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Review
. 2024 Jun 11;17(6):100904.
doi: 10.1016/j.waojou.2024.100904. eCollection 2024 Jun.

Identifying patients at risk of anaphylaxis

George DuToit  1 , Pete Smith  2 , Antonella Muraro  3 , Adam T Fox  4 , Graham Roberts  5 , Johannes Ring  6 , Margitta Worm  7
Affiliations
Review

Identifying patients at risk of anaphylaxis

George DuToit et al. World Allergy Organ J. .

Abstract

Anaphylaxis is an acute, potentially fatal, systemic hypersensitivity reaction that warrants prompt diagnosis and management. It continues to be challenging to anticipate who may be at risk of a severe, life-threatening allergic reaction. Anaphylaxis can be caused by a range of allergens, such as certain foods, medications, latex, insect stings, etc. Cofactors that augment the severity of clinical symptoms and increase the risk of poor outcomes include exercise, stress, infectious diseases, underlying mast cell disease, active allergic disease such as asthma, advanced age, intake of certain medications, history of previous anaphylaxis, and delayed or missed administration of adrenaline. According to the European Anaphylaxis Registry, food is the major elicitor of anaphylaxis, especially eggs, cow milk, and nuts, in children and adolescents. Reaction to insect venom has also been noted in young adulthood. Early recognition of signs and symptoms and prompt treatment are crucial in anaphylaxis management to avoid serious and even fatal outcomes. It is crucial for both individuals and clinicians to identify the cause of anaphylaxis. Biomarkers of anaphylaxis, such as histamine, tryptase, platelet activation factor (PAF), chymase, carboxypeptidase A3, dipeptidyl peptidase I (DPPI), basogranulin, CCL-2, hsa-miR-451a, may be useful in diagnosis and management. The purpose of this review article is to present a comprehensive overview of current evidence and expert opinions regarding the risk factors that predispose individuals to anaphylaxis. Additionally, it provides insights into potential biomarkers and genetic markers for accurate diagnosis and management. This review underscores the significance of expert guidance in enhancing patient outcomes and enabling self-management of anaphylactic episodes.

Keywords: Anaphylaxis; Biomarkers; Prevention and control; Risk factors; Self-management.

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Conflict of interest statement

George DuToit has received financial funding and honorarium from Aimmune and DBV. He has received speaker fees from BSAG, ALK-Abello, and DBV. Peter Smith received research grant from Mylan (now Viatris), GSK and Sanofi. He has also received honoria for participating in AZ and Viatris Advisory Boards. Antonella Muraro serves as a consultant for Novartis, Viatris, DVB Technology, and Aimmune Therapeutics Ireland. She has received speaker fees from Novartis, Viatris, DVB Technology, Nestle Health Sciences and Aimmune Ireland. Adam T Fox serves as a member of consultant for Independent Drug Monitoring Committee for ALK-Abello sublingual immunotherapy trials and has received consultancy fees from GS1 and LG. Graham Roberts has received consultant fees from ALK-Abello, Viatris, DBV, and Astra Zeneca. Johannes Ring serves as a consultant for Viatris. He has received speaker fees from Galderma, Viatris, Bencard, Sanofi and AbbVie. Margitta Worm has received speaker fees from ALK-Abelló Arzneimittel GmbH, Mice Service GmbH, Bencard Allergie GmbH Novartis AG, Biotest AG, Actelion Pharmaceuticals Deutschland GmbH, Sanofi-Aventis Deutschland GmbH, HAL Allergie GmbH, Aimmune Therapeutics UK Ltd., Lilly Deutschland GmbH, med update GmbH, streamedup! GmbH, DERFO mbH, Meinhardt Congress GmbH, Phadia GmbH, Agentur Herzberg, ECM GmbH, Amgen GmbH, FomF GmbH. She also received honoria from Bencard Allergie GmbH, Novartis Pharma GmbH, Biotest AG, Sanofi-Aventis Deutschland GmbH, HAL Allergie GmbH, DBV Technologies S.A., Aimmune Therapeutics UK Ltd., Regeneron Pharmaceuticals, Inc, Mice Service GmbH, Leo Pharma GmbH, Boehringer Ingelheim Pharma GmbH & Co.KG, Stallergenes GmbH, Swixx Biopharma, RTI Health Solutions, Pharm Research Associates (UK) Ltd, AstraZeneca GmbH, Worg Pharmaceutics (Hangzhou) Co. Ltd. for participating as an advisory board member.

Figures

Fig. 1
Fig. 1
Guidance for the assessment of an anaphylactic event: check list of crucial questions.
See this image and copyright information in PMC

References

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