Anaphylaxis Pearls

5 Pearls on Anapylaxis Learned at Noon Conference from Dr. Montanaro

1. Mild forms of anaphylaxis include symptoms of itching, nasal congestion, and metallic taste.

2. Skin testing for penicillin allergy is often unreliable, as it only predicts IgE reactions and 50% of patients lose skin testing reactivity after 10 years.

3.  In patients with known NSAID sensitivity, high dose acetaminophen (>3g) may cross-react (cox mechanism)

4. Was your patient stung by an Apid (honey bee) or a Vespid (yellow jacket/wasp/hornet)?  Honey bees leave their venom sac behind after stinging, which should be scraped off rather than rubbed into the skin.

5. Concern for anaphylaxis? Order a tryptase within 48 hours of an anaphylaxis event.  Concern for system mastocytosis or mast cell activation syndrome? Order a tryptase anytime.