Anaphylaxis in hospital is most commonly caused by drugs. Outside hospital, environmental antigens such as food and venoms are the most common causes.

Anaphylaxis is most commonly related to drug therapy. The Boston Collaborative Drug Surveillance Program (1973) reported a hospital incidence of anaphylaxis of three in 10 000 patients. Incidences of anaphylaxis mediated by various substances are as follows: penicillin, 15 to 40 in 100 000; contrast media, one in 1000; blood volume replacement solutions, one in 400; anaesthetic drugs, one in 20 000. Up to 1 per cent of the population have antibodies to hymenoptera stings, with 60 to 80 deaths occurring annually in the USA.

Protein-based substances, including blood products, vaccines, antivenoms, gammaglobulins, protamine, and desensitizing solutions, cause the majority of reactions. These substances may produce reactions due to specific antibodies or form aggregates which activate complement. Multiple drugs are implicated in anaphylaxis, with antibiotics representing some of the most common parenterally administered agents. Foods (particularly peanuts) and environmental allergens, such as insect stings, are also common causes.

Chapter References

Boston Collaborative Drug Surveillance Program (1973). Drug induced anaphylaxis. Journal of the American Medical Association, 224, 613-15.

Fisher, M. (1987). Anaphylaxis. Disease-a-Month, 33.

Levy, J.H. (1992). Anaphylactic reactions in anaesthesia and intensive care (2nd edn). Butterworth, Stoneham, MA.

Levy, J.H., Schwieger, I.M., Zaidan, J.R., Faraj, B.A., and Weintraub, W.S. (1989). Evaluation of patients at risk for protamine reactions.

Journal of Thoracic and Cardiovascular Surgery, 98, 200-4.

Vigorito, C., Russo, P., Picotti, G.B., Chiariello, M., Poto, S., and Marone, G. (1983). Cardiovascular effects of histamine infusion in man.

Journal of Cardiovascular Pharmacology, 5, 531-7.

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