use of injectible epinephrine has been shown to be effective in the initial management of food-induced anaphylaxis, but subsequent doses may be needed. (C)
ÎPatients who experience anaphylaxis should be observed for longer periods than for other causes if they have experienced food-induced anaphylaxis. (C)
ÎFood-dependant, exercise-induced anaphylaxis is a unique clinical syndrome in which anaphylaxis occurs within a few hours of specific food ingestion or any meal, and exercise. (C)
ÎPatients with food allergy should pay close attention to food advisory labels (eg, ''may contain''), which have become more prevalent. (C)
Natural Rubber Latex (NRL)-Induced Anaphylaxis
ÎThere are three groups that are at high risk of reaction to latex: health care workers; children with spina bifida and genitourinary abnormalities; and workers with occupational exposure to latex. (C)
ÎIn vitro assays for IgE to NRL are typically recommended as a first step in evaluating latex sensitivity. However, due to their suboptimal diagnostic predictive value, positive and negative results must be interpreted based on the history.
If the test is positive with a high
clinical likelihood, latex sensitivity would be reasonable to pursue. In contrast, if the test is negative with a high clinical likelihood, latex sensitivity still must be considered. (C)
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