Anaphylactoid reaction

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vidit Bhargava, M.B.B.S [2]

Synonyms and keywords:

Overview

Definition

Anaphylactoid reaction or pseudo allergic reaction is defined as a condition presenting with symptoms similar to an allergic reaction but without detectable immunological sensitization, as found in classical allergic reactions. (Raised IgE levels in blood)

Historical Perspective

Classification

Pathophysiology

The pathophysiological mechanism behind anaphylactoid reactions is not clear. One of them is direct histamine release and release of other mediators caused by some drugs such as such as opioids, intravenous narcotics, colloid volume substitutes on gelatin basis, radiographic contrast media, and others. [1] [2] [3] [4] [5] Direct activation of complement system and kinin-kallikrenin system may also play a role in the development of these reactions. [6] Local anesthetics or stress can induce neuropsychogenic reflexes in the body leading to release of mediators. Involvement of mast cells and basophils has also been found to play a role in the pathogenesis of anaphylactoid reaction.

Causes

Differentiating Anaphylactoid Reaction From Other Diseases

Epidemiology and Demographics

Risk Factors

Diagnosis

History

Symptoms

The clinical features are quite similar to anaphylaxis, however the presentation is almost always milder. Most commonly the syndrome begins with involvement of the skin, usually as pruritus, flush, urticaria or angioedema. Paresthesia's, itching of pharynx and genital area, and feeling of anxiety are common symptoms. Almost all organ systems may be involved as explained below:

Respiratory

  • Sneezing or rhinorrhea is the earliest manifestation.
  • Hoarseness or throat tightness
  • Cough and wheezing
  • Change of voice (dysphonia)
  • Dyspnea due to laryngeal obstruction
  • Cyanosis or even respiratory arrest may occur

Gastrointestinal

  • Nausea and cramping
  • vomiting and diarrhea
  • Micturition and defecation


Cardiovascular

  • Tachycardia
  • Hypotension
  • Arrythmia
  • Shock
  • Cardiac arrest

The following system of grading is sometimes used to grade the severity of reactions:

Symptoms


Skin


Abdomen Respiratory


Cardiovascular


Grade I Pruritus, flush, urticaria, angioedema - - -
Grade II Pruritus, flush, urticaria, angioedema Nausea, cramping Rhinorrhea, hoarseness, dyspnea Tachycardia, arrhythmia
Grade III Pruritus, flush, urticaria, angioedema Vomiting, defecation, diarrhea Laryngeal edema, bronchospasm, cyanosis Shock
Grade IV Pruritus, flush, urticaria, angioedema Vomiting, defecation, diarrhea Respiratoy arrest Cardiac arrest

Adapted from Ring and Mesmer

Physical Examination

Laboratory Findings

Treatment

Prophylaxis

References

  1. Doenicke, A.; Ennis, M.; Lorenz, W. (1985). "Histamine release in anesthesia and surgery: a systematic approach to risk in the perioperative period". Int Anesthesiol Clin. 23 (3): 41–66. PMID 2411666.
  2. Levi, R. (1972). "Effects of exogenous and immunologically released histamine on the isolated heart: a quantitative comparison". J Pharmacol Exp Ther. 182 (2): 227–38. PMID 4114900. Unknown parameter |month= ignored (help)
  3. Lorenz, W.; Doenicke, A.; Dittmann, I.; Hug, P.; Schwarz, B. (1977). "[Anaphylactoid reactions following administration of plasma substitutes in man. Prevention of this side-effect of haemaccel by premedication with H1- and H2-receptor antagonists (author's transl)]". Anaesthesist. 26 (12): 644–8. PMID 23706. Unknown parameter |month= ignored (help)
  4. Gehrhardt, B. (1991). "[Dental assistant. Situation of dental assistant in France]". Quintessenz J. 21 (9): 807–9. PMID 1819105. Unknown parameter |month= ignored (help)
  5. "Management of anaphylactic and anaphylactoid reactions during anesthesia - Springer". Retrieved 14 January 2014.
  6. Caine, M. (1986). "Clinical experience with alpha-adrenoceptor antagonists in benign prostatic hypertrophy". Fed Proc. 45 (11): 2604–8. PMID 2428670. Unknown parameter |month= ignored (help)