Talk:Anaphylaxis/Archive 1

True anaphylaxis

This page is actually incorrect. Anaphylactic reactions are different from type I hypersensitivity rxns. Anaphylactic rxns affect all members of a species, regardless of previous exposure, because of their effects on immune pathways (alternative complement pathway and arachadonic acid metabolism, specifically). The underlying mechanisms, however, are the same as a type I hypersensitivity rxn which requires an intital exposure that "sensitivizes" the individual by production of IgE against the antigen. I think the author was getting at this when he/she mentioned "true anaphylaxis" but it is incorecct as written. 66.109.184.164 01:48, 15 June 2007 (UTC)Ike

This isn't my field of expertise. But the definitions of pseudoanaphylaxis/anaphylactoid shock/anaphylactoid crisis[1] and plain anaphylaxis[2] sure make it sound like the article is reasonably correct as written. It appears that the IgE-based definition is relatively new; immunology is a young field. Could your information be out of date? WhatamIdoing 18:22, 4 August 2007 (UTC)

Anaphylaxis is classified as a Type 1 hypersensitivity reaction - well according to all the texts that I am studying. Check Harrison's Priniciples of Internal Medicine and Robbins Pathological Basis of Disease. Anaphylaxis requires previous sensitisation and production of IgE. I think that you are thinking more of the anaphylactoid reactions (I am guessing that is what other authors meant by pseudo-anaphylaxis). Mast cell degranulation can be triggered by more than just IgE. Other mediators such as C3a and C5a, physical events (trauma - see dermatographism - heat and sun), drugs such as codeine and morphine and even exercise can trigger degranulation. Clinically in the acute setting, this is irrelevant as the treatment is the same. The importance comes in identifying the trigger or further research. Once the initial trigger for mast cell degranulation has occurred, further steps in the pathway and the final clinical outcome is the same. 210.49.62.60 22:38, 12 September 2007 (UTC)

Symptoms

I added vomiting as a symptom. I have anaphylactic allergies and vomiting is always a clear symptom during my reactions. --216.240.152.74 03:29, 9 August 2005 (UTC)

Good. JFW | T@lk 17:16, 9 August 2005 (UTC)

I, now at age 13, suffered from a severe case of anaphylactic shock at the age of 11. Except, this happened to be idiopathic, meaning the doctors still have not figured out, and probably won't ever discover, the cause of the reaction. While it is true that this could have killed me within a short period of time, I found that the illness took awhile to gradually get worse and worse, until finally i had to take a trip to the emergency room. I seemed to feel fine that morning, then throughout the day i felt weaker and very tired. I was at a football game, and started feeling terrible until i had unbearable stomach cramps. these stomach cramps turned into diarrhea, vomiting, then hives. not too much longer, i was hooked up to machines and breathing tubes and wanted nothing but to sleep, after all it was almost 6 in the morning and i hadn't slept at all. so, that describes one case of anaphylaxis.

The following text seems to be more commentary than informational - suggest it be removed:

"This can be disconcerting to bystanders, particularly if a person in a restaurant starts gasping, then reaches into her bag and calmly gives herself three injections at the table.

It is especially disconcerting if the person watching had ignored repeated requests not to light cigarettes upwind of the allergic person, or if a waiter had lied about ... A few injections constitute a small interruption and a small expense; an ambulance ride te the ER is a major interruption—cancelling one's plans for the evening or longer—and a major expense."

I suffer from Anaphylaxis too, my first attack was not too bad. Just hives, diarrhea and some minor breathing trouble. I like the previous post, found it got worse the more attacks I had. My last one, 3 years ago, left me in my local hospital with major breathing issues, hives, internal bleeding, diarrhea, and the discovery that one of the medications designed to make my system better, Hydrocortisone, caused my heart to stop. I died for nearly 90 seconds. I now carry 2 Epipens, and I am on permanent anti-histamine treatment (Fexofenadine) for the rest of my natural life. I also like the previous poster, have a liquid form of antihistamine, Piriton, which I use if I am unable to swallow an anti-histamine tablet during an attack. (amended post to remove chat style message).Thor Malmjursson (talk) 16:56, 23 October 2008 (UTC)

This page is for discussing improvements to this article, not chatting about our personal experiences. WhatamIdoing (talk) 17:23, 23 October 2008 (UTC)

Just so you know, I am aware that the talk page is not a chat board. However, since I noticed that some of the things which I experienced as part of my last major attack are not listed in the article, such as the hypersensitivity to Hydrocortisone and also the internal bleeding, i figured I would detail an attack where such things occurred. I suppose i should not have added the bit about my diet and stuff at the end which made it seem chatty, but my point in putting this post there I would say is, since those things have happened to me, would adding them to the article be classed as OR?  :) Thor Malmjursson (talk) 22:11, 23 October 2008 (UTC)

Yes. Adding your own personal experience to any article is always a violation of WP:OR. Now if you could find a reliable source that just "happened" to say the same thing, then it's probably okay. WhatamIdoing (talk) 01:06, 24 October 2008 (UTC)

Cold?

"First aid for anaphylactic shock consists of obtaining advanced medical care at once; rescue breathing (a skill which is part of CPR) is likely to be ineffective but should be attempted if the victim stops breathing."

While waiting for advanced medical care, how about applying cold material to the area around the throat to minimize swelling?

An interesting idea. I wonder if that would trigger the mammalian diving reflex or something. I have no idea. I have heard, though, that it's no longer indicated to put cold packs on the neck of a patient with heat stroke, as it could be a shock to the brain. I would definitely say that any treatment cannot be recommended unless there's medical evidence that it's indicated. Peace, delldot | talk 19:33, 21 November 2005 (UTC)

That sounds like OR. Considering the seriousness of this subject, OR is particularly inappropriate. Durova 15:02, 18 September 2006 (UTC)

That does indeed sound like inappropriate original research. But if it's me stretched out on the floor, then please: (1) Call an ambulance, (2) see if anyone has an Epipen, and (3) pour a little liquid Benadryl down my throat. The active ingredient will absorb through the lining of the mouth, and if the patient is already unable to breathe, then they can't very well inhale the drug, no? WhatamIdoing 01:25, 7 June 2007 (UTC)

Bear in mind that this is severe shock, the body will start systematically shutting itself down to conserve its vital functions. It would be quite inadvisable to pour any form of liquid into a casualties mouth as they would be incapable of swallowing it and it would serve to block the airway even more. Worst case scenario it would enter the lungs and be fatal. AlexJFox (talk) 00:03, 24 July 2008 (UTC)

Etymology

The name was created by Charles Richet who discovered the phenomenon. It was to define a state where an organism became hypersensitive to a toxin - the opposite to "prophylaxis". He defined it as "ana" - against "phylaxis" a seldom-used Greek word for protection.--Bel wills 16:41, 18 September 2007 (UTC)

While it is true that "anaphylaxis" is from New Latin and "ana-" is from the Greek preposition, meaning "against," the latter portion of the word (-phylaxis) comes from the Greek word "phylax," (root phylak-) meaning "guard," or "of or relating to defense." 199.184.237.196 (talk · contribs)

I thought phylum was a bit anachronistic here. Let's see what the others think. JFW | T@lk 07:29, 14 December 2005 (UTC)

Yeah, the etymology given here is totally wrong. It is from phylaxis "guarding" with the prefix ana- which means "up, again, back, against" and a variety of other things. I'm not sure where the connection is to the medical condition, but that is transparently the etymology, and dictionaries agree on this point. The entry in the AMH implies that it's meant to be the opposite of prophylaxis, but I'm not sure that makes sense either. It would be nice to know what the semantic link is, as it would make the necessary rewrite much easier, but in any case this must be the etymology.

Even if the word did come from phylon "tribe, division" the whole digression about taxonomy would be totally irrelevant. Has anyone heard this fake etymology before? If it's commonly circulated (outside of Wikipedia) then perhaps we shoudl say "the word is not connected to phylum, except by folk etymology" or the like. --Iustinus 04:56, 26 December 2005 (UTC)

Fruit

I didn't add references when I added fruit to the list because readers might misunderstand the following as applying to a broader range of allergens:

• kiwi
• ackee
• general fruit anaphylaxis
• apple, banana, and lychee
• grape

The list could go on considerably, but that's enough to make the point. Durova 15:10, 18 September 2006 (UTC)

Photo

The photo seems a little dumb to me. Come on. Peanuts? 219.89.24.163 22:18, 22 October 2006 (UTC)

Medical advice

Is it not irresponsible for an open public wiki to offer advice about medical treatment in cases of life threatening acute conditions? What would be the reprocussions if someone acted on incorrect or incomplete advice read here - a death, potential litigation etc. Isn't there some sort of policy on this? 4kinnel 12:38, 10 February 2007 (UTC)

You're absolutely right, 4kinnel, thanks for bringing this up (see Wikipedia:medical disclaimer). I'll tag this with {{howto}} and work on fixing it more when I have the time. delldot | talk 00:58, 11 February 2007 (UTC)

Well, I tried to remove the how to wording, and I added the howto banner. If you think my improvements were enough, please remove the banner or discuss it further here. If not, please be bold and make the changes you think need to be made. You can also bring specific points here to the talk page and we can collaborate to figure out how to put them better. Thanks again for bringing this up! Peace, delldot | talk 01:29, 11 February 2007 (UTC)

There may be reasons for not giving medical advice, but legal liability isn't one of them. I read an article by a lawyer who said that there is no liability for publishing information that is harmful, even chemistry textbooks that publish experiments that harm children. I've seen peanut butter recipies in children's magazines. (One exception is navigation maps.) I don't think you could find a case in which someone was found liable for publishing medical advice. I'd be interested to see one. Nbauman 05:52, 17 February 2007 (UTC)

anaphalactic percentage

How can the limits of the range be so precise? Does it do anyone any good to be so precise? How about something like: Some unknown fraction of the population is susceptable to anaphylaxis. 71.117.248.179 (talk) 19:53, 19 March 2008 (UTC) Oh, that's right wikipedia deleted my account. Thanks, guys. [REMOVED email address]

That's what the listed source says. We presume that they have the data to back it up. WhatamIdoing (talk) 20:30, 19 March 2008 (UTC)

Poemisaglock 18:52, 17 July 2007 (UTC) 1.24 to 16.8%, can't you get a better range? i would guess it is much closer to the lower figure, because it is pretty rare. i'd say something like 1-3%. Thanks.

No, those are the actual numbers. It's the proportion of Americans who might experience anaphylaxis at least once in their lives if they are exposed to a significant amount of a particular antigen/everything went wrong/all the stars were aligned/etc. WhatamIdoing 03:58, 24 August 2007 (UTC)

Expansion of lede on anaphylactic shock

I added this sentence because the lede failed to convey how the localized allergic reaction cascades into a life-threatening systemic response. I found what I was looking for in Immunity and Abnormal Responses, which appears to be note form from an authoritative medical textbook. A reliable crib sheet is better than nothing, but I didn't cite it as a reference because of inconsistent spellings and non-standard abbrev's. MaxEnt 00:39, 6 August 2007 (UTC)

The lead still needs work. One important point to add to the lead (and to the article body) is that anaphylaxis involves a threshold effect, not a dose-response curve. --Una Smith (talk) 23:02, 25 December 2007 (UTC)

Humans and other mammals

I found sources stating it has also been investigated in birds (pigeons) and frogs, but does not manifest to the same intensity as mammals. Google cache reports the fragment "anaphylaxis has been observed in all animals: horses, goats, cattle, rats, pigeons, ducks, and even in frogs" from the coin-operated Scandinavian Journal of Immunology. MaxEnt 02:13, 6 August 2007 (UTC)

Un-encyclopedic

I'm killing this:

At times the sight af a person taking three injections in a public place, such as a restaurant, can be disturbing to other people, especially those who supplied the allergen—such as a waiter who brought food laced with MSG or a customer who smoked several cigarettes in a row and refused to stop to spare a person's allergies. Most people who have not dealt with severe allergies cannot immagine their severity.

on the grounds that it's unencyclopedic. The editor who originally wrote it has so far failed to respond to comments left on the user pageWhatamIdoing 03:59, 24 August 2007 (UTC)

While I agree it may be unencyclopedic, I can understand the authors point of view. I was once wearing a facemask on a bus to avoid symptoms. I sat well back and I took it off going out of the bus. But before I got off I got a look back at me from a young female as I was some really crazy person just because they saw me in the mirror. I know it probably sounds pathetic to complain about "a dirty look", but this girl seemed so 100% certain that I must have been making it up and must have had some weird beliefs that were obviously not true. I was looked at like I was someone from outer space, like I was doing something so ridiculous and I was still struggling to breathe properly. And it definitely wasn't because she was "afraid" either, she just wanted to pretend like I was some kind of weirdo.

It's as though people without it want it both ways. They want to have the allergies to give them a story, and an excuse for things and something to complain about and then they act as though it's something absurd and something made up when a person who ACTUALLY has it and actually has the real IgE allergies. Anonywiki 17:53, 11 October 2007 (UTC)

The Symptoms Section

Thanks to the people who wrote this, you recently saved my life. --71.114.129.165 06:25, 31 August 2007 (UTC)

Planning for treatment section

The "Planning for treatment" section of this article seems to have some information that is out of place, and some links that aren't in sentences that reference the links.

The first 3 sentences make sense in the context and provide valuable information, but then there is a link and 2 sentences about treatment for shock caused by allergies to bees. That information seems to be out of place. Watercat04 22:00, 28 September 2007 (UTC)

PAF

Raised platelet-activating factor (PAF) levels and polymorphisms causing reduced degradation of PAF predispose to anaphylaxis: NEJM. JFW | T@lk 08:32, 6 January 2008 (UTC)

Localized Anaphylaxis ?

"localized anaphylaxis" is not a term I have ever encountered and a PubMed search gives single hit PMID 5881428 "Experimental bronchitis in dogs subjected to bronchially localized anaphylaxis". "Localised anaphylaxis" gains just 7 hits which do not seem to support (as far as I can tell from abstracts) use of term in this way. Localised reactions may be rashes, urticaria and limited angiooedema. But anaphylaxis always, in my understanding, implies a more systemic effect although this may be of varying degrees of severity (eg restrictive airways, alternations in pulse rate and evenual drop in blood pressure - ie shock). David Ruben ^Talk 04:14, 25 February 2008 (UTC)

Yeah, I'm no expert, but my understanding has always been that anaphylaxis is by definition a systemic reaction. delldot on a public computer talk 10:36, 25 February 2008 (UTC)

Despite the lack of a large number of articles in PubMed describing local anaphylaxis, it is true that there are two different degrees of anaphylaxis recognized in immunology. It is incorrect to assume that the term anaphylaxis is always referring to the systemic variety, even if that is the assumption in medical practice. I will leave the page alone but you are misleading the public. It bears at least mentioning that there does exist a distinction. —Preceding unsigned comment added by 71.204.15.239 (talk) 16:46, 23 March 2008 (UTC)

If the term local anaphylaxis is used by a small number of people to mean non-systemic Type 1 allergic reaction, then I don't mind having a sentence in the article that says that. However, this is conditional on a reliable source supporting this use, and I don't think it merits more than a sentence. It is not a notable or common use of the term in English. In nearly all the English-speaking world, nearly all of the medical researchers and clinicians understand anaphylaxis as a generalized systemic reaction. For example, many clinicians define anaphylaxis in ways that require a noticeable drop in blood pressure as key evidence of anaphylaxis. No documented drop in blood pressure = no proof of anaphylaxis. I've never understood how you could have a drop in blood pressure in, say, the part of your face near the bee sting, but not have that the blood pressure change affect your whole body. I am unhappy with the recent changes to the article, especially the changes which present this minority definition before the major use. WhatamIdoing (talk) 20:50, 23 March 2008 (UTC)

The recent changes wiped through the citation mark-up for the initial 7 references, so frankly disruptive to the article. The edit summary stated "No matter the number of hits on PubMed, there is a difference and it ought to be explained. Pretending there are not two forms is ridiculous" - but some extraordinary WP:Reliable source citation is required to support that there are two forms, if we are to ridicule and override the abstracting of 17 million citations from approximately 5,000 worldwide biomedical journals in 37 languages !

This is not a dispute that local allergic reactions can occur, they clearly can, but that these are not considered nor generally termed localised forms of "anaphylaxis" - i.e. it is an issue of naming. As per the policy of WP:NPOV - minority viewpoints do need to be mentioned but not to an WP:UNDUE extent, and trivial minority viewpoints should not be included at all:

• The provided links of National Library of Medicine - Medical Subject Headings MESH database http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?field=uid&term=D000707 defines as "The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic SHOCK, and death" and at bottom of the page will be seen the MeSH Tree Structures which shows that the local skin reaction of urticaria has a separate entry.
• The WHO ICD-10 coding link, http://www.who.int/classifications/apps/icd/icd10online/?gt66.htm+t782 , has "anaphylactic shock" as separate from just "Angioneurotic oedema" and "Allergy, unspecified"
• The eMedicine article link, http://www.emedicine.com/med/topic128.htm , gives a fairly typical and accepted discussion of the topic and its 1st section gives as the background and definition:

  "Portier and Richet first coined the term anaphylaxis in 1902 when a second vaccinating dose of sea anemone toxin caused a dog's death. The response was the opposite of prophylaxis and thus was referred to as anaphylaxis, meaning without protection.
  Anaphylaxis is an acute systemic reaction caused by..."

  David Ruben ^Talk 02:15, 24 March 2008 (UTC)

Assessment

The standards for B class specifically state that the article may have "some gaps or missing elements or references, needs editing for language usage or clarity, balance of content, or contains other policy problems..." WhatamIdoing (talk) 04:01, 24 March 2008 (UTC)

Tagged: {{technical}} 18th July 2008

This is to notify all editors on this article that I have tagged it as being too technical for a general audience. Hell, I suffer from it and even I don't understand what it says in parts (See Pathophysiology for a good example of what I mean). Anyone interested, please have a go at making this article generally accessible to a standard audience, i.e not so you require a medical degree to read it! Thor Malmjursson (talk) 16:01, 18 July 2008 (UTC)

The mojority of the article seems ok, but I think you are right about the pathophysiology section. It sounds like it has been lifted from a research paper or somethingPhilman132 (talk) 14:17, 27 February 2009 (UTC) In fact upon googling some of the senances, some of this section has been lifted directly from this book: http://books.google.co.uk/books?id=76LV6OzS204C&pg=PA413&lpg=PA413&dq=Mast+cells+are+large+cells+found+in+particularly+high+concentrations+in+vascularized+connective+tissues+just+beneath+epithelial+surfaces,+including+the+submucosal+tissues+of+the+gastrointestinal+and+respiratory+tracts,+and+the+dermis+that+lies+just+below+the+surface+of+the+skin&source=bl&ots=wlSQ3TI1b0&sig=cv02aWl4X6n1-33pdB3HM1mduHE&hl=en&ei=dfanScOCCNm0jAeUsoXXDw&sa=X&oi=book_result&resnum=1&ct=result#PPA413,M1 —Preceding unsigned comment added by Philman132 (talk • contribs) 14:26, 27 February 2009 (UTC)

Original research

Moshe,

It's not our job to guesstimate what percentage of at-risk people are going to encounter their allergens, nor what (small) percentage of them will anaphylax as a result. We cite reliable sources. You're applying guesses to get us from 1.24% "at-risk" down to 18 deaths, and on the sole basis of your guess, you're trying to declare the data wrong. The data trumps your guesses! If you don't get from 1.24% to 18 deaths in a year, let me suggest that you blame the inaccuracy of your guesses instead of deleting numbers taken from scientific reports. WhatamIdoing (talk) 03:11, 25 September 2008 (UTC)

A letter "¬" is found in many abbreviations

Is the letter only able to be dropped off? --Tossh eng (talk) 07:19, 6 November 2008 (UTC)

Numbers at the end of the paragraphs

What are the numbers at the end of the paragraphs in "Phathophysiology" section?
At the end of the third paragraph: "...the mast cell.4".
At the end of the fifth paragraph: "...mast cells.9". --Tossh eng (talk) 07:19, 6 November 2008 (UTC)

9 is apparently <ref>{{cite journal |author=Gilfillan A., Tkacyk C. |title=Integrated signaling pathways for mast-cell activation |journal=Nature Reviews Immunology |volume=6 |pages=218-230 |year=2002}}</ref>

I can't figure out what 4 is supposed to be. WhatamIdoing (talk) 19:26, 6 November 2008 (UTC)

Pathophysiology

It might just be me, but the pathophysiology section is really difficult to understand. I realize that it's very a technical subject, but I think it might only be helpful to people in graduate level microbiology or physiology classes, and at they probably have textbooks that explain it better... I don't exactly know what I'm suggesting. I guess I'm just frustrated that I didn't know what 85% of that section was saying. I think it might have been missing a few indefinite articles, and other minor grammatical issues, but I'm not sure, since I'm not sure. JRNorbergé (talk) 01:10, 9 June 2009 (UTC)

I just noticed that there was another section addressing this, but meh.JRNorbergé (talk) 01:12, 9 June 2009 (UTC)

It's not just you, and I've been avoiding that nightmare section for a long while. Can you tell me whether the new first paragraph in that section is easy to understand? Even if we go into a fully technical discussion afterwards, the first paragraph should be simple enough for anyone to get a general overview. WhatamIdoing (talk) 02:34, 9 June 2009 (UTC)

Yes, I think that's better. I suppose the rest can remain abstruse, so long as there is a coherent introduction.. JRNorbergé (talk) 00:55, 13 June 2009 (UTC)

Only to the extent that the jargon-filled stuff were entirely accurate, which it isn't. (This nonsense about IgEs becoming "sensitized" to an antigen was beyond sloppy.) I haven't bothered to source today's salami slice (yet), but do please keep reminding me to work on this. WhatamIdoing (talk) 01:04, 19 June 2009 (UTC)

Deaths

I'm not sure about this edit, which asserts that one out of every 45 deaths in the United States is due to anaphylaxis. This seems rather high to me, especially since it exceeds the number of people that will ever experience anaphylaxis according to most studies (which place the incidence at 1-2%). Support for neither seems to be present on the listed source any longer.

• http://emedicine.medscape.com/article/756150-overview says that there are probably between 500 and 1,000 deaths from anaphylaxis in the US each year.
• PMID 12542990 estimates 1,500 deaths from anaphylaxis in the US each year.
• PMID 15727574 says one to three deaths per million people. Since I haven't finished reading the full text, I don't know whether this is worldwide (probable) or country-specific, or whether this is a lifetime risk instead of an annual incidence.
• PMID 19117599 gives about 12 deaths from anaphylaxis each year in Australia, and also provides a breakdown of the trigger (drugs: no matter how much people talk about food allergies, drugs (penicillin, radiocontrast, and chemotherapeutics) are by far the leading cause of deaths from anaphylaxis).

At any rate, the current statement is wrong, so I'm going to change it to something that is at least approximately correct, and I hope someone else can help sort out the rest of this. WhatamIdoing (talk) 20:28, 15 July 2009 (UTC)

Support section

WhatamIdoing has twiced removed the Support section, classifying it as charity spam. She has also removed external links to a related UK support organization.

Is the latter acceptable? Such links to American organizations are certainly common across Wikipedia's medical articles. How about relevant specialist organizations outside the US?

Or perhaps there could be a separate more generic support page created with an internal link from this article and others. This would be useful information for users, I feel.

Views welcome.

Hildebrand the Editor (talk) 04:47, 7 October 2009 (UTC)

Are you familiar with the relevant guidelines, which are at WP:EL and WP:MEDMOS#External_links?

In general, there shouldn't be any "Oh, look, yet another medical charity!" links. The links should go to information about the condition that would be interesting to a reader who is not affected by the condition (e.g., a student writing a paper for school). It doesn't matter what country the charity is located in: "Oh, look, it's a charity!" is not what we're aiming for, either in the article itself (which would require an independent reliable source to back up your claims anyway) or in the appendices at the end. WhatamIdoing (talk) 07:05, 7 October 2009 (UTC)

Thanks. I'll follow up the links you have provided. If I add anything, it will follow the guidelines. Hildebrand the Editor (talk) 15:06, 7 October 2009 (UTC)

Note that links to highly informative pages on charities are often very good links. If there's a page at your website that gives more detail than this article, or provides solid information about some aspect of this condition that isn't brought out well in this article, then I (and Wikipedia) would be very happy to have it listed. We want something that we can legitimately label "Information (about ____) from a charity" instead of "Only look, another charity website that you could have found with your favorite web search engine!"

We also don't want all the links to provide the same information. We've already got two very detailed "encyclopedia articles" listed, plus one on resuscitation. So you'd want to propose a page that covered something else. Additionally, some webpages could be referenced for various facts that it contains. These can be added to the article itself. (The ideal source for medical information is probably a medical textbook or review paper, but charity websites are okay, too.) WhatamIdoing (talk) 15:56, 7 October 2009 (UTC)

Thanks. Understood. By the way, the charity's site I referenced before is not my website. I support the charity, but I am not employed by it. Hildebrand the Editor (talk) 02:34, 8 October 2009 (UTC)

Latex and anaphylaxis

Google "how common is latex anaphylaxis" and the entire first page lists it as one of the top common causes of anaphylaxis. It would seem that a person doing editing would first try that before deleting the inclusion. And certainly so since none of the other causes, food, meds, etc., had any ref what so ever. Gandydancer (talk) 17:15, 20 December 2009 (UTC)

This is a summary of the sections that follow. A these three are the most common causes of anaphylaxis. Doc James (talk · contribs · email) 18:03, 20 December 2009 (UTC)

The three most common? What does that have to do with it? The section supposedly lists the causes, not the 3 most frequent causes. Since you state that you are a practicing physician, I really am surprised that you would not list latex allergies, since among medical workers it has become a serious problem, and one that most (all?) people in the medical field are well aware of. Gandydancer (talk) 18:41, 20 December 2009 (UTC)

Anaphylaxis from latex is much less common than allergies to latex. The ref I added lists it so I have no issue with it being there. Anyway please add references and properly format them.Doc James (talk · contribs · email) 19:02, 20 December 2009 (UTC)

It is good to see that you have now changed your mind and have no objections to the addition of latex, since you initally deleted it. As for the way I reference, I have been told that it is acceptable. Gandydancer (talk) 20:06, 20 December 2009 (UTC)

True vs pseudo anaphylaxis contradiction?

In the intro paragraph it says:

... "true" anaphylaxis is always caused directly by 
degranulation of mast cells ... and pseudo-anaphylaxis 
occurs due to all other causes.

But in the pseudoanaphylaxis section it says:

The presentation and treatment of pseudoanaphylaxis
is similar to that of anaphylaxis. It however does not
involve an allergic reaction but is due to direct mast
cell degranulation.

Which of these statements is correct? Or am I misunderstanding what they are saying? --24.190.224.244 (talk) 09:37, 4 March 2010 (UTC)

Fixed I hope.Doc James (talk · contribs · email) 11:11, 4 March 2010 (UTC)

Yes, your change should clarify things. The restrictive clause that the anon replaced with an ellipsis above was absolutely critical to understanding.

As a point of fact, I believe that you could technically achieve pseudoanaphylaxis without degranulating mast cells (e.g., exogenous administration of histamines). I'm not aware of it happening naturally, though. WhatamIdoing (talk) 19:59, 4 March 2010 (UTC)

2 Treatment sections

Could someone please amalgamate the two sections on treatment - there is no need for both.

Why do the bronchioles constrict, why would that would help?

Bronchioles constrict due to the effects of the biogenic amines (primarily histamine) that are released. Histamine causes spasm of the smooth muscle in the small airways of the lungs. Other mediators also cause bronchospasm (particularly the cysteinyl leukotrienes - LTB4, C4 and D4). There is also an effect on the lungs due to other cytokines (such as IL-13 which causes epithelial cells to secrete mucus) and other inflammatory cells brought to the area, particularly eosinophils as part of the delayed phase response. To answer the second part of your question - this does not help. In fact, this is one of the major problems with anaphylaxis and can lead to respiratory failure. The mechanism is similar to that which occurs in asthma - and can be lethal.

Reviews

• Tupper J, Visser S (2010). "Anaphylaxis: A review and update". Can Fam Physician. 56 (10): 1009–11. PMC 2954079. PMID 20944042. {{cite journal}}: Unknown parameter |month= ignored (help)

Doc James (talk · contribs · email) 01:03, 1 December 2010 (UTC)

• [3] --Doc James (talk · contribs · email) 11:02, 6 April 2011 (UTC)

The UK National Institute for Health and Clinical Excellence (NICE) is imminently publishing a guideline on anaphylaxis. This is the page that links to the guideline documents. JFW | T@lk 16:48, 5 December 2011 (UTC)

GA Review

This review is transcluded from Talk:Anaphylaxis/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Axl (talk · contribs) 20:47, 1 December 2011 (UTC)

Okay, I'll review it. Axl ¤ [Talk] 20:47, 1 December 2011 (UTC)

Thanks --Doc James (talk · contribs · email) 20:01, 7 December 2011 (UTC)

From "Signs and symptoms": "Anaphylaxis typically presents with many different symptoms over minutes or hours." Harrison's Principles states "The life-threatening anaphylactic response of a sensitized human appears within minutes after administration of specific antigen". Do Oswalt and Simons really indicate onset over hours? If so, is this truly "rapid in onset"? Axl ¤ [Talk] 21:06, 1 December 2011 (UTC)

Quote is "Clinically, anaphylaxis is considered likely to be present if any one of three criteria is satisfied within minutes to hours" And from the second review in 2009 "Anaphylaxis triggered by red meat thatoccurs 4 to 6 hours after ingestion is due to the oligosaccharide galactose a-1,3 galactose rather than to a protein." I have found a free pdf for the 2009 review--Doc James (talk · contribs · email) 20:01, 7 December 2011 (UTC)

Okay, thanks. Axl ¤ [Talk] 11:47, 8 December 2011 (UTC)

From "Signs and symptoms": "Respiratory symptoms may also be present, including shortness of breath, wheezes or stridor, and low oxygen." Low oxygen is not a symptom. (Technically, stridor isn't a symptom either. Wheezing is sometimes a symptom in the acute setting, but more usually a sign.) Axl ¤ [Talk] 20:50, 1 December 2011 (UTC)

Sure I was hoping to get away with one or the other since they are similar. Will say symptoms and signs.Doc James (talk · contribs · email) 20:06, 7 December 2011 (UTC)

Thanks. Axl ¤ [Talk] 11:58, 8 December 2011 (UTC)

From "Signs and symptoms": "Due to the presence of histamine-releasing cells in the heart, coronary artery spasm may occur with subsequent myocardial infarction or dysrhythmia even in the absence of epinephrine use." Is it reasonable to remove the qualifier "even in the absence of epinephrine use"? Axl ¤ [Talk] 20:53, 1 December 2011 (UTC)

This is important from an ER perspective. MI is typically blamed on Epi. We could move it to the treatment section?Doc James (talk · contribs · email) 20:09, 7 December 2011 (UTC)

A general reader wouldn't necessarily have known that MI in this context is typically blamed on epinephrine use. (Actually I didn't know; I inferred it from the sentence.) Perhaps remove the "epinephrine" comment from the "Signs and symptoms" section and add it to the "Management" section? Perhaps say that epinephrine increases the risk of MI? Axl ¤ [Talk] 14:44, 8 December 2011 (UTC)

Moved with new ref.--Doc James (talk · contribs · email) 06:30, 9 December 2011 (UTC)

Thanks. Axl ¤ [Talk] 12:16, 9 December 2011 (UTC)

From "Signs and symptoms": "A Bezold–Jarisch reflex has been described in 10% of cases, with slow heart rate in association with low blood pressure." Anaphylaxis typically causes tachycardia, doesn't it? It's worth mentioning this before the Bezold–Jarisch reflex. Also, it is worth mentioning "distributive shock" somewhere. Axl ¤ [Talk] 21:14, 1 December 2011 (UTC)

Done--Doc James (talk · contribs · email) 07:49, 9 December 2011 (UTC)

Thanks for mentioning fast heart rate. I don't see distributive shock mentioned anywhere though. Axl ¤ [Talk] 13:28, 9 December 2011 (UTC)

Mention shock here [4] Anaphylaxis can cause shock by cardiogenic mechanisms aswell thus I do not feel mentioning that exact subtype adds anything. --Doc James (talk · contribs · email) 06:19, 15 December 2011 (UTC)

I am surprised that you consider the Bezold–Jarisch reflex to be more relevant than distributive shock. Anaphylaxis is one of the classic causes of distributive shock. The main benefits of epinephrine are vasoconstriction (to increase systemic vascular resistance), relax bronchial smooth muscle, and reduce vascular permeability. Cardiac output plays a minor role. Axl ¤ [Talk] 21:17, 15 December 2011 (UTC)

Okay added.Doc James (talk · contribs · email) 03:55, 16 December 2011 (UTC)

Thank you. Axl ¤ [Talk] 11:29, 16 December 2011 (UTC)

From "Causes", subsection "Medication": "The most common ones include antibiotics (β-lactam antibiotics in particular), aspirin, ibuprofen, and other analgesics." I presume that these are the commonest because they are so commonly prescribed/dispensed? Axl ¤ [Talk] 21:21, 1 December 2011 (UTC)

Partly and partly because they are more allergenic.Doc James (talk · contribs · email) 07:49, 9 December 2011 (UTC)

Could you include that in the article (with a reference)? Axl ¤ [Talk] 13:57, 9 December 2011 (UTC)

Have added it here [5]--Doc James (talk · contribs · email) 06:19, 15 December 2011 (UTC)

Thanks. Axl ¤ [Talk] 14:17, 15 December 2011 (UTC)

From "Causes", subsection "Medication": "Chemotherapy agents and herbal preparations have also been implicated." Why are chemotherapy agents specifically called out? Axl ¤ [Talk] 22:06, 1 December 2011 (UTC)

Diferent agents have different rates of anaphylaxis associated with them. These are sort of mid risk.Doc James (talk · contribs · email) 08:14, 9 December 2011 (UTC)

Okay. I still don't understand why chemotherapy agents have been specifically called out. Axl ¤ [Talk] 19:27, 9 December 2011 (UTC)

The ref does not say why they where singled out. Probably that they are more common than some other types but this is not said directly.--Doc James (talk · contribs · email) 06:19, 15 December 2011 (UTC)

Would you consider removing "chemotherapy agents" from the article? Axl ¤ [Talk] 21:21, 15 December 2011 (UTC)

I have found a book that states "chemotherapy agents are especially implicated" along with a few others I have listed.Doc James (talk · contribs · email) 04:17, 16 December 2011 (UTC)

Thanks. Axl ¤ [Talk] 11:54, 16 December 2011 (UTC)

From "Causes", subsection "Medication": "Some medications (vancomycin, morphine, x-ray contrast among others) cause anaphylaxis by directly triggering mast cell degranulation." Is this truly anaphylaxis (allergy-mediated) or anaphylactoid? Axl ¤ [Talk] 22:02, 1 December 2011 (UTC)

Again, in the "Pathophysiology" section, are non-immunological mechanisms truly "allergic"? Axl ¤ [Talk] 22:56, 1 December 2011 (UTC)

The WHO does not use the term anaphylactoid and includes what was previously this group into anaphylaxis. This distinction is discussed some under diagnosis.Doc James (talk · contribs · email) 08:14, 9 December 2011 (UTC)

Okay, that's fine. Axl ¤ [Talk] 19:36, 9 December 2011 (UTC)

Split 1

From "Causes", subsection "Venom": "Venom from stinging or biting insects such as ... Hemiptera (kissing bugs) may induce anaphylaxis in susceptible people." "Kissing bugs" apparently refer to "Triatominae", a subfamily of Hemiptera. Axl ¤ [Talk] 22:33, 1 December 2011 (UTC)

Change it to Triatominae?Doc James (talk · contribs · email) 08:14, 9 December 2011 (UTC)

The source (Simons) states: "Hemiptera [kissing bugs]". Simons references Peng ("Immune responses to mosquito saliva in 14 individuals with acute systemic allergic reactions to mosquito bites") and Freeman ("Clinical practice. Hypersensitivity to Hymenoptera stings").

This reference clearly and reliably links triatominae with anaphylactic reactions. Axl ¤ [Talk] 20:05, 9 December 2011 (UTC)

The ref says "Kissing bugs belong to the family Reduviidae, subfamily Triatominae in the order Hemiptera, and are referred to as triatomines." Not sure what you are suggesting? Doc James (talk · contribs · email) 06:24, 15 December 2011 (UTC)

I am suggesting that Klotz should used as the reference for "kissing bugs"/triatominae, not Simons. Axl ¤ [Talk] 13:49, 15 December 2011 (UTC)

Added Klotz however it is not a review Doc James (talk · contribs · email) 04:17, 16 December 2011 (UTC)

Well, that's debatable. Klotz does include several illustrative example cases. Also, PubMed does not flag it as a review. On the other hand, over half of the article summarizes the available information in the literature. Anyway, thank you for adding it as a reference. Axl ¤ [Talk] 12:11, 16 December 2011 (UTC)

From "Causes", subsection "Venom": "Previous systemic reactions to stings is a risk factor for future anaphylaxis." What is a "systemic reaction" in this context? Axl ¤ [Talk] 22:35, 1 December 2011 (UTC)

Anything more than a local reaction.Doc James (talk · contribs · email) 08:16, 9 December 2011 (UTC)

lol Then what is a local reaction? The term "systemic reaction" needs clarification in the article. Axl ¤ [Talk] 20:09, 9 December 2011 (UTC)

How is "systemic reactions, which are anything more than a local reaction around the site of the sting" reffed to [6] Doc James (talk · contribs · email) 06:35, 15 December 2011 (UTC)

Thanks. Axl ¤ [Talk] 14:02, 15 December 2011 (UTC)

In "Pathophysiology", I am wary of the weight being given to the IgE-independent immunological mechanism, given that it has not been established in humans. Perhaps it should be given just a single sentence at the end of the "Immunologic" subsection? Axl ¤ [Talk] 23:41, 1 December 2011 (UTC)

Thanks for the review. I am a little under the weather right now. Hopefully will be better and able to address this in a few days... Doc James (talk · contribs · email) 01:26, 4 December 2011 (UTC)

I hope that you're feeling better soon. There is no rush with this article. I am about half-way through the review. I should be able to finish it in the next couple of days. Axl ¤ [Talk] 02:00, 4 December 2011 (UTC)

Shortened. --Doc James (talk · contribs · email) 04:25, 16 December 2011 (UTC)

I have re-written the subsection. Axl ¤ [Talk] 12:56, 16 December 2011 (UTC)

From "Pathophysiology", subsection "Non-immunologic": "These include agents such as ... temperature." Hot or cold temperature? Axl ¤ [Talk] 12:51, 4 December 2011 (UTC)

Either / or.Doc James (talk · contribs · email) 08:16, 9 December 2011 (UTC)

Can you add this information to the article, please? Axl ¤ [Talk] 01:27, 11 December 2011 (UTC)

Yes have here "temperature (either hot or cold)" Doc James (talk · contribs · email) 06:37, 15 December 2011 (UTC)

Er, where? Axl ¤ [Talk] 21:27, 15 December 2011 (UTC)

Thought you where referring to the causes section here [ http://en.wikipedia.org/wiki/Anaphylaxis#Causes]. Have mentioned in both places.--Doc James (talk · contribs · email) 04:25, 16 December 2011 (UTC)

Thanks. Axl ¤ [Talk] 19:27, 24 December 2011 (UTC)

From "Diagnosis": "During an attack, blood tests for tryptase or histamine (released from mast cells) might be useful in diagnosing anaphylaxis due to insect stings or medications, but are of limited utility if the cause is food or the person has a normal blood pressure." Can this long sentence be split? Axl ¤ [Talk] 13:14, 4 December 2011 (UTC)

Sure--Doc James (talk · contribs · email) 04:25, 16 December 2011 (UTC)

Thanks. I have adjusted the text. Axl ¤ [Talk] 19:31, 24 December 2011 (UTC)

From "Prevention": "Oral immunotherapy may be effective at desensitizing some people to certain food including mild." "Milk"? Axl ¤ [Talk] 16:29, 5 December 2011 (UTC)

Thanks. --Doc James (talk · contribs · email) 08:39, 9 December 2011 (UTC)

"Management", subsection "Epinephrine" contains extended details of doses and administration. WP:MEDMOS recommends "Do not include dose, titration or pricing information except when they are extensively discussed by secondary sources, or necessary for the discussion in the article. Wikipedia is not an instruction manual or textbook and should not include instructions, advice (legal, medical or otherwise) or "how-to"s." Axl ¤ [Talk] 16:46, 5 December 2011 (UTC)

Yes I know. It is tough as this is extensively covered in secondary sources. Have removed the exact dosing.Doc James (talk · contribs · email) 08:17, 9 December 2011 (UTC)

Thanks. I have removed the concentrations from the article. Axl ¤ [Talk] 01:31, 11 December 2011 (UTC)

The "Prognosis" section needs to be expanded. Axl ¤ [Talk] 21:10, 5 December 2011 (UTC)

Have combined into epidemiology as their is not sufficient content.Doc James (talk · contribs · email) 20:30, 9 December 2011 (UTC)

Moving the text into "Epidemiology" isn't the solution. The "Prognosis" information needs to be expanded. Axl ¤ [Talk] 01:33, 11 December 2011 (UTC)

Managed to dig some stuff up from textbooks and expanded :-) Doc James (talk · contribs · email) 05:00, 16 December 2011 (UTC)

Thanks. That looks a bit better. (I have adjusted the text.) Axl ¤ [Talk] 12:23, 27 December 2011 (UTC)

From "Epidemiology": "Lifetime prevalence of anaphylaxis is estimated at between 0.05–2% globally or 4 to 50 per 100,000 persons per year. Rates appear to be increasing: prevalence in the 1980s was approximately 20 per 100,000 per year, while in the 1990s it was 50 per 100,000 per year." There is confusion between "prevalence" and "incidence" here. Axl ¤ [Talk] 21:23, 5 December 2011 (UTC)

Thanks Doc James (talk · contribs · email) 08:41, 9 December 2011 (UTC)

I have adjusted the syntax. Axl ¤ [Talk] 16:05, 11 December 2011 (UTC)

• If I can chip in with an outside comment: my impression is that I've more frequently encountered the term "anaphylactic shock" than "anaphylaxis" per se -- it might be good if the article dealt explicitly with that term, especially since it redirects here. Looie496 (talk) 17:20, 5 December 2011 (UTC)

Yes anaphylactic shock specifically refers to anaphylacis with a BP 30% less usual. Will add.Doc James (talk · contribs · email) 08:26, 9 December 2011 (UTC)

Review article pending publication

I am wanting to combine the NICE guideline into this article as it is coming out this month.[7] Hopefully can use it to clarify the last couple of remaining comments.Doc James (talk · contribs · email) 08:43, 9 December 2011 (UTC)

Review is out. It does not really add anything. Any further comments?Doc James (talk · contribs · email) 10:25, 22 December 2011 (UTC)

Opinion

Wondering if I could get peoples opinion on "with 2–20% of cases resulting in death.[8]" This seems high to me, but that is what the ref says... Doc James (talk · contribs · email) 04:48, 16 December 2011 (UTC)

Found another ref which says 0.7% --Doc James (talk · contribs · email) 05:03, 16 December 2011 (UTC)

Diagnosis in a table

What do people think of this change? Doc James (talk · contribs · email) 17:17, 9 December 2011 (UTC)

It's more confusing. Does diagnosis require involvement of the skin/mucosa and respiratory difficulty/low blood pressure and two or more of the specific symptoms and low blood pressure after exposure to a known allergen? (I know the answer, but the format was less confusing before.) Axl ¤ [Talk] 17:53, 9 December 2011 (UTC)

Have adjusted the table and readded the other format... --Doc James (talk · contribs · email) 18:10, 9 December 2011 (UTC)

Now the information is duplicated. I don't think that table format adds anything; it should be deleted. Axl ¤ [Talk] 01:23, 11 December 2011 (UTC)

Sure removed. --Doc James (talk · contribs · email) 06:37, 15 December 2011 (UTC)

Summary

1. The article is clear and well-written.
2. The text is accurate, with appropriate reliable references.
3. The article covers the topic thoroughly, without excessive detail.
4. The article presents information with a neutral viewpoint.
5. The article is stable; there is no edit war.
6. The pictures are all free images from Wikimedia Commons. They are appropriately used in this article to complement the text.

I am awarding GA status. My thanks and congratulations to Doc James.

For future improvement, several subsections would benefit from expansion. Also, many of the reference titles have two full stops (periods), which should be fixed.

Axl ¤ [Talk] 12:50, 27 December 2011 (UTC)

"Post-mortem findings"

The "Diagnosis" section has a new subsection: "Post-mortem findings". This subsection has several problems with it. I have removed some of the syntax and formatting problems. However it is filled with medical jargon. Also, it is unclear to me why blood test findings are included in this subsection. Axl ¤ [Talk] 14:50, 26 January 2012 (UTC)

Feel free to remove it. I have not had time to look into things.--Doc James (talk · contribs · email) 18:41, 27 January 2012 (UTC)

Most-mortem blood tests may be used, particularly when a death is otherwise unexplained. A prime example is postmortem toxicology in cases where poisoning may have contributed. JFW | T@lk 21:11, 28 January 2012 (UTC)

"Vasodilation (in anaphylasis) is caused by IgE-mediated and non–IgE-mediated histamine release by the mast cells". Also, increase in total and specific IgE serum levels could be detected by RAST (radioallergosorbent test) or ELISA (Enzyme-linked immunosorbent assay). vldscore

My concern is not with the factual accuracy. Rather it is for comprehension by the lay reader.

JFW, of course you are aware these blood tests are useful in living patients. So why is this information in the "Post-mortem findings" section? It is not specific to fatal cases. Axl ¤ [Talk] 22:59, 29 January 2012 (UTC)

Perhaps we should emphasise that these tests have some use in postmortem analysis also. JFW | T@lk 21:02, 31 January 2012 (UTC)

Missing Anchor / Topic: Anaphylaxis#Exercise-induced anaphylaxis

In various articles (particularly in relation to wheat allergy etc.) there are links to "Exercise-induced anaphylaxis". This redirects to Anaphylaxis#Exercise-induced anaphylaxis, which section does not currently exist. Chrisyoung1974 (talk) 13:52, 16 October 2012 (UTC)

Errors in the article.

I made several edits that have been undone.

Rather than get precious about the exact wording, here are the main points of contention:

Anaphylaxis is solely IgE mediated - no it is not, it is also IgG mediated, and I provided a reference to validate this. This therefore should stand as the reference was published material. Merely that others fail to mention it does not refute the science, it merely shows that it is poor material.

Non-immune mediated "Anaphylaxis". The article as is gets itself in knots talking about pseudo-anaphylaxis and non-immune mediated anaphylaxis even though anaphylaxis is by definition immune mediated as the article states elsewhere. These are referred to as "anaphylactoid". Even the mEDRA terms for Pharmacovigilance make this distinction under these headings.

Adrenaline has no contraindications - again, a quick look at the Summary of Product Characteristics shows that it does have listings under 4.3 - so again this is demonstrably wrong. — Preceding unsigned comment added by 176.252.136.15 (talk) 21:32, 2 December 2012 (UTC)

I conducted this article's GA review a year ago. At that time, I too was concerned about the issue of "non-immunological anaphylaxis". Doc James assures me that the WHO has categorized "anaphylactoid reaction" as part of "anaphylaxis".

Prior to my review, there was significant information about IgG-mediated anaphylaxis in the article. However I was concerned by the lack of data describing this mechanism in humans. Therefore we agreed to cut this information to just a single sentence. In "Pathophysiology", subsection "Immunologic": "There is also an immunologic mechanism that does not rely on IgE, but it is not known if this occurs in humans." I am happy to review this if there are now WP:MEDRS-compliant secondary sources describing this in humans. Axl ¤ [Talk] 20:57, 5 December 2012 (UTC)

The nomenclature was revised in 2001 (doi:10.1111/j.1398-9995.2001.00002.x-i1). It was recognised that not all anaphylaxis is IgE-mediated, but that clinical management is identical. JFW | T@lk 22:11, 5 December 2012 (UTC)

There are no absolute contraindications for the use of epi in anaphylaxis. There is a ref to support this. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:44, 5 December 2012 (UTC)

Angioedema

Concerning #Skin, I reviewed reference 6 and, unless the medical community uses the term "e.g." (for example) differently than most others, I revised the statement to describe swelling, specifically angioedema, of the afflicted tissues rather than solely that of the lips. If there was a reason for the previous wording, please correct that portion of my edit; otherwise — and except for providing an example of steroid use under #Management —, it was strictly clean-up. JamesEG (talk) 19:50, 4 July 2013 (UTC)

Used a specific part as an example to keep the wordier clearer, but yes swelling can occur in any tissue. Swelling of the airway however is of course more concerning. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:47, 4 July 2013 (UTC)

Diagnosis

I think the following change to that section would be an improvement compared to the present summary of the source document, though perhaps it is a bit too terse for most readers. However, I am not a physician, so, perhaps it is silly, but I'll only make the change if one such approves it. Or whatever: you could be a Barbary pirate, for all I'd know. JamesEG (talk)

Anaphylaxis is highly likely with analytic diagnosis of the following symptoms:

1. Acute onset (minutes to several hours) of an illness involving the skin and/or mucosal tissue — for example, generalized hives, itchiness, flushing, or swelling (angioedema) of the afflicted tissues — and at least one of the following:
   1. Respiratory difficulties (e.g., shortness of breath, wheezes or bronchospasm, stridor, reduced peak expiratory flow, hypoxemia)
   2. Reduced blood pressure or associated symptoms of bodily dysfunction — such as weak posture, falling, lessened muscular response, fainting, incontinence

If exposure to a likely allergen is known, onset (also minutes to several hours) of the following two or more symptoms can be used by a medical expert:

1. Involvement of the skin or mucosal tissues, as described above
2. respiratory difficulties, as above
3. Reduced blood pressure or associated symptoms, as above
4. Persistent gastrointestinal symptoms, such as crampy abdominal pain or vomiting

If a known allergen was encountered, the occurance (also minutes to several hours) of reduced blood pressure, determined by:

1. Infants and children: low systolic blood pressure (which is depentant on age) or a greater than 30% decrease in systolic blood pressure
2. Adults: systolic blood pressure of less than 90 mm Hg or a decrease farther than 30% from that person’s baseline

can be used by a medical expert to diagnose anaphylaxis.

JamesEG (talk) 21:42, 4 July 2013 (UTC)

The current wording IMO is less complicated and IMO should thus be prefered. Never used the phrase "analytic diagnosis" before for example. Additionally one can simply say "within minute or hours" and leave the technical term acute out all together. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:53, 4 July 2013 (UTC)

Text

"The wasp species Ropalidia romandi is known to have a particularly dangerous sting.<refQueensland Museum (2011). "Paper Wasps: Fact Sheet" (PDF). Queensland Government.</ref>"

I do not see in this text that they cause more anaphylaxis? Doc James (talk · contribs · email) 05:45, 10 November 2014 (UTC)

The source is about three genera: Polista, Romalidia and Vespula. The source mentions anaphylaxis, but not particularly with one species/genus. In any case, the source is about paper wasps, not anaphylaxis. Therefore the source should not be used for this article; it would be undue weight. Axl ¤ [Talk] 10:57, 10 November 2014 (UTC)

There is inconsistency between the introduction section:
"The term comes from the Ancient Greek: ἀνά ana against, and the Ancient Greek: φύλαξις phylaxis protection."
and the history section:
"The term comes from the Greek words ἀνά, ana, up, and φύλαξις, phylaxis, protection." --141.135.64.119 (talk) 09:02, 6 December 2015 (UTC)

contradiction with Benadryl / Diphenhydramine article

I have been told, in a recent advanced first aid training, that Benadryl (from memory, I may be mistaken!) was used to treat patients after an Epinephrine ("Epipen" and similar) injection, as the effect of the epipen lasts only a few minutes. Yet that is enough time for the anti-histaminic to have a more long-term effect through the digestive system.

Yet this article explicitely states, in Anaphylaxis#Adjuncts, that:

Antihistamines (both H1 and H2), while commonly used and assumed effective based on theoretical reasoning, are poorly supported by evidence. A 2007 Cochrane review did not find any good-quality studies upon which to base recommendations and they are not believed to have an effect on airway edema or spasm.

Now, the Diphenhydramine#Medical_uses (AKA Benadryl), a "first-generation antihistamine", or, as stated above, a H1) article states the contrary:

It is frequently used when an allergic reaction requires fast, effective reversal of a massive histamine release. Diphenhydramine is available as an over-the-counter drug or prescription-only solution for injection. Injectable diphenhydramine can be used for life-threatening reactions (anaphylaxis) to allergens such as bee stings, peanuts, or latex, as an adjunct to epinephrine.

Now, I don't have a bias either way - Benadryl is pretty heavy medication and histaminics do not always have clear means of operation... But if it works, and can save lives, it should probably be noted here. Someone with more of a clue or more researches should probably clarify this stuff, for sure. Note that the review mentionned in the Anaphylaxis#Adjuncts article dates from 2007 and the reference from the Benadryl dates from later, in 2011. However, there's a second reference from 2011 in the Anaphylaxis#Adjuncts article. :( --TheAnarcat (talk) 02:27, 16 February 2016 (UTC)

Looks like the benedryl article needs fixing. Will have a look. Doc James (talk · contribs · email) 11:59, 16 February 2016 (UTC)

Hmm... what did you change exactly? I don't feel the contradiction is really resolved here. Furthermore, there *were* sources for the Benadryl effectivemness article, which were published at around the same time as the contradicting sources in this article. For me, the situation is still unclear. --TheAnarcat (talk) 19:22, 16 April 2016 (UTC)

I made these edits [8] Doc James (talk · contribs · email) 13:47, 17 April 2016 (UTC)

It is not clear to me how those edits relate to the issue at hand. It seems to me critical that the preferred "post-epipen medication" be clarified here.--TheAnarcat (talk) 19:08, 1 August 2016 (UTC)

The prefered post epi med? That depends on the situation. If you still have significant symptoms the prefered post epi med is more IM epi. And then if you are not better it is more IM epi again. And then if you are still not better one might move to iv epi or if you are on beta blockers glucagon. You can thrown in some diphenydramine, ranitidine, and steroids but are not to fool yourself that these at any time replace epi. At least that is my reading of the literature. Doc James (talk · contribs · email) 07:43, 2 August 2016 (UTC)

US Death Rate

The article includes "Currently, anaphylaxis leads to 500–1,000 deaths per year (2.4 per million) in the United States, 20 deaths per year in the United Kingdom (0.33 per million), and 15 deaths per year in Australia (0.64 per million)."

It seems odd that the rate in the US is seven time higher than in the UK. I have found this [9] that gives a much lower rate (0.86 per million) in a recent US study. MB 16:03, 13 July 2017 (UTC)

Per ths source "These results indicate that the US has one of the highest prevalences of fatal anaphylaxis in the world". Appears to be based on a 2010 study.

What we have in the article is based on this source [10] which is a peer reviewed review article.

Have added this estimate aswell.Doc James (talk · contribs · email) 20:56, 13 July 2017 (UTC)

Diagnosis, 2nd bullet

Hello James or Wakkie1379, you really think, that involvement of the skin or mucosa AND gastrointestinal symptoms together means anafylaxis? Urtica and diarrhea after strawberries? --DRobert (talk) 08:15, 28 May 2018 (UTC)

Not the editors' fault, this is straight from the first table in the WAO guidelines.[11]. JFW | T@lk 17:33, 28 May 2018 (UTC)

And your opinion is that's right? Only skin and intestinal problems? Iḿ only poor anesthesiologist :), but I call it allergy. OK, I will ask my histamine friends. Its bad formulation in guidelines, I'ḿ afraid.--DRobert (talk) 18:48, 29 May 2018 (UTC)

The bar for anaphylaxis has decreased over the years. Doc James (talk · contribs · email) 19:20, 29 May 2018 (UTC)

Preferred post-epipen medication?

To followup on a conversation that was archived while I was gone...

The prefered post epi med? That depends on the situation. If you still have significant symptoms the prefered post epi med is more IM epi. And then if you are not better it is more IM epi again. And then if you are still not better one might move to iv epi or if you are on beta blockers glucagon. You can thrown in some diphenydramine, ranitidine, and steroids but are not to fool yourself that these at any time replace epi. At least that is my reading of the literature. Doc James (talk · contribs · email) 07:43, 2 August 2016 (UTC)

So I believe the advice I got in my "advanced remote areas first aid training" was that Benadryl would indeed *follow* administration of Epipen medication. I guess that correlates with the current statement in the Benadryl page:

By injection it is often used in addition to epinephrine for anaphylaxis. Its use for this purpose had not been properly studied as of 2007. Its use is only recommended once acute symptoms have improved.

The situation(s) I am expecting (but obviously not hoping for) are when I travel in a remote area without access to proper medical facilities. IV, extra epi, any assistance is out of the question. The best case scenario is that the allergic person was smart enough to bring *one* epipen, but considering evacuation might take hours, I want to be able to keep the person stable in the long term. My understanding of the Epipen is that it lasts long enough to bring the patient to the hospital for further treatment, which is often impossible (in the short term) in the situations I end up with. My hope is that Benadryl pills might provide the necessary stabilization until we evacuate properly. But maybe that's naïve? In any case, I guess I should talk this over the counter with my pharmacist instead of asking Wikipedia. ;) Thanks for the references anyways, the drugs.com and literature review are especially interesting: from what I understand, they "neither confirm nor deny" the practice, but it's still a commonly used pattern to treat severe allergic reactions... --TheAnarcat (talk) 20:34, 6 July 2019 (UTC)

If one still has significant symptoms 5 min after a dose of epi, one gives more epi. Doc James (talk · contribs · email) 04:56, 7 July 2019 (UTC)

References

Inaccuracies in "Management"

Several allergy medications are described as being substitutes in beer. This is misleading and does not make sense. 72.134.116.163 (talk) 00:51, 2 September 2020 (UTC)

The word "beer" does not occur in the text - I think you might have misread! JFW | T@lk 15:00, 2 September 2020 (UTC)

Cleanup needed

Attention to wikilinking is needed, and there is text sourced to 2011 sources that needs repair. It appears that the article has not been updated since the 2011 GA review. SandyGeorgia (Talk) 02:11, 17 March 2021 (UTC)

Pathophysiology

Re: "Pathophysiology - Immunologic" My understanding is that mast cells and basophils are studded with IgE, and antigen binds membrane-bound IgE causing cross-linking and degranulation. This section emphasizes that the first step in the mechanism is antigen binding plasma IgE, then antigen-IgE complex binding FCER1 causing degranulation. Thoughts? 2600:6C64:647F:FF7A:3D62:38DB:396A:34BC (talk) 03:12, 14 August 2022 (UTC)