Approach to Idiopathic Anaphylaxis in Adolescents

1. Diagnosis a. In summary, clinical features suggestive of anaphylaxis, without a readily evident trigger, should prompt expanded diagnostic considerations. b. A comprehensive history and timeline of exposures and subsequent symptoms is the most useful diagnostic tool. Objective findings as available, such as vital signs and observations of the airway and skin, can help validate anaphylaxis or suggest an alternative disorder. c. Using anaphylactic diagnostic criteria is recommended given strong positive and negative predictive values. d. For obscure causes of anaphylaxis, a broad differential of rare food, drug, venom triggers should be considered, with additional consideration of summative anaphylaxis, which may involve 2 or more cofactors. e. Patients with unexplained anaphylaxis require evaluation for an underlying mast cell disorder. Multiple laboratory diagnostics can help confirm or refute certain etiologies and aid to narrow the differential diagnoses.f. Referral to an allergy specialist is strongly recommended to guide evaluation when confronted with anaphylaxis of uncertain cause. Hematologist support is necessary to assist with the diagnosis of clonal mast cell disorders. 2. Management a. Medical management of anaphylaxis should follow guideline-based practices. This includes preparedness with epinephrine autoinjectors and extensive training with the adolescent and their family. Provision of written action plans is recommended. b. As adolescents mature, they should have guided support for symptom self -recognition and management responsibilities. c. Preparation with written emergency action plans and emergency simulations can reduce feared poor outcomes and provide confidence. d. As unexplained recurrent and unpredictable anaphylaxis can cause significant anxiety, addressing mental health concerns early and often with this invisible disability is important. e. Although medical options to prevent anaphylaxis without cause are presently few, there is significant hope that what is presently idiopathic will be later diagnosable. f. Existing pharmacologic drugs, many used off-label, may minimize the frequency and/or severity of reactions in the interim. Future medications in research and development offer significant hope for future control of anaphylaxis.

Automated summary

Diagnosis of anaphylaxis should involve comprehensive consideration, including detailed history and objective findings. Using diagnostic criteria and considering rare triggers, as well as evaluating for mast cell disorders, can aid in the diagnosis. Referral to specialists may be necessary.