Questions to ask if a patient has a suspected episode of anaphylaxis

Editor: V. Dimov, M.D., Allergist/Immunologist, Cleveland Clinic Florida, Clinical Associate Professor, FAU Charles E. Schmidt College of Medicine
Reviewer: S. Randhawa, M.D.

Questions to ask if a patient has a suspected episode of anaphylaxis

1. Any food or drugs taken within 6 hours before the event? (within 2 hours for food allergy). Was the food raw, semi-cooked, cooked, or baked? Quantity of allergen ingested (how much of the food)?

2. Activity in which the patient was engaged at the time of the event?

3. Location of the event? (home, school, work, indoors, or outdoors)

4. Exposure to heat or cold?

5. Any related sting or bite?

6. Time of day or night?

7. Duration of the event? How long did it last?

8. Recurrence of symptoms after initial resolution?

9. Exact nature of the symptoms (eg, if skin symptoms, determine whether flush,
pruritus (itching), urticaria (hives), angioedema). Ask about urticaria, angioedema, erythema, pruritus, vomiting, abdominal pain, persistent cough, hoarse voice, wheeze, stridor, respiratory distress, or nasal congestion. Cardiovascular symptoms such as hypotension, extreme lethargy, or syncope.

10. Physical factors or triggers? Exercise or ingestion of aspirin or alcohol?

11. In a female, any relationship between the event and menstrual cycle?

12. Was medical care given and what treatments were administered? Epinephrine? Was EpiPen or Auvi-Q prescribed?

Possible causes of anaphylaxis

Common

- Foods: most commonly peanuts, tree nuts, egg, fish, shellfish, cow’s milk, and wheat
- Medications: most commonly antibiotics or NSAIDs
- Allergen immunotherapy
- Insect stings (bees and wasps)
- Unidentified (no cause found; idiopathic anaphylaxis)

Less common

- Exercise, WDEIA - omega-5 gliadin sIgE
- Natural rubber latex
- Semen
- Hormonal changes: menstrual factors
- Topical medications (e.g., chlorhexidine, polysporin)
- Transfusions
- Alpha-gal

References:

Treatment of patients who present after an episode of anaphylaxis. Lieberman P. Ann Allergy Asthma Immunol. 2013 Sep;111(3):170-5. doi: 10.1016/j.anai.2013.06.018.
http://www.ncbi.nlm.nih.gov/pubmed/23987190
Anaphylaxis. Practical guide for allergy and immunology in Canada 2018 https://buff.ly/2MydS0V

Updated: 12-11-2018