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Table 7 Diagnosis of anaphylaxis: summary of unmet needs

From: International consensus on (ICON) anaphylaxis

  High-resource countries1 Limited-resource countries2
Symptoms and signs (typically with onset in minutes to a few hours after exposure; multi-system; rapid progression) need improved recognition and diagnosis of anaphylaxis and its sudden onset in relationship to exposure to a trigger (the context) among all healthcare professionals (including EMS personnel), patients, caregivers and the public need improved recognition and diagnosis of anaphylaxis and its sudden onset in relationship to exposure to a trigger (the context) among all healthcare professionals, patients, caregivers, and the public
Clinical diagnosis of anaphylaxis need to operationalize the clinical criteria for the diagnosis of anaphylaxis by healthcare professionals; need improved coding for anaphylaxis and training of coders need to operationalize the clinical criteria for the diagnosis of anaphylaxis; need ↑ availability of basic equipment and supplies to aid in recognition, eg. pulse oximetry and sphygmomanometers with arm cuffs of various sizes
Laboratory tests to confirm the clinical diagnosis eg. serum total tryptase measurement 3 need ↑ awareness of optimal timing of tests, and lack of test specificity (eg. ↑ tryptase in some patients with MI); need ↑ awareness that current lab tests are not useful at the time of patient presentation; need ongoing development of tests for biologic markers need awareness that inability to measure tryptase levels (which is unlikely to be a priority for change due to high cost) is not a barrier to prompt diagnosis of anaphylaxis, which depends on recognition of symptoms and signs
Differential diagnosis need ↑ awareness that among the >40 entities in the differential diagnosis, acute asthma, acute urticaria, and panic or anxiety attacks are most common need awareness that in some countries, pneumonia and sepsis are the most likely diagnoses in patients with sudden-onset respiratory distress and sudden-onset hypotension/ distributive shock, respectively
Diagnosis of anaphylaxis in special populations need improved prompt recognition of anaphylaxis in infancy, adolescence, pregnancy, and advanced age need improved prompt recognition of anaphylaxis in infancy, adolescence, pregnancy, and advanced age
  1. 1Within high-resource countries, limited-resource areas can be found in inner cities, some rural areas, many public venues, and situations such as anaphylaxis on airplanes.
  2. 2In this Table, “limited-resource countries” include mid- and low-resource countries.
  3. 3The tryptase assay is standardized worldwide; in contrast, histamine assays are not standardized and are less practical for clinical use because of the need to refrigerate specimens.
  4. EMS, emergency medical services; MI, myocardial infarction.