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Anaphylaxis: An alarming medical anomaly on the rise


Earn Category 2 CME Credit:  Click Here to Read the Full Summary on TODAY!

What should your patients know about anaphylaxis?

Anaphylaxis is the rapid onset of a severe and potentially lethal allergic reaction. Unpredictable in nature, the key identifiers for this condition are variable. While most people who experience an anaphylactic reaction have a pre-existing and known allergy to a trigger substance, a smaller fraction of those afflicted are not even aware that they have an allergy. Although the lifetime prevalence is estimated at 0.05-2%, the rate of occurrence is on the rise and even the first episode of anaphylaxis can result in fatality.

Key Components:

  • Symptom onset commonly occurs within 2 minutes to 1 hour of exposure to a specific trigger.

  • It is uncommon, but it is possible that symptoms do not develop for several hours.

  • 80- 90% of anaphylactic reactions include hives (urticarial) and swelling of the skin (angioedema).

  • Approximately 70% of reactions cause respiratory symptoms, which are more common in individuals with chronic respiratory diseases.

  • Severe anaphylaxis causes sudden collapse without other symptoms; this form occurs most commonly after a person is given a medication intravenously or is stung by an insect.

Common Symptoms:

  • EYES: Tearing, redness, itching and swelling

  • SKIN: Flushing, hives (urticaria), or swelling (angioedema)

  • HEART: Weakness, dizziness, fainting, rapid or irregular heartbeat, and low blood pressure

  • NERVOUS SYSTEM: Confusion and anxiety

  • DIGESTIVE SYSTEM: Vomiting, abdominal cramps, nausea and diarrhea

  • NOSE & MOUTH: Runny nose, sneezing, nasal congestion, swelling of the tongue and metallic taste

  • LUNG & THROAT:  Difficulty breathing, excessive coughing, chest tightness, wheezing or other sounds of labored breathing, increased mucus production, throat swelling or itching, hoarseness, change in voice and choking sensation

Who is at risk?

Some people are more likely than others to experience anaphylaxis, for example, those who have one or more of the following:

  1. Previously experienced a sudden severe allergic reaction involving the whole body

    •  Those who have had allergic reactions to a particular substance in the past are at increased risk. However, the severity of past allergic reactions does not reliably predict the severity of future reactions.

  2. Those diagnosed with asthma

    • Individuals with asthma are more likely to have severe respiratory problems during anaphylaxis. Data indicate the combination of food allergy (especially to nuts) and asthma seems to put people at increased risk for life-threatening episodes of anaphylaxis when exposed to a trigger.

  3. Those with other types of diagnoses

    • People with chronic lung disease, especially older adults with chronic obstructive pulmonary disease (COPD) or emphysema, are at increased risk of complications during an anaphylactic reaction. People with coronary artery disease and other heart diseases are also at greater risk of developing complications.

How to prevent/treat?

If patient has had an anaphylactic reaction or has suspected triggers:

  • See an allergist for evaluation and for specific training and diagnosis.

  • Seek out testing to determine the trigger; an allergist should perform skin testing at least 3-4 weeks after an anaphylactic reaction b  because if done too soon after the event, such tests may give false negative results.

  • Avoid triggers! When a trigger has been identified, the individual should be urged to stay away from the substance.

  • Always wear medical identification and carry epinephrine!

During an anaphylactic episode:

  • Call for emergency help immediately. Episodes are often times life-threatening-- it should be treated as a medical emergency.

  • Treat the person with epinephrine, those with a history of anaphylaxis should always carry an injector.

  • Place the person on their back or in a semi–reclining position with the lower extremities raised

  • During the episode, if needed, give high flow supplemental oxygen, establish intravenous access to provide high volume fluids, and perform cardiopulmonary resuscitation.

  • Go to the hospital,  after injecting epinephrine; it is important to be evaluated in a hospital emergency department. There is no reliableway to predict whether or not a late-phase reaction will occur, but up to 20% of people with anaphylaxis have a late-phase reaction and might require additional treatment.

All HCPs are encouraged to talk with their patients who have a history of these types of reactions to develop an Anaphylaxis Action Plan. Many people find having a treatment plan to respond to future reactions reassuring.


FDA: Revised recommendations for cardiovascular monitoring and use of multiple sclerosis drug Gilenya (fingolimod)


FDA issues drug safety annoucement for multiple sclerosis drug Gilenya (fingolimod).

The U.S. Food and Drug Administration (FDA) has completed its evaluation of a report of a patient who died after the first dose of multiple sclerosis drug Gilenya (fingolimod). The agency also has evaluated additional clinical trial and postmarket data for Gilenya, including reports of patients who died of cardiovascular events or unknown causes. FDA could not definitively conclude that Gilenya was related to any of the deaths (see Data Summary, below). However, based on its reevaluation of the data, FDA remains concerned about the cardiovascular effects of Gilenya after the first dose. Data show that, although the maximum heart rate lowering effect of Gilenya usually occurs within 6 hours of the first dose, the maximum effect may occur as late as 20 hours after the first dose in some patients (See Data Summary).

For this reason, Gilenya is now contraindicated (FDA advises against its use) in patients with certain pre-existing or recent (within last 6 months) heart conditions or stroke, or who are taking certain antiarrhythmic medications. See CONTRAINDICATION section of the drug label2.

FDA continues to recommend that all patients starting Gilenya be monitored for signs of a slow heart rate (bradycardia) for at least 6 hours after the first dose. FDA is now recommending hourly pulse and blood pressure measurement for all patients starting Gilenya. Electrocardiogram (ECG or EKG) testing should be performed prior to dosing and at the end of the observation period. Cardiovascular monitoring should continue until any symptoms resolve.

Read full release here.

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