Anaphylaxis DDx

Overview

Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction. It is characterised by rapidly developing life-threatening airway (pharyngeal or laryngeal edema) and/or breathing (bronchospasm and tachypnea) and/or circulation (hypotension and tachycardia) problems usually associated with skin and mucosal changes.

Causes of Anaphylaxis

Common

  • Insect stings (most commonly honeybee, ants, wasps)
  • Foods (most commonly peanuts, tree nuts, and seafood in adults; eggs, cows milk, dairy products, seeds, and fruit in children)
  • Medications (most commonly antibiotics, non-steroidal anti-inflammatory drugs, contrast-induced anaphylactoid reactions, immunotherapy)
  • Unidentified (no cause found, more than 50% of cases)

Uncommon

  • Physical triggers (exercise, heat, cold, UV light)
  • Biological fluids (transfusions, immunoglobulin, antivenoms, semen)
  • Latex
  • Tick bites
  • Hormonal changes (breastfeeding, menstrual factors)
  • Dialysis membranes (haemodialysis-associated anaphylaxis)
  • Hydatid cyst rupture
  • Aeroallergens (domestic/laboratory animals, pollen)
  • Food additives (monosodium glutamate, metabisulfite, preservatives, colours, natural food chemicals)
  • Topical medications (antiseptics)

Differential diagnosis of conditions that mimic anaphylaxis

  • Tissue swelling
    • Idiopathic urticaria
    • Isolated angioedema
      • Idiopathic
      • Angiotensin-converting enzyme inhibitor-induced
      • Acquired or hereditary C1 esterase inhibitor deficiency
  • Conditions mimicking upper airway oedema
    • Dystonic reactions mimicking symptoms of a swollen tongue
    • Acute oesophageal reflux (sudden onset of painful throat “swelling”)
  • Flushing syndromes
    • Peptide-secreting tumours (eg, carcinoid syndrome, VIPomas)
    • Alcohol-related
    • Medullary carcinoma of thyroid
    • Red man syndrome (associated with vancomycin infusion)
  • Neurological syndromes
    • Epileptic seizure
    • Stroke
  • Other causes of collapse
    • Vasovagal episodes
    • Systemic inflammatory response syndrome
    • Shock due to other causes
  • Acute respiratory distress
    • Asthma
    • Panic disorders
    • Globus hystericus
    • Laryngospasm
    • Vocal cord dysfunction
  • Miscellaneous
    • Scombroid fish poisoning
    • Serum sickness
    • Phaeochromocytoma
    • Systemic mastocytosis

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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