Table 3.

Clinical features, diagnostic tests and management of different causes of anaphylaxis.

Cause of anaphylaxis	Range of possible clinical features	Laboratory and other tests to consider	Management/management options
Food allergy	Oral itching and swelling	Skin prick tests	Avoidance of responsible allergen
	Urticaria	Specific IgEs	Patient education
	Vomiting and/or diarrhoea	Challenge testing	Epipen provision and training
	Stridor
	Wheeze
	Hypotension
	Collapse
	Cardiac arrest and death
Stinging insect venom allergy	Local itching, urticaria and/or swelling	Skin prick tests	Patient education
	Distal itching, urticaria and/or swelling	Specific IgEs	Behaviour modification to reduce risk of further stings
	Wheeze	Western blotting if required	Epipen provision and training
	Hypotension		Desensitization immunotherapy
	Collapse
	Cardiac arrest and death
Drug allergy	Urticarial or other rash	Mast cell tryptase	Avoidance of drug Marking of medical notes/records
	Hypotension	Skin prick tests (require careful interpretation)	Infrorm all health professionals involved in patient's care
	Collapse	Specific IgEs (only available for limited number of drugs and require careful interpretation)	Patient education
	Cardiac arrest Death	Intradermal testing
		Challenge testing
Latex allergy	Local rash and swelling	Mast cell tryptase	Avoidance of latex Marking of medical notes/records
	Wheeze	Skin prick tests	Inform all health professionals involved in patient's care
	Hypotension	Specific IgEs	Patient education
	Collapse	Latex challenge	Alert bracelet or equivalent
	Cardiac arrest
	Death
Exercise induced	Urticaria	Mast cell tryptase	Exclusion of food allergy (e.g. wheat)
	Angioedema	Skin prick tests	Anti-histamines prior to exercise
	Wheeze	Specific IgEs	Doxepin
	Hypotension	Exercise challenge	H2 antagonists
	Collapse		Montelukast
Idiopathic anaphylaxis	Urticaria	Mast cell tryptase	Exclusion of above
	Angioedema	Skin prick tests	Anti-histamines
	Wheeze	Specific IgEs	Doxepin
	Hypotension		H2 antagonists
	Collapse		Montelukast