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Table 4 Differential Diagnosis of Anaphylaxis

From: World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis

Common diagnostic dilemmas

Flush syndromes

   Acute asthmaa

   Peri-menopause

   Syncope (faint)

   Carcinoid syndrome

   Anxiety/panic attack

   Autonomic epilepsy

   Acute generalized urticariaa

   Medullary carcinoma of the thyroid

   Aspiration of a foreign body

 

   Cardiovascular (myocardial infarctiona, pulmonary embolus)

Nonorganic Disease

 

   Vocal cord dysfunction

 

   Hyperventilation

   Neurologic events (seizure, cerebrovascular event)

   Psychosomatic episode

Postprandial syndromes

 

   Scombroidosisb

Shock

   Pollen-food allergy syndromec

   Hypovolemic

 

   Cardiogenic

   Monosodium glutamate

   Distributived

   Sulfites

   Septic

   Food poisoning

 

Excess endogenous histamine

Other

   Mastocytosis/clonal mast cell disorderse

   Nonallergic angioedema

   Basophilic leukemia

Hereditary angioedema types I, II, & III

 

ACE inhibitor-associated angioedema

 

   Systemic capillary leak syndrome

 

   Red man syndrome (vancomycin)

 

   Pheochromocytoma (paradoxical response)

  1. aAcute asthma symptoms, acute generalized urticaria, or myocardial infarction symptoms can also occur during an anaphylactic episode.
  2. bHistamine poisoning from fish, eg. tuna that has been stored at an elevated temperature; usually, more than one person eating the fish is affected.
  3. cPollen-food allergy syndrome (oral allergy syndrome) is elicited by fruits and vegetables containing various plant proteins that cross-react with airborne allergens. Typical symptoms include itching, tingling and angioedema of the lips, tongue, palate, throat, and ears after eating raw, but not cooked, fruits and vegetables.
  4. dDistributive shock may be due to anaphylaxis or to spinal cord injury.
  5. eIn mastocytosis and clonal mast cell disorders, there is an increased risk of anaphylaxis; also, anaphylaxis may be the first manifestation of the disease.
  6. Adapted from references [2, 2225, 31, 32, 91, 92].