Curr Treat Options Allergy (2018) 5:212–220
DOI 10.1007/s40521-018-0167-3
Anaphylaxis (M Sánchez-Borges, Section Editor)
An Update on the Management
of Anaphylaxis
Keith A. Sacco, MD
1,*
Alexei Gonzalez-Estrada, MD
2
Address
*,1
Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville,
FL, 32224, USA
Email: sacco.keith@mayo.edu
2
Division of Allergy, Pulmonary and Sleep Medicine, Department of Medicine,
Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
Published online: 20 April 2018
* Springer International Publishing AG, part of Springer Nature 2018
This article is part of the Topical Collection on Anaphylaxis
Keywords Anaphylaxis
I
Management
I
Epinephrine
I
Corticosteroids
I
H1-antihistamine
I
Treatment
Abstract
Purpose of review To highlight the latest evidence supporting management recommenda-
tions in anaphylaxis and discuss the implications for further research in anaphylaxis
management.
Recent findings The acute management of anaphylaxis is largely centered on resuscitation
and administration of epinephrine. There is little evidence to support the use of antihis-
tamines and corticosteroids in the acute management of anaphylaxis.
Summary Anaphylaxis is an acute, systemic, potentially life-threatening reaction caused
by the release of mast cell and basophil mediators that could lead to distributive shock.
Anaphylaxis is associated with increased healthcare utilization and costs. The definition of
anaphylaxis is largely based on clinical criteria with no validated biomarker confirming the
diagnosis. Long-term follow-up is recommended to identify triggers and co-factors of
anaphylaxis. Further, this helps to establish a plan for trigger avoidance and emergency
action plan to manage subsequent episodes. Given the significant morbidity and mortality
associated with this diagnosis, high quality randomized controlled studies are lacking to
support management decisions in anaphylaxis.
Introduction
Anaphylaxis is an acute, systemic, potentially life-
threatening reaction that often results in emergency de-
partment visits and hospital admissions [1••,2••,3••].
It is caused by the release of mast cell and basophil
mediators that could lead to distributive shock [4]. The
lifetime prevalence of anaphylaxis is estimated between
0.05 and 2% [5]. However, this is likely to be
underestimated as anaphylaxis is largely underreported
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