An Approach to Anaphylaxis

Anaphylaxis is a life-threatening, mast cell-mediated reaction triggered by IgE or non-IgE pathways, resulting in a systemic release of mediators like histamine and leukotrienes. Clinical diagnosis relies on identifying rapid-onset symptoms across skin, respiratory, cardiovascular, and gastrointestinal systems, often following exposure to known allergens. Early recognition remains critical, as delayed treatment increases risks of respiratory failure or cardiovascular collapse. Standard management involves intramuscular epinephrine, with specific considerations for patients on beta-blockers who may require glucagon to bypass beta-receptor blockade. Biphasic reactions necessitate 6 to 12 hours of monitoring post-treatment. Recent advancements include the FDA-approved intranasal epinephrine, which offers a needle-free alternative that effectively increases blood pressure, though it exhibits a slower time to peak serum levels compared to traditional intramuscular injections.