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Table 2 Food, insect sting, and drug/iatrogenic triggers

From: 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines

Food [34, 3849]
In a prospective study, 10/12 patients with IgE-mediated mammalian meat-induced systemic allergic reactions had OFCs with meat. Symptom onset occurred in 3–7 hours and correlated with basophil activation and increased CD63 expression, likely reflecting the appearance of galactose-alpha 1,3-galactose (alpha-gal) in the blood. Controls remained asymptomatic after OFCs [45].
Attributed to higher alpha-gal concentrations (or more accessible alpha-gal epitopes), pork kidney elicited symptoms and positive skin tests more consistently than pork muscle meat. Co-factors, including alcohol, NSAIDs, and exercise, amplified low levels of alpha-gal sensitization [34].
Hymenoptera Venom [5054]
The relevance of asymptomatic sensitization to Hymenoptera venom was tested in 94 people who had previously tolerated field stings without a systemic allergic reaction. On screening, they had elevated venom-specific IgE levels. They underwent a complete evaluation (skin tests, component-resolved diagnosis, BATs, and physician-supervised insect sting challenges). Large local reactions occurred in 43.6 %, and systemic reactions occurred in 5.3 %. Current venom allergy tests did not distinguish asymptomatic sensitization from risk of local or systemic reactions [52].
The predictive value of in vitro tests with Hymenoptera venoms can be improved by use of recombinant venom allergens and component resolved testing, for example, by utilizing a panel of honeybee allergens that are free from cross-reactive carbohydrate determinants [53, 54].
Drugs/Iatrogenic Agents [5577]
The health consequences of penicillin “allergy” included costly longer admissions, greater use of broad-spectrum antibiotics, and increased prevalence of serious infections with Clostridium difficile, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci [58].
Risk factors for fatal anaphylaxis to a neuromuscular blocker included male sex, emergency setting, CVD/hypertension, concurrent beta-blocker treatment, and obesity [71].
Of 228 consecutive patients with perioperative anaphylaxis, 9.6 % were sensitized to the antiseptic/disinfectant chlorhexidine, as determined using specific IgE measurements, basophil activation tests, and standardized skin tests [73].
  1. alpha-gal galactose-alpha 1,3-galactose; BATs basophil activation tests, CVD cardiovascular disease, NSAIDs non-steroidal anti-inflammatory drugs; OFCs oral food challenges