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Anaphylaxis in pregnant and breastfeeding women

Michael Schatz, MD, MS
Mitchell P Dombrowski, MD
Section Editors
Bruce S Bochner, MD
David L Hepner, MD
Deputy Editors
Anna M Feldweg, MD
Vanessa A Barss, MD, FACOG


Anaphylaxis is defined clinically as "a serious allergic or hypersensitivity reaction that is rapid in onset and may cause death" [1]. In pregnancy, it can be catastrophic for both mother and fetus [2]. This topic will review issues specific to anaphylaxis in pregnant and breastfeeding women.


The lifetime prevalence of anaphylaxis in the general population is estimated as 0.05 to 2 percent [3-6]. Data regarding the prevalence among pregnant women are limited. One study estimated the prevalence of anaphylaxis in women near or at the time of delivery in state-licensed hospitals in Texas and reported 2.7 cases of anaphylaxis per 100,000 deliveries (95% CI 1.7-4.2) (ie, 0.002 to 0.004 percent) [7]. A Scottish study estimated the incidence of anaphylaxis similarly at 3 per 100,000 pregnancies (95% CI 1.0-7.0) [8].


Observations about anaphylaxis in pregnant and breastfeeding women are largely derived from case reports and small series [2,7,9-17]. The clinical manifestations of anaphylaxis do not appear to be altered by pregnancy. (See "Anaphylaxis: Emergency treatment".)

The term "anaphylactoid" is no longer recommended for use, and anaphylactic and anaphylactoid reactions do not need to be distinguished with respect to diagnosis and acute treatment [1,6].

Mother — Anaphylaxis may present with any combination of approximately 40 symptoms and signs (table 1). Only a few symptoms and signs may be present. Two or more organ systems are typically involved. In pregnant women, it is particularly important to recognize symptoms and signs that involve the uterus and fetus (figure 1) [1,2].

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Literature review current through: Nov 2017. | This topic last updated: Sep 21, 2016.
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