Anaphylaxis for Internists: Definition, Evaluation, and Management, with a Focus on Commonly Encountered Problems

Abstract

Anaphylaxis is an acute systemic allergic reaction that can be life threatening. In adults, the most common causes of anaphylaxis are foods, drugs, and insect stings. This article reviews the definition, classification, evaluation, differential diagnosis, prognosis, complications, and management of anaphylaxis. Tailored for internists, the article focuses on anaphylactic medication allergies. It provides a guide to optimally evaluate and manage patients with antibiotic allergy using a simple, rapid risk stratification technique, graded antibiotic challenge (test dose), and/or allergist-guided drug desensitization. It also reviews other causes of anaphylaxis that internists are likely to encounter, and an approach to their management.

Keywords: Anaphylaxis; Antibiotic allergy (including penicillin and cephalosporin β-lactams); Desensitization; Epinephrine; Graded challenge (test dose); Meta-analysis; Type I hypersensitivity (immediate hypersensitivity); Urticaria and pseudoallergy.