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

J ALLERGY CLIN IMMUNOL
VOLUME 115, NUMBER 3
Lieberman et al S487
FIG 1. Algorithm for the initial evaluation and management of a patient with a history of an episode of
anaphylaxis. ACE, Angiotensin-converting enzyme.
Annotation 1A: Consider consultation with
an allergist-immunologist
Patients with anaphylaxis might be first seen with
serious and life-threatening symptoms. Evaluation and
diagnosis, as well as long-term management, can be
complex. The allergist-immunologist has the training
and expertise to obtain a detailed allergy history, coordinate
laboratory and allergy testing, evaluate the
benefits and risks of therapeutic options, and counsel the
patient on avoidance measures. For these reasons, patients
with a history of anaphylaxis should be considered for
referral to an allergy-immunology specialist.
Annotation 2: Pursue other diagnoses or
make appropriate referral
Other conditions that should be considered in the differential
diagnosis include the following: (1) vasodepressor
(vasovagal-neurocardiogenic) syncope; (2) syndromes
that can be associated with flushing (eg, metastatic carcinoid);
(3) postprandial syndromes (eg, scombroid poisoning);
(4) systemic mastocytosis; (5) psychiatric disorders
that can mimic anaphylaxis, such as panic attacks or vocal
cord dysfunction syndrome; (6) angioedema (eg, hereditary
angioedema); (7) other causes of shock (eg, cardiogenic);
and (8) other cardiovascular or respiratory events.