ÎThere might be a need for specific laboratory studies to exclude systemic disorders, such as indolent systemic mastocytosis.
Comment: This might include a measurement of serum tryptase when the patient is asymptomatic, measurement of total tryptase during or within 4 hours of an acute episode, and the ratio of mature (β) tryptase to total tryptase during an episode. (C)
ÎThere might be a need for selective skin testing for detection of anti- food IgE antibodies when foods have been ingested within 2 hours of the onset of an episode. (C)
ÎEmpiric use of oral corticosteroids combined with H1-antagonists has been demonstrated to reduce the frequency/severity of episodes. (C)
ÎPatients with idiopathic anaphylaxis should carry epinephrine, know the indications for self-administration, and can carry information denoting their condition. (C)
Anaphylaxis to Allergen Immunotherapy Extract (Vaccine)
ÎThere is a small risk of near-fatal and fatal anaphylactic reactions to allergen immunotherapy. (C)
ÎPatients with asthma, particularly if poorly controlled, are at higher risk for serious potentially life-threatening anaphylaxis to allergen immunotherapy injections. (C)
ÎIt is unclear whether patients taking beta adrenergic blocking agents are at increased risk of having a serious systemic reaction to allergen immunotherapy injections, but since beta blockers interfere with the activity of epinephrine, beta blockers should be discontinued if possible. (B)
ÎAnaphylaxis in patients taking beta adrenergic blocking agents may be more difficult to treat. (C)
ÎAllergen immunotherapy vaccines should be administered only by health care professionals trained in the recognition and treatment of anaphylaxis, only in health care facilities with the proper equipment for the treatment of anaphylaxis, and in clinics with policies and procedures that minimize the risk of anaphylaxis. (D)
Anaphylaxis to Drugs and Biological Agents
ÎLow-molecular-weight medications induce an IgE-mediated reaction only after combining with a carrier protein to produce a complete multivalent antigen. (B)
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