What disease process increases the risk for anaphylaxis?

From the Guidelines

Individuals with cardiovascular disease, asthma, and older age are at increased risk for severe anaphylaxis, as these conditions can exacerbate the allergic reaction and lead to poorer outcomes, as noted in the 2020 practice parameter update 1.

Risk Factors for Anaphylaxis

The risk factors for anaphylaxis include:

• Cardiovascular disease, which can increase the severity of anaphylaxis
• Asthma, particularly poorly controlled disease, which can lead to more severe reactions
• Older age, which can increase the risk of severe anaphylaxis
• Additional coexisting, comorbid conditions, which can also increase the risk of severe anaphylaxis

Triggers for Anaphylaxis

The triggers for anaphylaxis include:

• Medications, such as beta-blockers and ACE inhibitors, which can interfere with the body's compensatory mechanisms during anaphylaxis or enhance mediator effects
• Stinging insects, which are a common trigger for anaphylaxis in adults
• Foods, which are a common trigger for anaphylaxis in children and adolescents
• Other allergens, such as latex and certain antibiotics, which can also trigger anaphylaxis

Management of Anaphylaxis

The management of anaphylaxis includes:

• Prompt administration of epinephrine, which is the first-line treatment for anaphylaxis
• Avoidance of known triggers, which can help prevent anaphylaxis
• Carrying emergency epinephrine, such as an EpiPen, which can help treat anaphylaxis if it occurs
• Wearing medical alert identification, which can help ensure prompt treatment if anaphylaxis occurs
• Ensuring family members know how to recognize and respond to anaphylaxis, which can help ensure prompt treatment and improve outcomes, as recommended in the 2020 practice parameter update 1.

From the FDA Drug Label

Patients with hyperthyroidism, Parkinson's disease, diabetes, and pheochromocytoma are at greater risk of having adverse reactions when used intramuscularly or subcutaneously

• Disease processes that increase the risk for anaphylaxis or adverse reactions to epinephrine include:
  • Hyperthyroidism
  • Parkinson's disease
  • Diabetes
  • Pheochromocytoma 2

From the Research

Disease Process and Anaphylaxis Risk

The disease process that increases the risk for anaphylaxis is mastocytosis, a condition characterized by the accumulation of clonal mast cells in the skin and/or internal organs 3, 4, 5, 6, 7.

Key Factors

Some key factors that contribute to the increased risk of anaphylaxis in mastocytosis include:

• Excessive mast cell mediator release 3, 7
• Higher basal tryptase values 3, 5
• Extensive skin involvement, particularly in children 3, 4, 6
• Systemic mastocytosis, which is more common in adults 3, 4
• Presence of certain plasma biomarkers, such as tryptase, E-selectin, and adrenomedullin 5

Trigger Factors

Common trigger factors for anaphylaxis in patients with mastocytosis include:

• Hymenoptera stings 3, 4, 7
• Foods 3, 4
• Medication 3, 4
• Idiopathic anaphylaxis 4
• Physical factors, such as heat, cold, vibration, stress, sun, or physical effort 6