What do we know? The incidence rate of anaphylaxis is increasing, especially in young
Reviews and feature articleAnaphylaxis: Recent advances in assessment and treatment
Section snippets
Epidemiology
The true rate of occurrence of anaphylaxis from all triggers in the general population is unknown.3, 4 Community-based population estimates are difficult to evaluate because of under-diagnosis and under-reporting, as well as miscoding and the use of a variety of case definitions and measures of occurrence.4, 5, 6 Despite this, it is clear that anaphylaxis is not rare and that the rate of occurrence is increasing, especially in the first 2 decades of life.7, 8, 9 In a retrospective,
Pathogenesis
An understanding of potential triggers, mechanisms, and patient-specific risk factors in anaphylaxis is the key to performing an appropriate risk assessment in someone who has previously experienced an acute anaphylaxis episode (Fig 1).1, 3, 15, 16
Risk assessment: Diagnosis of anaphylaxis
Anaphylaxis is unpredictable and can occur in anyone, anywhere, at any time. It is underrecognized by patients and underdiagnosed by health care professionals.6
Risk assessment: Confirmation of the anaphylaxis trigger
In each patient with a history of anaphylaxis, it is important to identify and confirm the trigger and the effector mechanism, because most long-term preventive measures are trigger-and mechanism-specific.
Long-term risk reduction: Preventive measures
Long-term preventive measures to reduce the risk of fatality in patients with anaphylaxis include optimal management of relevant comorbidities such as asthma, cardiovascular disease, and mastocytosis, and awareness of other concomitant factors as described in the “Patient-specific risk factors” section, as well as trigger avoidance and immunomodulation (Fig 2).1, 3, 15
Long-term risk reduction: Emergency preparedness
Anaphylaxis sometimes recurs despite relevant avoidance measures and immunomodulation. When this happens, it is impossible to predict whether the patient will die within minutes, respond to treatment, or recover spontaneously because of endogenous compensatory mechanisms such as secretion of epinephrine, angiotensin II, and endothelin I.16 Therefore, those at risk, and their caregivers and friends should be prepared to recognize and treat unanticipated recurrences of anaphylaxis in the
Summary
This clinical review has highlighted important recent advances leading to a better understanding of anaphylaxis epidemiology, pathogenesis, risk assessment, and long-term risk reduction in the community. These advances are summarized in the text box “What do we know?” Despite the excellent progress made in the past few years, many crucial questions remain to be answered, as summarized in the text box “What is still needed?”
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Series editors: Donald Y.M Leung, MD, PhD, and Dennis K. Ledford, MD