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
tests indicated: allergy skin Are further diagnostic
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: 10
• General: Patient education > Risk assessment > Consider appropriate discontinuation of ACE inhibitors and b-blockers > Medication: self-administered epinephrine
• 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
Consider idiopathic anaphylaxis (See Box 10)
NO
> Diagnosis established on basis of history
NO
Pursue other diagnoses or make appropriate referral
> Risk of testing > Limitaions of tests > Patients refuses tests > Other management options available
> Management (See Box 10)
