Differential diagnosis of anaphylaxis in children and adults
- John M Kelso, MD
John M Kelso, MD
- Section Editor – Anaphylaxis
- Division of Allergy, Asthma, and Immunology
- Scripps Clinic, San Diego, CA
- Ronna L Campbell, MD, PhD
Ronna L Campbell, MD, PhD
- Associate Professor of Emergency Medicine
- Mayo Clinic
Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death . The diagnosis may be readily apparent in patients with a clear history of exposure to a known or likely allergen in the minutes or few hours preceding onset of characteristic symptoms in several body systems. However, anaphylaxis is not always easy to diagnose, as the symptoms and signs overlap with those of many other disorders [1-3].
Disorders that may present with similar symptoms and signs to anaphylaxis in children and adults will be reviewed here. The differential diagnosis of anaphylaxis in infants (ie, children under two years of age) and in pregnant women during labor and delivery is reviewed elsewhere. The rapid recognition and acute treatment of anaphylaxis are also presented separately. (See "Anaphylaxis in infants" and "Anaphylaxis in pregnant and breastfeeding women" and "Anaphylaxis: Emergency treatment".)
CLINICAL DIAGNOSIS OF ANAPHYLAXIS
The diagnosis of anaphylaxis is based on recognition of characteristic symptoms and signs occurring within minutes to a few hours after exposure to potential triggering agents or events. These symptoms and signs may include itching, flushing, urticaria, angioedema, hoarseness, throat tightness, stridor, wheezing, coughing, shortness of breath, abdominal pain, vomiting, and/or hypotension, dizziness, or collapse (table 1). (See "Anaphylaxis: Emergency treatment".)
Involvement of body organ systems varies among patients and even in the same patient from one episode to another. However, review of anaphylaxis case series and study cohorts reveals that episodes involve the skin and mucosa in up to 90 percent, respiratory tract in up to 70 percent, gastrointestinal tract in up to 45 percent, cardiovascular system in up to 72 percent, and central nervous system (CNS) in up to 15 percent of episodes .
If the patient is seen after resolution of the acute anaphylactic episode (eg, in the clinician's office weeks or months later), the relevant emergency medical services and emergency department records should be obtained and reviewed [1-4].
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- CLINICAL DIAGNOSIS OF ANAPHYLAXIS
- LABORATORY TESTS TO CONFIRM THE DIAGNOSIS OF ANAPHYLAXIS
- DIFFERENTIAL DIAGNOSIS OF ANAPHYLAXIS
- Common disorders
- - Acute generalized urticaria and/or angioedema
- - Asthma exacerbation
- - Vasovagal syncope
- - Panic attack/acute anxiety
- - Other causes of sudden collapse
- - Other causes of acute respiratory distress
- Vocal cord dysfunction
- - Other forms of shock
- Flushing disorders
- - Menopause
- - Medications
- - Alcohol
- - Tumors
- Postprandial syndromes
- - Scombroidosis
- - Anisakiasis
- - Pollen-food allergy syndrome
- - Food poisoning
- - Caustic ingestion (young children)
- Excess histamine syndromes
- - Mastocytosis and mast cell activation syndromes
- - Certain forms of leukemia
- - Hydatid cysts
- Rare disorders
- - Pheochromocytoma
- - Capillary leak syndrome
- Nonorganic diseases
- - Munchausen stridor
- - Undifferentiated somatoform anaphylaxis