Aines

CURRENT THERAPY
J Oral Maxillofac Surg
68:855-862, 2010

Management Protocol for Anaphylaxis
Rohit Sharma, MDS,* Ramen Sinha, MDS,†
P.S. Menon, MDS, FIBOMS,‡ and Deepika Sirohi, MD§
There is no universal agreement on the definition of anaphylaxis or the criteria for establishing its
diagnosis, although it has been known to the field of emergency medicine for more than 100 years. Twomeetings were convened by the National Institute of Allergy and Infectious Disease and Food Allergy and
Anaphylaxis Network in April 2004 and July 2005. Representatives from 16 different organizations and
government bodies, including representatives from developed nations, continue working toward a
universally accepted definition, criteria for diagnosis, and management of anaphylaxis. This articlepresents the latest concepts on anaphylaxis in the literature including the research needs in this area.
© 2010 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 68:855-862, 2010
induced reaction to various allergens resulting in mast
cell degranulation and basophil activation.4 The incidence of anaphylaxis is unknown but is estimated to
be 1/10,000 in the generalpopulation per year with
an increased risk in women of 3-10:1.
Anaphylactoid reactions present with an identical
clinical picture involving similar mediators but without IgE involvement. Various mechanisms are responsible:

Anaphylaxis was described more than 100 years ago
but continues to be one of the most alarming disorders encountered in medicine, with no universal
agreement on itsdefinition or criteria for diagnosis.
This has hindered research in its epidemiology, pathophysiology, and management, and has led to confusion on the part of first responders, emergency personnel, primary care physicians, and patients, as well
as failure to diagnose and treat anaphylaxis in a consistent manner.1-3 In an attempt to resolve problems
regarding this issue, this article presents the newconcepts of defining and managing anaphylaxis based
on the latest literature in the field of emergency medicine.

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Definition

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The term anaphylaxis is derived from the Greek
words a (against) and phylaxis (immunity, protection). Anaphylaxis is a type I immune-mediated, lifethreatening severe systemic allergic reaction. It is a
specific immunoglobulin IgE–mediated, antigen-Generation of kinins with activation of coagulation or fibrinolysis
Activation of complement cascade (eg, gelofusine)
Modulation of arachidonic acid metabolism (eg,
aspirin)
Direct histamine release (eg, opioids, contrast
injections).

Etiology
Anaphylactic (IgE) reactions may have any of the
following etiologies:

*Major and Graded Specialist, Maxillofacial Surgery, Military Dental Center,Jalandhar, India.
†Colonel, Professor, and Head of Department, Department of
Dental Surgery, Armed Forces Medical College, Pune, India.
‡Colonel, Director “E” and “S”, Office of the Director General
Dental Services, Army Headquarters, New Delhi, India.
§Lt Colonel and Classified Specialist, Pathology, Military Hospital,
Jalandhar, India.
Address correspondence and reprint requests to MAJSharma: Military Dental Center, Jalandhar, India.

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© 2010 American Association of Oral and Maxillofacial Surgeons

0278-2391/10/6804-0023$36.00/0
doi:10.1016/j.joms.2009.06.008

855

Food
Drugs
Local anesthetics containing methyl paraben
Vaccines
Venoms
Allergen extracts
Foreign proteins
Parasites
Latex
Hormones, enzymes
Muscle relaxantsExercise and food triggers

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MANAGEMENT PROTOCOL FOR ANAPHYLAXIS

Anaphylactoid (non-IgE) reactions may derive from
any of the following:
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Muscle relaxants
Opioids
Radiological contrast media
Immunoglobulins
Aspirin and nonsteroidal anti-inflammatory drugs
(NSAIDs)
Dextran and gelatin

Pathophysiology
The common feature in anaphylaxis, whether initiated by...