Key messages

• Anaphylaxis is a complex clinical syndrome characterized by acute cardiopulmonary dysfunction.

• Multiple biological pathways can produce a similar clinical syndrome by mediator release, although these reactions are not immmunological in origin.

• There are few human data regarding the acute changes that occur during anaphylactic shock.

• The effects of mediators on the heart, the vascular endothelium and smooth muscle, and the lung produce a complex, enigmatic, and unpredictable adverse response.

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