What is the most significant risk factor for anaphylactic shock in a patient with a past medical history (PMHx) of asthma and eczema who experiences anaphylactic shock after eating at a restaurant?

From the Guidelines

The most significant risk factor for anaphylactic shock in a patient with a past medical history of asthma and eczema who experiences anaphylactic shock after eating at a restaurant is a history of asthma.

Risk Factors for Anaphylaxis

Patients with asthma are at higher risk for developing severe anaphylaxis and experiencing fatal or near-fatal reactions, as asthma and anaphylaxis both involve similar inflammatory mediators and pathways, particularly those affecting the respiratory system 1.

• During anaphylaxis, patients with asthma may experience more severe bronchospasm that is more difficult to reverse with standard treatments.
• The presence of poorly controlled asthma particularly increases this risk.

Comparison with Other Factors

While eczema is associated with atopy and allergic tendencies, it does not carry the same level of risk for severe anaphylaxis as asthma does 1.

• The absence of rash is not a risk factor, as anaphylaxis can present with or without cutaneous manifestations.
• Symptoms occurring within 30 minutes of eating is actually a typical presentation of food-induced anaphylaxis rather than a risk factor for its development.

Management and Treatment

Prompt administration of epinephrine is key in the management of anaphylaxis, and patients with a history of asthma should be particularly vigilant in recognizing the signs of anaphylaxis and seeking immediate medical attention 1.

• Education on the use of self-injectable epinephrine and the development of a personalized anaphylaxis emergency action plan are crucial for patients at risk of anaphylaxis.

From the Research

Risk Factors for Anaphylactic Shock

The most significant risk factor for anaphylactic shock in a patient with a past medical history (PMHx) of asthma and eczema who experiences anaphylactic shock after eating at a restaurant can be identified by considering the following points:

• Coexisting asthma is associated with severe or fatal anaphylactic reactions 2
• Food is a common trigger for anaphylaxis, especially in patients with a history of allergies 2, 3
• The patient's history of eczema and asthma increases their risk of anaphylaxis due to active allergic disease 3

Triggers for Anaphylaxis

Some common triggers for anaphylaxis include:

• Foods, such as peanuts, tree nuts, eggs, cow milk, and fish 2, 3
• Medications 2
• Insect stings 2, 3
• Latex 3

Management of Anaphylaxis

The management of anaphylaxis involves:

• Removal of the trigger 2, 4, 5
• Early administration of intramuscular epinephrine 2, 4, 5, 6
• Supportive care for the patient's airway, breathing, and circulation 2, 4, 5
• Monitoring for potential biphasic reactions 2, 5