Resumo
定义
病史和体格检查
关键诊断因素
- acute onset
- airway swelling (angio-oedema)
- inspiratory stridor and hoarse voice
- shortness of breath
- wheezing, chest hyperinflation, and accessory muscle use
- cyanosis
- respiratory arrest
- pale, clammy skin
- hypotension
- increased pulse rate (tachycardia)
- bradycardia
- cardiac arrest
- confusion or disorientation
- urticaria (hives)
- erythema
- pruritus
- rhinitis
- bilateral conjunctivitis
其他诊断因素
- risk factors
- nausea, vomiting, diarrhoea, and incontinence
- abdominal cramps and pain
- agitation, anxiety, and a sense of impending doom (angor animi)
危险因素
- adult age: food-, insect venom- and medicine-related
- <30 years old: food-associated, exercise-induced
- female sex
- atopy/asthma
- history of anaphylaxis
- exposure to a common sensitiser (e.g., latex)
诊断性检查
首要检查
- mast cell tryptase
- 12-lead ECG
- blood gases
- urea and electrolytes
需考虑的检查
- chest x-ray
治疗流程
presumed anaphylaxis: in cardiorespiratory arrest
presumed anaphylaxis: not in cardiorespiratory arrest
after initial treatment: not in cardiorespiratory arrest
post-anaphylaxis
撰稿人
专家顾问
Alexander Alexiou, MB BS BSc DCH FRCEM Dip IMC RCSEd
Emergency Medicine Consultant
Barts Health NHS Trust
Physician Response Unit Consultant
London’s Air Ambulance
Royal London Hospital
London
UK
利益声明
AA declares that he has no competing interests.
Thomas Palmer, BSc MBChB FRCEM
Emergency Medicine Consultant
Royal London Hospital
London
UK
利益声明
TP declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:
Doerthe Adriana Andreae MD
Assistant Professor
Pediatric Allergy and Immunology
Penn State Health Milton S. Hershey Medical Center
Hershey
PA
Michael Henning Andreae MD
Associate Professor
Department of Anesthesiology
Penn State Health Milton S. Hershey Medical Center
Hershey
PA
利益声明
DAA is author of an UpToDate article on food allergy and a number of references cited in this topic. MHA is an author of a reference cited in this topic.
同行评议者
Robert Taylor, MBChB MRCP(UK) MRCP(London) DipMedTox DipTher PGDME FHEA FRCEM
Acute Hospital Sub Dean (Cornwall)
Honorary Clinical Senior Lecturer
Consultant Emergency Physician
The Knowledge Spa
Royal Cornwall Hospital
Truro
UK
利益声明
RT declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Resuscitation Council (UK). Emergency treatment of anaphylactic reactions: guidelines for healthcare providers. May 2021 [internet publication].全文
Cardona V, Ansotegui IJ, Ebisawa M, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020 Oct;13(10):100472.全文 摘要
National Institute for Health and Care Excellence. Anaphylaxis: assessment and referral after emergency treatment. August 2020 [internet publication].全文
Muraro A, Worm M, Alviani C, et al. EAACI guidelines: anaphylaxis (2021 update). Allergy. 2022 Feb;77(2):357-77.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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