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Idiopathic anaphylaxis differential diagnosis RE – Kirsty Rollinson – in red are test not done Anaphylaxis is ;Hypotension & increased pulse rate • Wheezing & stridor • Hives, angioedema, flushing, & itching • Nausea, vomiting, diarrhea, difficulty swallowing • Light-headedness and loss of consciousness True allergy – Rast , patch and prick testing , Total IGE . If its not high enough to cause anaphylaxis look else were . Rare allergen combinations Pork and Cat allergies Mammalian meat IGE allergy NON IGE mast cell activation Exercise induced anaphylaxis Food associated exercise induced anaphylaxis Mastocytosis , mast cell activation syndrome , monoclonal mast cell activation Mast cell tryptase level on a good day and in an event , within 2 hours of symptoms beginning . Tryptase is a minor criteria for mastocytosis by WHO definitions as systemic mastocytosis can be present with normal tryptase . Measures mast cell load not illness level . . If over lab top level definite systemic mastocytosis or if it rises from baseline in an event . If in normal limits but patient has symptoms 24 hour urine collection for prostaglandins and histamine. Serotonin can be raised . But if its off the scale high look for carciniod syndrome. It can be very low and the patient not be clinically depressed . . 24 hour urine collection is baseline test for carciniod syndrome . for 5-11HA. Which measures serotoinin derivatives . Carciniod syndrome , pheaocryocythoma – mimic mastocytosis so should be excluded . Hereditary Angiodeama C1 esterase and function and full compliment screen Autoimmune disease causing Angiodeama and anaphylaxis - Hashimotos thyroiditis – thyroid pyroxidase enzyme antibody - Adrenal autoimmunity – adrenal antibodies - Lupus - ANA - Amiloyodosis – plasma electrophresis - Myloma ( falsely raising IGE ) Autoimmune - Autoantibodies against the High-Affinity IgE Receptor – causes histamine release in chronic Angiodeama and urticaria and can cause anaphylaxis IGG mediated disease - Myasthenia Gravis - Details of conditions , symptoms and treatments . All conditions have triggers which trigger mast cells / kinin system Patients are individual in triggers . Many have evidence of mast cell activation in medical literature . In histamine and autoimmune conditions mast cells are activated by these substances or by compliment activation . The chemicals from the mast cell cause symptoms . This is the list from tmsforacure.org with Kirsties triggers added Alcohol Anesthetic agents Antibiotics - mycin antibiotics Bacteria or fungi Certain foods - Lactose is in singulair and explains seizure reaction . Cold (temperature) Coloring & flavoring in foods Coloring & flavoring in medications Emotional upset Environmental toxins Exercise or exertion Fatigue Fever Friction Heat (temperature) Infection with viruses, bacteria or fungi Mold MSG Narcotics Perfumes Pesticides Plasma expanders (i.e. dextran) Preservatives – sulphites Gelatin in capsules - , nitrites Room freshener sprays Smells Spices Stress Sunlight Metroclopamide , tricyclic antidepressants , beta blockers - have contraindications that make them an absolute NO
