This document summarizes information from a presentation on allergies given by Dr. Summit Shah. It discusses common allergy symptoms, the mechanisms of allergic reactions and anaphylaxis, treatments including avoidance, medications, and immunotherapy, and myths about allergies. Rush immunotherapy provides faster results than traditional immunotherapy but requires pre-medication, while traditional immunotherapy involves longer treatment with weekly shots but no pre-medication. Food is a leading cause of anaphylaxis, and accidental exposures are common. Proper and immediate epinephrine administration is important for treating anaphylactic reactions.
12. “I am Always Clearing my Throat!”
Rush IT
Less Shots
Faster Results
Need for pre-medication
Not offered by most
allergists
Traditional IT
Longer course
1-2/weekly shots
No need for pre-medication
Offered by traditional
allergists, ENT, family
practice
13. “I Have Been Putting Up
With Allergies Forever!”
14. Definition of Anaphylaxis
Systemic allergic reaction
Affects body as a whole
Multiple organ systems may be involved
Onset generally acute
Manifestations vary from mild to fatal
15. Sensitization Stage
Antigen (allergen)
exposure
Plasma cells
produce IgE antibodies
against the allergen
IgE antibodies
attach to mast
cells
and basophils
Mast cell with
fixed IgE
antibodies
IgE
Granules
containing
histamine
Antigen
Plasma cell
17. Anaphylaxis Fatalities
Estimated 500–1000 deaths annually
1% risk
Risk factors:
Failure to administer epinephrine immediately
Peanut, Soy & tree nut allergy (foods in general)
Beta blocker, ACEI therapy
Asthma
Cardiac disease
Rapid IV allergen
Atopic dermatitis (eczema)
18. Food Induced Anaphylaxis
35%–55% of anaphylaxis is caused by food allergy
6%–8% of children have food allergy
1%–2% of adults have food allergy
Incidence is increasing
Accidental food exposures are common and
unpredictable
19. Venom Induced
Anaphylaxis
0.5%–5% (13 million) Americans are
sensitive to one or more insect venoms
Incidence is underestimated
Incidence increasing due to fire ants and Africanized
bees
Incidence rising due to more outdoor activities
At least 40–100 deaths per year
20. Venom: Common Culprits
Hymenoptera
Bees
Wasps
Yellow jackets
Hornets
Fire ants
Geographical
Honeybees, yellow jackets most common in East,
Midwest, and West regions of US
Wasps, fire ants most common in Southwest
and Gulf Coast
21. Venom Immunotherapy
Medical criteria
Hx of any systemic reaction in adults
Hx of life-threatening reaction in
children
Positive venom skin test
97% effective
Can be discontinued in most after 3–5 years;
10% risk of systemic reaction to subsequent
stings
22. Myth: Insect Stings are the
most fatal
REALITY:
While any trigger can be fatal, Most common trigger resulting
in a fatal outcome is food allergies, especially in peds.
This is especially true with other risk factors , like Asthma
Also aggravated as most kids forget Epi Pen or have the wrong
size.
Most common fatal food allergies are:
Peanuts
Tree Nuts
23. Myth: Prior Reactions
Predict Future Reactions
REALITY:
No predictable pattern
Severity depends on:
Sensitivity of the individual
Dose of the allergen
Anaphylactoid vs Anaphylactic
24. Myth: Anaphylaxis is Rare
REALITY:
Anaphylaxis is underreported
Incidence seems to be increasing
Up to 41 million Americans at risk (Neugut AI et al,
2001)
63,000 new cases per year
(Yocum MW et al, 1999)
5% of adults may have a history of anaphylaxis
(various surveys)
25. Myth: Anaphylaxis is Easy to Avoid if
you know what you are Allergic To
REALITY:
Most cases of anaphylaxis are due to
accidental exposures
Clinical studies have found repeatedly that,
even when patients attempt strict avoidance
of a known allergen, their efforts are rarely
100% successful.
26. Myth: Epinephrine is
Dangerous
REALITY:
Risks of anaphylaxis far outweigh risks
of epinephrine administration
Minimal cardiovascular effects in children
(Simons et al, 1998)
Caution when administering epinephrine in
elderly patients or those with known cardiac
disease
27. Myth: Cause of
Anaphylaxis is Obvious
REALITY:
Idiopathic anaphylaxis is common
Triggers may be hidden
Foods
Latex
Patient may not recall details of exposure, clinical
course
28. Myth: Anaphylaxis Always Presents
with Cutaneous Manifestations
REALITY:
Approximately 10%-20% of anaphylaxis cases will
not present with hives or other cutaneous
manifestations
80% of food-induced, fatal anaphylaxis cases were
not associated with cutaneous signs or symptoms
29. Asthma: A Topic on Its Own
Pathogenesis
Symptoms
Testing (PFTs and Skin Testing)
Acute Treatment
Chronic Treatment