Immunotherapy Safety for the Primary Care ... - U.S. Coast Guard

• In addition they may have:
• Gastrointestinal symptoms:
Nausea, vomiting, cramping, and diarrhea - sometimes bloody
• Upper airway symptoms: (especially in children)
Stridor secondary to laryngeal edema
Early presentation may consist of
hoarseness
dysphonia, or
“a lump in the throat”
• Lower airway symptoms, typical of asthma:
SOB, wheezing, and chest tightness
• Cardiovascular symptoms:
Hypotension, shock, and arrhythmias
Differential diagnosis
1. Loss of consciousness: In the diagnosis of sudden collapse in the absence of
accompanying pruritus, urticaria and angioedema, one must consider several other
disorders:
• Cardiac arrhythmias
• Myocardial infarction
• Pulmonary embolism
• Seizures
• Asphyxiation/foreign body
• Hypoglycemia
• Vaso-vagal reaction: (Most common similar syndrome)
• Patient collapses after an injection or painful situation
• Bradycardia (rather than rapid, thready pulse of anaphylaxis)
• Pallor (rather than flushing)
• No respiratory difficulty nor pruritus, urticaria or angioedema
2. Acute respiratory distress:
• Status asthmaticus
• Epiglottitis
• Foreign-body aspiration
• Pulmonary embolism
• Hereditary angioedema
Stridor secondary to laryngeal edema, but no pruritus or urticaria.
Slower onset,
Usually a history of recurrent attacks or a positive family history.
Poor response to epinephrine
3. Disorders with similar cutaneous manifestations.
• Systemic mastocytosis: The mast cells may degranulate causing systemic effects
exactly like anaphylaxis. Indeed some patients originally diagnosed as
having idiopathic anaphylaxis have later been found to have systemic