Talk:Anaphylaxis

True anaphylaxis

This page is actually incorrect. Anaphylactic reactions are different from type I hypersensitivity rxns. Anaphylactic rxns affect all members of a species, regardless of previous exposure, because of their effects on immune pathways (alternative complement pathway and arachadonic acid metabolism, specifically). The underlying mechanisms, however, are the same as a type I hypersensitivity rxn which requires an intital exposure that "sensitivizes" the individual by production of IgE against the antigen. I think the author was getting at this when he/she mentioned "true anaphylaxis" but it is incorecct as written. 66.109.184.164 01:48, 15 June 2007 (UTC)Ike

This isn't my field of expertise. But the definitions of pseudoanaphylaxis/anaphylactoid shock/anaphylactoid crisis[1] and plain anaphylaxis[2] sure make it sound like the article is reasonably correct as written. It appears that the IgE-based definition is relatively new; immunology is a young field. Could your information be out of date? WhatamIdoing 18:22, 4 August 2007 (UTC)

Anaphylaxis is classified as a Type 1 hypersensitivity reaction - well according to all the texts that I am studying. Check Harrison's Priniciples of Internal Medicine and Robbins Pathological Basis of Disease. Anaphylaxis requires previous sensitisation and production of IgE. I think that you are thinking more of the anaphylactoid reactions (I am guessing that is what other authors meant by pseudo-anaphylaxis). Mast cell degranulation can be triggered by more than just IgE. Other mediators such as C3a and C5a, physical events (trauma - see dermatographism - heat and sun), drugs such as codeine and morphine and even exercise can trigger degranulation. Clinically in the acute setting, this is irrelevant as the treatment is the same. The importance comes in identifying the trigger or further research. Once the initial trigger for mast cell degranulation has occurred, further steps in the pathway and the final clinical outcome is the same. 210.49.62.60 22:38, 12 September 2007 (UTC)

Symptoms

I added vomiting as a symptom. I have anaphylactic allergies and vomiting is always a clear symptom during my reactions. --216.240.152.74 03:29, 9 August 2005 (UTC)

Good. JFW | T@lk 17:16, 9 August 2005 (UTC)

I, now at age 13, suffered from a severe case of anaphylactic shock at the age of 11. Except, this happened to be idiopathic, meaning the doctors still have not figured out, and probably won't ever discover, the cause of the reaction. While it is true that this could have killed me within a short period of time, I found that the illness took awhile to gradually get worse and worse, until finally i had to take a trip to the emergency room. I seemed to feel fine that morning, then throughout the day i felt weaker and very tired. I was at a football game, and started feeling terrible until i had unbearable stomach cramps. these stomach cramps turned into diarrhea, vomiting, then hives. not too much longer, i was hooked up to machines and breathing tubes and wanted nothing but to sleep, after all it was almost 6 in the morning and i hadn't slept at all. so, that describes one case of anaphylaxis.

The following text seems to be more commentary than informational - suggest it be removed:

"This can be disconcerting to bystanders, particularly if a person in a restaurant starts gasping, then reaches into her bag and calmly gives herself three injections at the table.

It is especially disconcerting if the person watching had ignored repeated requests not to light cigarettes upwind of the allergic person, or if a waiter had lied about ... A few injections constitute a small interruption and a small expense; an ambulance ride te the ER is a major interruption—cancelling one's plans for the evening or longer—and a major expense."

I suffer from Anaphylaxis too, my first attack was not too bad. Just hives, diarrhea and some minor breathing trouble. I like the previous post, found it got worse the more attacks I had. My last one, 3 years ago, left me in my local hospital with major breathing issues, hives, internal bleeding, diarrhea, and the discovery that one of the medications designed to make my system better, Hydrocortisone, caused my heart to stop. I died for nearly 90 seconds. I now carry 2 Epipens, and I am on permanent anti-histamine treatment (Fexofenadine) for the rest of my natural life. I also like the previous poster, have a liquid form of antihistamine, Piriton, which I use if I am unable to swallow an anti-histamine tablet during an attack. (amended post to remove chat style message).Thor Malmjursson (talk) 16:56, 23 October 2008 (UTC)

This page is for discussing improvements to this article, not chatting about our personal experiences. WhatamIdoing (talk) 17:23, 23 October 2008 (UTC)

Just so you know, I am aware that the talk page is not a chat board. However, since I noticed that some of the things which I experienced as part of my last major attack are not listed in the article, such as the hypersensitivity to Hydrocortisone and also the internal bleeding, i figured I would detail an attack where such things occurred. I suppose i should not have added the bit about my diet and stuff at the end which made it seem chatty, but my point in putting this post there I would say is, since those things have happened to me, would adding them to the article be classed as OR?  :) Thor Malmjursson (talk) 22:11, 23 October 2008 (UTC)

Yes. Adding your own personal experience to any article is always a violation of WP:OR. Now if you could find a reliable source that just "happened" to say the same thing, then it's probably okay. WhatamIdoing (talk) 01:06, 24 October 2008 (UTC)

Cold?

"First aid for anaphylactic shock consists of obtaining advanced medical care at once; rescue breathing (a skill which is part of CPR) is likely to be ineffective but should be attempted if the victim stops breathing."

While waiting for advanced medical care, how about applying cold material to the area around the throat to minimize swelling?

An interesting idea. I wonder if that would trigger the mammalian diving reflex or something. I have no idea. I have heard, though, that it's no longer indicated to put cold packs on the neck of a patient with heat stroke, as it could be a shock to the brain. I would definitely say that any treatment cannot be recommended unless there's medical evidence that it's indicated. Peace, delldot | talk 19:33, 21 November 2005 (UTC)

That sounds like OR. Considering the seriousness of this subject, OR is particularly inappropriate. Durova 15:02, 18 September 2006 (UTC)

That does indeed sound like inappropriate original research. But if it's me stretched out on the floor, then please: (1) Call an ambulance, (2) see if anyone has an Epipen, and (3) pour a little liquid Benadryl down my throat. The active ingredient will absorb through the lining of the mouth, and if the patient is already unable to breathe, then they can't very well inhale the drug, no? WhatamIdoing 01:25, 7 June 2007 (UTC)

Bear in mind that this is severe shock, the body will start systematically shutting itself down to conserve its vital functions. It would be quite inadvisable to pour any form of liquid into a casualties mouth as they would be incapable of swallowing it and it would serve to block the airway even more. Worst case scenario it would enter the lungs and be fatal. AlexJFox (talk) 00:03, 24 July 2008 (UTC)

Etymology

The name was created by Charles Richet who discovered the phenomenon. It was to define a state where an organism became hypersensitive to a toxin - the opposite to "prophylaxis". He defined it as "ana" - against "phylaxis" a seldom-used Greek word for protection.--Bel wills 16:41, 18 September 2007 (UTC)

While it is true that "anaphylaxis" is from New Latin and "ana-" is from the Greek preposition, meaning "against," the latter portion of the word (-phylaxis) comes from the Greek word "phylax," (root phylak-) meaning "guard," or "of or relating to defense." 199.184.237.196 (talk · contribs)

I thought phylum was a bit anachronistic here. Let's see what the others think. JFW | T@lk 07:29, 14 December 2005 (UTC)

Yeah, the etymology given here is totally wrong. It is from phylaxis "guarding" with the prefix ana- which means "up, again, back, against" and a variety of other things. I'm not sure where the connection is to the medical condition, but that is transparently the etymology, and dictionaries agree on this point. The entry in the AMH implies that it's meant to be the opposite of prophylaxis, but I'm not sure that makes sense either. It would be nice to know what the semantic link is, as it would make the necessary rewrite much easier, but in any case this must be the etymology.

Even if the word did come from phylon "tribe, division" the whole digression about taxonomy would be totally irrelevant. Has anyone heard this fake etymology before? If it's commonly circulated (outside of Wikipedia) then perhaps we shoudl say "the word is not connected to phylum, except by folk etymology" or the like. --Iustinus 04:56, 26 December 2005 (UTC)

Fruit

I didn't add references when I added fruit to the list because readers might misunderstand the following as applying to a broader range of allergens:

• kiwi
• ackee
• general fruit anaphylaxis
• apple, banana, and lychee
• grape

The list could go on considerably, but that's enough to make the point. Durova 15:10, 18 September 2006 (UTC)

Photo

The photo seems a little dumb to me. Come on. Peanuts? 219.89.24.163 22:18, 22 October 2006 (UTC)

2 Treatment sections

Could someone please amalgamate the two sections on treatment - there is no need for both.

Medical advice

Is it not irresponsible for an open public wiki to offer advice about medical treatment in cases of life threatening acute conditions? What would be the reprocussions if someone acted on incorrect or incomplete advice read here - a death, potential litigation etc. Isn't there some sort of policy on this? 4kinnel 12:38, 10 February 2007 (UTC)

You're absolutely right, 4kinnel, thanks for bringing this up (see Wikipedia:medical disclaimer). I'll tag this with {{howto}} and work on fixing it more when I have the time. delldot | talk 00:58, 11 February 2007 (UTC)

Well, I tried to remove the how to wording, and I added the howto banner. If you think my improvements were enough, please remove the banner or discuss it further here. If not, please be bold and make the changes you think need to be made. You can also bring specific points here to the talk page and we can collaborate to figure out how to put them better. Thanks again for bringing this up! Peace, delldot | talk 01:29, 11 February 2007 (UTC)

There may be reasons for not giving medical advice, but legal liability isn't one of them. I read an article by a lawyer who said that there is no liability for publishing information that is harmful, even chemistry textbooks that publish experiments that harm children. I've seen peanut butter recipies in children's magazines. (One exception is navigation maps.) I don't think you could find a case in which someone was found liable for publishing medical advice. I'd be interested to see one. Nbauman 05:52, 17 February 2007 (UTC)

Why do the bronchioles constrict, why would that would help?

Bronchioles constrict due to the effects of the biogenic amines (primarily histamine) that are released. Histamine causes spasm of the smooth muscle in the small airways of the lungs. Other mediators also cause bronchospasm (particularly the cysteinyl leukotrienes - LTB4, C4 and D4). There is also an effect on the lungs due to other cytokines (such as IL-13 which causes epithelial cells to secrete mucus) and other inflammatory cells brought to the area, particularly eosinophils as part of the delayed phase response. To answer the second part of your question - this does not help. In fact, this is one of the major problems with anaphylaxis and can lead to respiratory failure. The mechanism is similar to that which occurs in asthma - and can be lethal.

anaphalactic percentage

How can the limits of the range be so precise? Does it do anyone any good to be so precise? How about something like: Some unknown fraction of the population is susceptable to anaphylaxis. 71.117.248.179 (talk) 19:53, 19 March 2008 (UTC) Oh, that's right wikipedia deleted my account. Thanks, guys. [REMOVED email address]

That's what the listed source says. We presume that they have the data to back it up. WhatamIdoing (talk) 20:30, 19 March 2008 (UTC)

Poemisaglock 18:52, 17 July 2007 (UTC) 1.24 to 16.8%, can't you get a better range? i would guess it is much closer to the lower figure, because it is pretty rare. i'd say something like 1-3%. Thanks.

No, those are the actual numbers. It's the proportion of Americans who might experience anaphylaxis at least once in their lives if they are exposed to a significant amount of a particular antigen/everything went wrong/all the stars were aligned/etc. WhatamIdoing 03:58, 24 August 2007 (UTC)

Expansion of lede on anaphylactic shock

I added this sentence because the lede failed to convey how the localized allergic reaction cascades into a life-threatening systemic response. I found what I was looking for in Immunity and Abnormal Responses, which appears to be note form from an authoritative medical textbook. A reliable crib sheet is better than nothing, but I didn't cite it as a reference because of inconsistent spellings and non-standard abbrev's. MaxEnt 00:39, 6 August 2007 (UTC)

The lead still needs work. One important point to add to the lead (and to the article body) is that anaphylaxis involves a threshold effect, not a dose-response curve. --Una Smith (talk) 23:02, 25 December 2007 (UTC)

Humans and other mammals

I found sources stating it has also been investigated in birds (pigeons) and frogs, but does not manifest to the same intensity as mammals. Google cache reports the fragment "anaphylaxis has been observed in all animals: horses, goats, cattle, rats, pigeons, ducks, and even in frogs" from the coin-operated Scandinavian Journal of Immunology. MaxEnt 02:13, 6 August 2007 (UTC)

Un-encyclopedic

I'm killing this:

At times the sight af a person taking three injections in a public place, such as a restaurant, can be disturbing to other people, especially those who supplied the allergen—such as a waiter who brought food laced with MSG or a customer who smoked several cigarettes in a row and refused to stop to spare a person's allergies. Most people who have not dealt with severe allergies cannot immagine their severity.

on the grounds that it's unencyclopedic. The editor who originally wrote it has so far failed to respond to comments left on the user pageWhatamIdoing 03:59, 24 August 2007 (UTC)

While I agree it may be unencyclopedic, I can understand the authors point of view. I was once wearing a facemask on a bus to avoid symptoms. I sat well back and I took it off going out of the bus. But before I got off I got a look back at me from a young female as I was some really crazy person just because they saw me in the mirror. I know it probably sounds pathetic to complain about "a dirty look", but this girl seemed so 100% certain that I must have been making it up and must have had some weird beliefs that were obviously not true. I was looked at like I was someone from outer space, like I was doing something so ridiculous and I was still struggling to breathe properly. And it definitely wasn't because she was "afraid" either, she just wanted to pretend like I was some kind of weirdo.

It's as though people without it want it both ways. They want to have the allergies to give them a story, and an excuse for things and something to complain about and then they act as though it's something absurd and something made up when a person who ACTUALLY has it and actually has the real IgE allergies. Anonywiki 17:53, 11 October 2007 (UTC)

The Symptoms Section

Thanks to the people who wrote this, you recently saved my life. --71.114.129.165 06:25, 31 August 2007 (UTC)

Planning for treatment section

The "Planning for treatment" section of this article seems to have some information that is out of place, and some links that aren't in sentences that reference the links.

The first 3 sentences make sense in the context and provide valuable information, but then there is a link and 2 sentences about treatment for shock caused by allergies to bees. That information seems to be out of place. Watercat04 22:00, 28 September 2007 (UTC)

PAF

Raised platelet-activating factor (PAF) levels and polymorphisms causing reduced degradation of PAF predispose to anaphylaxis: NEJM. JFW | T@lk 08:32, 6 January 2008 (UTC)

Localized Anaphylaxis ?

"localized anaphylaxis" is not a term I have ever encountered and a PubMed search gives single hit PMID 5881428 "Experimental bronchitis in dogs subjected to bronchially localized anaphylaxis". "Localised anaphylaxis" gains just 7 hits which do not seem to support (as far as I can tell from abstracts) use of term in this way. Localised reactions may be rashes, urticaria and limited angiooedema. But anaphylaxis always, in my understanding, implies a more systemic effect although this may be of varying degrees of severity (eg restrictive airways, alternations in pulse rate and evenual drop in blood pressure - ie shock). David Ruben ^Talk 04:14, 25 February 2008 (UTC)

Yeah, I'm no expert, but my understanding has always been that anaphylaxis is by definition a systemic reaction. delldot on a public computer talk 10:36, 25 February 2008 (UTC)

Despite the lack of a large number of articles in PubMed describing local anaphylaxis, it is true that there are two different degrees of anaphylaxis recognized in immunology. It is incorrect to assume that the term anaphylaxis is always referring to the systemic variety, even if that is the assumption in medical practice. I will leave the page alone but you are misleading the public. It bears at least mentioning that there does exist a distinction. —Preceding unsigned comment added by 71.204.15.239 (talk) 16:46, 23 March 2008 (UTC)

If the term local anaphylaxis is used by a small number of people to mean non-systemic Type 1 allergic reaction, then I don't mind having a sentence in the article that says that. However, this is conditional on a reliable source supporting this use, and I don't think it merits more than a sentence. It is not a notable or common use of the term in English. In nearly all the English-speaking world, nearly all of the medical researchers and clinicians understand anaphylaxis as a generalized systemic reaction. For example, many clinicians define anaphylaxis in ways that require a noticeable drop in blood pressure as key evidence of anaphylaxis. No documented drop in blood pressure = no proof of anaphylaxis. I've never understood how you could have a drop in blood pressure in, say, the part of your face near the bee sting, but not have that the blood pressure change affect your whole body. I am unhappy with the recent changes to the article, especially the changes which present this minority definition before the major use. WhatamIdoing (talk) 20:50, 23 March 2008 (UTC)

The recent changes wiped through the citation mark-up for the initial 7 references, so frankly disruptive to the article. The edit summary stated "No matter the number of hits on PubMed, there is a difference and it ought to be explained. Pretending there are not two forms is ridiculous" - but some extraordinary WP:Reliable source citation is required to support that there are two forms, if we are to ridicule and override the abstracting of 17 million citations from approximately 5,000 worldwide biomedical journals in 37 languages !

This is not a dispute that local allergic reactions can occur, they clearly can, but that these are not considered nor generally termed localised forms of "anaphylaxis" - i.e. it is an issue of naming. As per the policy of WP:NPOV - minority viewpoints do need to be mentioned but not to an WP:UNDUE extent, and trivial minority viewpoints should not be included at all:

• The provided links of National Library of Medicine - Medical Subject Headings MESH database http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?field=uid&term=D000707 defines as "The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic SHOCK, and death" and at bottom of the page will be seen the MeSH Tree Structures which shows that the local skin reaction of urticaria has a separate entry.
• The WHO ICD-10 coding link, http://www.who.int/classifications/apps/icd/icd10online/?gt66.htm+t782 , has "anaphylactic shock" as separate from just "Angioneurotic oedema" and "Allergy, unspecified"
• The eMedicine article link, http://www.emedicine.com/med/topic128.htm , gives a fairly typical and accepted discussion of the topic and its 1st section gives as the background and definition:

  "Portier and Richet first coined the term anaphylaxis in 1902 when a second vaccinating dose of sea anemone toxin caused a dog's death. The response was the opposite of prophylaxis and thus was referred to as anaphylaxis, meaning without protection.
  Anaphylaxis is an acute systemic reaction caused by..."

  David Ruben ^Talk 02:15, 24 March 2008 (UTC)

Assessment

The standards for B class specifically state that the article may have "some gaps or missing elements or references, needs editing for language usage or clarity, balance of content, or contains other policy problems..." WhatamIdoing (talk) 04:01, 24 March 2008 (UTC)

Tagged: {{technical}} 18th July 2008

This is to notify all editors on this article that I have tagged it as being too technical for a general audience. Hell, I suffer from it and even I don't understand what it says in parts (See Pathophysiology for a good example of what I mean). Anyone interested, please have a go at making this article generally accessible to a standard audience, i.e not so you require a medical degree to read it! Thor Malmjursson (talk) 16:01, 18 July 2008 (UTC)

The mojority of the article seems ok, but I think you are right about the pathophysiology section. It sounds like it has been lifted from a research paper or somethingPhilman132 (talk) 14:17, 27 February 2009 (UTC) In fact upon googling some of the senances, some of this section has been lifted directly from this book: http://books.google.co.uk/books?id=76LV6OzS204C&pg=PA413&lpg=PA413&dq=Mast+cells+are+large+cells+found+in+particularly+high+concentrations+in+vascularized+connective+tissues+just+beneath+epithelial+surfaces,+including+the+submucosal+tissues+of+the+gastrointestinal+and+respiratory+tracts,+and+the+dermis+that+lies+just+below+the+surface+of+the+skin&source=bl&ots=wlSQ3TI1b0&sig=cv02aWl4X6n1-33pdB3HM1mduHE&hl=en&ei=dfanScOCCNm0jAeUsoXXDw&sa=X&oi=book_result&resnum=1&ct=result#PPA413,M1 —Preceding unsigned comment added by Philman132 (talk • contribs) 14:26, 27 February 2009 (UTC)

Original research

Moshe,

It's not our job to guesstimate what percentage of at-risk people are going to encounter their allergens, nor what (small) percentage of them will anaphylax as a result. We cite reliable sources. You're applying guesses to get us from 1.24% "at-risk" down to 18 deaths, and on the sole basis of your guess, you're trying to declare the data wrong. The data trumps your guesses! If you don't get from 1.24% to 18 deaths in a year, let me suggest that you blame the inaccuracy of your guesses instead of deleting numbers taken from scientific reports. WhatamIdoing (talk) 03:11, 25 September 2008 (UTC)

A letter "¬" is found in many abbreviations

Is the letter only able to be dropped off? --Tossh eng (talk) 07:19, 6 November 2008 (UTC)

Numbers at the end of the paragraphs

What are the numbers at the end of the paragraphs in "Phathophysiology" section?
At the end of the third paragraph: "...the mast cell.4".
At the end of the fifth paragraph: "...mast cells.9". --Tossh eng (talk) 07:19, 6 November 2008 (UTC)

9 is apparently <ref>{{cite journal |author=Gilfillan A., Tkacyk C. |title=Integrated signaling pathways for mast-cell activation |journal=Nature Reviews Immunology |volume=6 |pages=218-230 |year=2002}}</ref>

I can't figure out what 4 is supposed to be. WhatamIdoing (talk) 19:26, 6 November 2008 (UTC)

Pathophysiology

It might just be me, but the pathophysiology section is really difficult to understand. I realize that it's very a technical subject, but I think it might only be helpful to people in graduate level microbiology or physiology classes, and at they probably have textbooks that explain it better... I don't exactly know what I'm suggesting. I guess I'm just frustrated that I didn't know what 85% of that section was saying. I think it might have been missing a few indefinite articles, and other minor grammatical issues, but I'm not sure, since I'm not sure. JRNorbergé (talk) 01:10, 9 June 2009 (UTC)

I just noticed that there was another section addressing this, but meh.