World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis

Table 2 Symptoms and Signs of Anaphylaxis

Skin, subcutaneous tissue, and mucosa^{a, b, c}
Flushing, itching, urticaria (hives), angioedema, morbilliform rash, pilor erection
Periorbital itching, erythema and edema, conjunctival erythema, tearing
Itching of lips, tongue, palate, and external auditory canals; and swelling of lips, tongue, and uvula
Itching of genitalia, palms, and soles
Respiratory^a
Nasal itching, congestion, rhinorrhea, sneezing
Throat itching and tightness, dysphonia, hoarseness, stridor, dry staccato cough
Lower airways: increased respiratory rate, shortness of breath, chest tightness, deep cough, wheezing/bronchospasm, decreased peak expiratory flow
Cyanosis
Respiratory arrest
Gastrointestinal^a
Abdominal pain, nausea, vomiting (stringy mucus), diarrhea, dysphagia
Cardiovascular system^a
Chest pain
Tachycardia, bradycardia (less common), other arrhythmias, palpitations
Hypotension, feeling faint, urinary or fecal incontinence, shock
Cardiac arrest
Central nervous system^a
Aura of impending doom, uneasiness (in infants and children, sudden behavioral change, eg. irritability, cessation of play, clinging to parent); throbbing headache (pre-epinephrine), altered mental status, dizziness, confusion, tunnel vision
Other^a
Metallic taste in the mouth
Cramps and bleeding due to uterine contractions in females

^aSudden onset of symptoms and signs is characteristic of anaphylaxis.
^bThe purpose of listing signs and symptoms in this Table is to aid in prompt recognition of the onset of anaphylaxis and to indicate the possibility of rapid progression to multi-organ system involvement, not to grade severity.
^cSkin and mucosal symptoms are reported to occur in 80-90% of patients with anaphylaxis, respiratory tract involvement in up to 70%, gastrointestinal tract involvement in up to 45%, cardiovascular system involvement in up to 45%, and central nervous system involvement in up to 15%.
Symptom patterns vary from one patient to another, and even in the same patient, from one anaphylactic episode to another. Only a few symptoms might be present.
Adapted from references [2, 22–25, 31, 32].

ISSN: 1939-4551