eMedicine Specialties > Allergy and Immunology > Major Allergic Diseases

Anaphylaxis: Differential Diagnoses & Workup

Author: Stephen F Kemp, MD, FACP, Professor of Medicine, Associate Professor of Pediatrics, Director of Allergy and Immunology Fellowship Program, Departments of Medicine and Pediatrics, Associate Director of Division of Clinical Immunology and Allergy, Department of Medicine, University of Mississippi Medical Center; Consultant in Allergy and Immunology, Medical Service, G V (Sonny) Montgomery Veterans Affairs Medical Center
Coauthor(s): G William Palmer, MD, Consulting Staff, Shoreline Allergy and Asthma Associates
Contributor Information and Disclosures

Updated: Apr 29, 2009

Differential Diagnoses

Angioedema
Malignant Carcinoid Syndrome
Mastocytosis, Systemic
Pheochromocytoma
Thyroid, Medullary Carcinoma

Other Problems to Be Considered

Workup

Laboratory Studies

  • Anaphylaxis is a clinical diagnosis based on typical systemic manifestations, often with a history of acute exposure to a causative agent. Laboratory studies are not usually required and are rarely helpful.
  • If the diagnosis is unclear, especially with a recurrent syndrome, or if other diseases need to be excluded, some limited laboratory studies are indicated.
    • For example, if carcinoid syndrome is considered, urinary 5-hydroxyindoleacetic acid levels should be measured.
    • If a patient is seen shortly after an episode, plasma histamine, urinary histamine metabolites, or serum tryptase measurements may be helpful in confirming the diagnosis.2
      • Plasma histamine levels rise within 10 minutes of onset but fall again within 30 minutes.
      • Urinary histamine levels are generally not dependable, as this test can be affected by diet and by bacteria in the urine. Urinary histamine metabolites measurement is a better test but is not generally available.
      • Serum mature tryptase (previously called beta-tryptase) levels peak 60-90 minutes after the start of an episode and may persist for as long as 5 hours. The estimated positive predictive value of tryptase elevations in 259 subjects with anesthesia-associated anaphylaxis is 92.6%, and the estimated negative predictive value of normal tryptase levels is 54.3%. Serial tryptase measurements might improve diagnostic sensitivity, but further investigation is needed.
      • Detecting the rise of histamine or tryptase levels can be difficult, and some patients might have a rise in one but not the other. In one emergency department study evaluating patients with acute allergic reactions, 42 of 97 had elevated histamine while 20 had elevated tryptase levels.28 No correlation was demonstrated between the levels of tryptase and histamine.
      • Basal levels of total and mature tryptase between episodes of anaphylaxis can be helpful to rule out systemic mastocytosis. Patients with mastocytosis constitutively produce large quantities of alpha-tryptase, while individuals with anaphylaxis from other causes have normal levels of alpha-tryptase at baseline between episodes of anaphylaxis. During anaphylaxis, a ratio of total tryptase (alpha + mature) to mature tryptase of 20 or greater is consistent with mastocytosis, whereas a ratio of 10 or less suggests anaphylaxis of another etiology.

Imaging Studies

  • No role exists for imaging studies in the diagnosis or management of anaphylaxis.

Other Tests

  • Once an acute episode of anaphylaxis has occurred, additional testing may be helpful to identify an etiologic agent.
    • Patient diary: A thorough history remains the best test to determine a causative agent. For recurrent idiopathic episodes, a patient diary may be helpful to implicate specific foods or drugs.
    • Food reactions: If the patient's history suggests a possible association with eating, percutaneous food-skin tests and/or in vitro IgE tests (eg, radioallergosorbent assay test [RAST] or ImmunoCAP tests [Phadia AB, Uppsala, Sweden]) can be performed, with an understanding that false-positive results may occur. The rate of false positives is about 50% for both skin tests and RAST, whereas ImmunoCAP has about 95% positive predictive value. Conversely, the negative predictive value of skin testing is about 95% (may not be reliable for fresh fruits/vegetables or crustaceans because of the lack of labile allergenic proteins in commercial extracts).

      Many pan-allergens (eg, profilins, chitinases, lipid transfer proteins, tropomyosin) can add to the confusion, as foods may share pathogen-related proteins with nonfood allergens. Intradermal skin testing and IgG RAST tests have no role in food-skin testing. A double-blind, placebo-controlled food challenge may need to be performed to confirm clinical reactivity. However, when a particular food is clearly related temporally to the reaction, a food-skin test should not be performed with standard concentrations of food extracts because deaths have occurred secondary to food-skin testing, particularly with peanuts.
    • Insect stings: If the patient's history suggests an insect sting, skin testing and in vitro IgE tests to Hymenoptera venoms should be performed. The in vitro IgE tests should be considered because cases have occurred in patients with negative skin test results and with severe clinical reactivity and positive in vitro IgE results.
      • A patient's ability to identify the type of flying insect is unreliable, generally mandating testing of all flying Hymenoptera. For example, many patients confuse yellow jackets and bees. However, exceptions for this testing for multiple insect venoms can be made for patients whose stings were accompanied by sterile pustule formation within 24 hours (pathognomonic for fire ant sting) or for whom an impaled stinger and abdominal remnant were found at the sting site (the honeybee eviscerates itself as it stings). In these cases, testing may be limited to fire ant and honeybee allergen-specific IgE, respectively.
      • Skin testing and in vitro IgE testing should be performed 4-6 weeks following the episode of anaphylaxis to improve the sensitivity of the diagnostic test.
    • Suspected medication etiology
      • If the patient's history suggests a penicillin etiology and the reagents are available, skin testing for penicillin should be performed with the appropriate positive and negative controls. Penicillin G and major determinant (Pre-Pen) are usually commercially available for skin testing, although at the time this was last updated, Pre-Pen was unavailable in the United States. Minor determinant mix (MDM) is available primarily at research centers. The minor determinants comprise only 5% of penicillin metabolites but are implicated in anaphylaxis risk. Therefore, if MDM is not available for skin testing for patients with a good history, a desensitization protocol may be the safest path regardless of skin test results.
      • If MDM is not available for skin testing for patients with a history that is not suggestive of an immediate hypersensitivity reaction who have negative results to penicillin G and Pre-Pen, penicillin should only be administered as an incremental challenge under close medical observation. If possible, give oral penicillin before administering it intravenously or intramuscularly.
      • Skin testing for reactivity to other beta-lactam antibiotics, or any other medicine for that matter, should be considered experimental because the haptenic determinants are unknown. Skin testing with the parent drug may be beneficial if the results are positive, but a negative result does not exclude the potential for severe clinical reactivity.
    • Testing for IgE-independent etiologies: Because these reactions are not mediated through IgE, skin testing has no role in diagnosis. No other diagnostic tests help assess the risk of recurrent IgE-independent reactions.

More on Anaphylaxis

Overview: Anaphylaxis
Differential Diagnoses & Workup: Anaphylaxis
Treatment & Medication: Anaphylaxis
Follow-up: Anaphylaxis
References
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References

  1. Kemp SF, Lockey RF. Anaphylaxis: a review of causes and mechanisms. J Allergy Clin Immunol. Sep 2002;110(3):341-8. [Medline].

  2. Simons FE. 9. Anaphylaxis. J Allergy Clin Immunol. Feb 2008;121(2 Suppl):S402-7; quiz S420. [Medline].

  3. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. May 2004;113(5):832-6. [Medline].

  4. Alrasbi M, Sheikh A. Comparison of international guidelines for the emergency medical management of anaphylaxis. Allergy. Aug 2007;62(8):838-41. [Medline].

  5. Finkelman FD. Anaphylaxis: lessons from mouse models. J Allergy Clin Immunol. Sep 2007;120(3):506-15; quiz 516-7. [Medline].

  6. Schadt JC, Ludbrook J. Hemodynamic and neurohumoral responses to acute hypovolemia in conscious mammals. Am J Physiol. Feb 1991;260(2 Pt 2):H305-18. [Medline].

  7. Demetriades D, Chan LS, Bhasin P, Berne TV, Ramicone E, Huicochea F. Relative bradycardia in patients with traumatic hypotension. J Trauma. Sep 1998;45(3):534-9. [Medline].

  8. Moneret-Vautrin DA, Morisset M, Flabbee J, et al. Epidemiology of life-threatening and lethal anaphylaxis: a review. Allergy. Apr 2005;60(4):443-51. [Medline].

  9. Neugut AI, Ghatak AT, Miller RL. Anaphylaxis in the United States: an investigation into its epidemiology. Arch Intern Med. Jan 8 2001;161(1):15-21. [Medline].

  10. Yocum MW, Butterfield JH, Klein JS, et al. Epidemiology of anaphylaxis in Olmsted County: A population-based study. J Allergy Clin Immunol. Aug 1999;104(2 Pt 1):452-6. [Medline].

  11. Webb LM, Lieberman P. Anaphylaxis: a review of 601 cases. Ann Allergy Asthma Immunol. Jul 2006;97(1):39-43. [Medline].

  12. Bresser H, Sandner CH, Rakoski J. Anaphylactic emergencies in Munich in 1992 (abstract). J Allergy Clin Immunol. Jan 1995;95:368.

  13. Mertes PM, Laxenaire MC, Alla F,. Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000. Anesthesiology. Sep 2003;99(3):536-45. [Medline].

  14. Simons FE, Peterson S, Black CD. Epinephrine dispensing patterns for an out-of-hospital population: a novel approach to studying the epidemiology of anaphylaxis. J Allergy Clin Immunol. Oct 2002;110(4):647-51. [Medline].

  15. Bock SA, Munoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. Jan 2001;107(1):191-3. [Medline].

  16. Greenberger PA, Rotskoff BD, Lifschultz B. Fatal anaphylaxis: postmortem findings and associated comorbid diseases. Ann Allergy Asthma Immunol. Mar 2007;98(3):252-7. [Medline].

  17. Wang J, Sampson HA. Food anaphylaxis. Clin Exp Allergy. May 2007;37(5):651-60. [Medline].

  18. Pumphrey RS. Fatal posture in anaphylactic shock. J Allergy Clin Immunol. Aug 2003;112(2):451-2. [Medline].

  19. Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. Apr 2005;115(4):1048-57. [Medline].

  20. Golden DB. Insect sting anaphylaxis. Immunol Allergy Clin North Am. May 2007;27(2):261-72, vii. [Medline].

  21. Hourihane JO'B, Kilburn SA, Nordlee JA, Hefle SL, Taylor SL, Warner JO. An evaluation of the sensitivity of subjects with peanut allergy to very low doses of peanut protein: a randomized, double-blind, placebo-controlled food challenge study. J Allergy Clin Immunol. Nov 1997;100(5):596-600. [Medline].

  22. Amin HS, Liss GM, Bernstein DI. Evaluation of near-fatal reactions to allergen immunotherapy injections. J Allergy Clin Immunol. Jan 2006;117(1):169-75. [Medline].

  23. Bernstein DI, Wanner M, Borish L, Liss GM, et al. Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990-2001. J Allergy Clin Immunol. Jun 2004;113(6):1129-36. [Medline].

  24. Lockey RF, Benedict LM, Turkeltaub PC, Bukantz SC. Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol. Apr 1987;79(4):660-77. [Medline].

  25. Greenberger PA. Idiopathic anaphylaxis. Immunol Allergy Clin North Am. May 2007;27(2):273-93, vii-viii. [Medline].

  26. Meggs WJ, Pescovitz OH, Metcalfe D, Loriaux DL, Cutler G Jr, Kaliner M. Progesterone sensitivity as a cause of recurrent anaphylaxis. N Engl J Med. Nov 8 1984;311(19):1236-8. [Medline].

  27. Slater JE, Raphael G, Cutler GB Jr, Loriaux DL, Meggs WJ, Kaliner M. Recurrent anaphylaxis in menstruating women: treatment with a luteinizing hormone-releasing hormone agonist--a preliminary report. Obstet Gynecol. Oct 1987;70(4):542-6. [Medline].

  28. Lin RY, Schwartz LB, Curry A, et al. Histamine and tryptase levels in patients with acute allergic reactions: An emergency department-based study. J Allergy Clin Immunol. Jul 2000;106(1 Pt 1):65-71. [Medline].

  29. Lieberman P. Anaphylaxis and Anaphylactoid Reactions. In: Middleton Jr Adkinson Jr NF, Yunginger JW, Busse WW, Bochner BS, Holgate ST, and Simons FER, eds. Allergy Principles and Practice. 6th ed. St. Louis, Mo: Mosby; 2003:1497-1522.

  30. Lieberman P. Use of epinephrine in the treatment of anaphylaxis. Curr Opin Allergy Clin Immunol. Aug 2003;3(4):313-8. [Medline].

  31. Haymore BR, Carr WW, Frank WT. Anaphylaxis and epinephrine prescribing patterns in a military hospital: underutilization of the intramuscular route. Allergy Asthma Proc. Sep-Oct 2005;26(5):361-5. [Medline].

  32. Thomas M, Crawford I. Best evidence topic report. Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. Emerg Med J. Apr 2005;22(4):272-3. [Medline].

  33. Borish L, Tamir R, Rosenwasser LJ. Intravenous desensitization to beta-lactam antibiotics. J Allergy Clin Immunol. Sep 1987;80(3 Pt 1):314-9. [Medline].

  34. Rosen JP. Empowering patients with a history of anaphylaxis to use an epinephrine autoinjector without fear. Ann Allergy Asthma Immunol. Sep 2006;97(3):418. [Medline].

  35. Kemp SF. The post-anaphylaxis dilemma: how long is long enough to observe a patient after resolution of symptoms?. Curr Allergy Asthma Rep. Mar 2008;8(1):45-8. [Medline].

  36. Simons FE. Anaphylaxis: evidence-based long-term risk reduction in the community. Immunol Allergy Clin North Am. May 2007;27(2):231-48, vi-vii. [Medline].

  37. Nurmatov U, Worth A, Sheikh A. Anaphylaxis management plans for the acute and long-term management of anaphylaxis: a systematic review. J Allergy Clin Immunol. Aug 2008;122(2):353-61, 361.e1-3. [Medline].

  38. Choo K, Sheikh A. Action plans for the long-term management of anaphylaxis: systematic review of effectiveness. Clin Exp Allergy. Jul 2007;37(7):1090-4. [Medline].

  39. AAAAI Board of Directors. Anaphylaxis in schools and other childcare settings. American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol. Aug 1998;102(2):173-6. [Medline].

  40. Abela GS, Picon PD, Friedl SE, Gebara OC, Miyamoto A, Federman M. Triggering of plaque disruption and arterial thrombosis in an atherosclerotic rabbit model. Circulation. Feb 1 1995;91(3):776-84. [Medline].

  41. Anne S, Reisman RE. Risk of administering cephalosporin antibiotics to patients with histories of penicillin allergy. Ann Allergy Asthma Immunol. Feb 1995;74(2):167-70. [Medline].

  42. Brown SG, Blackman KE, Stenlake V, Heddle RJ. Insect sting anaphylaxis; prospective evaluation of treatment with intravenous adrenaline and volume resuscitation. Emerg Med J. Mar 2004;21(2):149-54. [Medline].

  43. Burks W, Bannon GA, Sicherer S, Sampson HA. Peanut-induced anaphylactic reactions. Int Arch Allergy Immunol. Jul 1999;119(3):165-72. [Medline].

  44. Clark S, Bock SA, Gaeta TJ, Brenner BE, Cydulka RK, Camargo CA. Multicenter study of emergency department visits for food allergies. J Allergy Clin Immunol. Feb 2004;113(2):347-52. [Medline].

  45. Clark S, Long AA, Gaeta TJ, Camargo CA Jr. Multicenter study of emergency department visits for insect sting allergies. J Allergy Clin Immunol. Sep 2005;116(3):643-9. [Medline].

  46. Erjefalt JS, Korsgren M, Malm-Erjefalt M, Conroy DM, Williams TJ, Persson CG. Acute allergic responses induce a prompt luminal entry of airway tissue eosinophils. Am J Respir Cell Mol Biol. Oct 2003;29(4):439-48. [Medline].

  47. Fisher MM. Clinical observations on the pathophysiology and treatment of anaphylactic cardiovascular collapse. Anaesth Intensive Care. Feb 1986;14(1):17-21. [Medline].

  48. Freeman TM. Clinical practice. Hypersensitivity to hymenoptera stings. N Engl J Med. Nov 4 2004;351(19):1978-84.

  49. Galli SJ. Pathogenesis and management of anaphylaxis: current status and future challenges. J Allergy Clin Immunol. Mar 2005;115(3):571-4. [Medline].

  50. Goetzl EJ, Wasserman SI, Austen F. Eosinophil polymorphonuclear leukocyte function in immediate hypersensitivity. Arch Pathol. Jan 1975;99(1):1-4. [Medline].

  51. Grammer LC, Greenberger PA. Drug Allergy and Protocols for Management of Drug Allergies. 3rd ed. Providence: OceanSide Press; 2003.

  52. Gruchalla RS. 10. Drug allergy. J Allergy Clin Immunol. Feb 2003;111(2 Suppl):S548-59. [Medline].

  53. Hepner DL, Castells MC. Anaphylaxis during the perioperative period. Anesth Analg. Nov 2003;97(5):1381-95. [Medline].

  54. Joint Task Force on Practice Parameters. Lieberman P, Kemp SF, Oppenheimer J, et al. (eds.). The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol. Mar 2005;115(3 Suppl):S483-523. [Medline].

  55. Kagan RS, Joseph L, Dufresne C, et al. Prevalence of peanut allergy in primary-school children in Montreal, Canada. J Allergy Clin Immunol. Dec 2003;112(6):1223-8.

  56. Kaliner M, Sigler R, Summers R, Shelhamer JH. Effects of infused histamine: analysis of the effects of H-1 and H-2 histamine receptor antagonists on cardiovascular and pulmonary responses. J Allergy Clin Immunol. Nov 1981;68(5):365-71. [Medline].

  57. Kounis NG. Kounis syndrome (allergic angina and allergic myocardial infarction): a natural paradigm?. Int J Cardiol. Jun 7 2006;110(1):7-14. [Medline].

  58. Kovanen PT, Kaartinen M, Paavonen T. Infiltrates of activated mast cells at the site of coronary atheromatous erosion or rupture in myocardial infarction. Circulation. Sep 1 1995;92(5):1084-8. [Medline].

  59. Lenchner K, Grammer LC. A current review of idiopathic anaphylaxis. Curr Opin Allergy Clin Immunol. Aug 2003;3(4):305-11. [Medline].

  60. Mansfield L. Successful oral desensitization for systemic peanut allergy. Ann Allergy Asthma Immunol. Aug 2006;97(2):266-7. [Medline].

  61. Marone G, Bova M, Detoraki A, Onorati AM, Rossi FW, Spadaro G. The human heart as a shock organ in anaphylaxis. Novartis Found Symp. 2004;257:133-49; discussion 149-60, 276-85. [Medline].

  62. Pumphrey R. Anaphylaxis: can we tell who is at risk of a fatal reaction?. Curr Opin Allergy Clin Immunol. Aug 2004;4(4):285-90. [Medline].

  63. Rang WQ, Du YH, Hu CP, Ye F, Tan GS, Deng HW. Protective effects of calcitonin gene-related peptide-mediated evodiamine on guinea-pig cardiac anaphylaxis. Naunyn Schmiedebergs Arch Pharmacol. Mar 2003;367(3):306-11. [Medline].

  64. Raper RF, Fisher MM. Profound reversible myocardial depression after anaphylaxis. Lancet. Feb 20 1988;1(8582):386-8. [Medline].

  65. Reid MJ, Lockey RF, Turkeltaub PC, Platts-Mills TA. Survey of fatalities from skin testing and immunotherapy 1985-1989. J Allergy Clin Immunol. Jul 1993;92(1 Pt 1):6-15. [Medline].

  66. Romano A, Gueant-Rodriguez RM, Viola M, et al. Cross-reactivity and tolerability of cephalosporins in patients with immediate hypersensitivity to penicillins. Ann Intern Med. Jul 6 2004;141(1):16-22. [Medline].

  67. Rubin LE, Levi R. Protective role of bradykinin in cardiac anaphylaxis. Coronary-vasodilating and antiarrhythmic activities mediated by autocrine/paracrine mechanisms. Circ Res. Mar 1995;76(3):434-40. [Medline].

  68. Sampson HA. Update on food allergy. J Allergy Clin Immunol. May 2004;113(5):805-19; quiz 820. [Medline].

  69. Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. Aug 6 1992;327(6):380-4. [Medline].

  70. Sampson HA, Munoz-Furlong A, Bock SA, et al. Symposium on the definition and management of anaphylaxis: summary report. J Allergy Clin Immunol. Mar 2005;115(3):584-91. [Medline].

  71. Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A. Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. Feb 2006;117(2):391-7. [Medline].

  72. Schuligoi R, Amann R, Donnerer J, Peskar BA. Release of calcitonin gene-related peptide in cardiac anaphylaxis. Naunyn Schmiedebergs Arch Pharmacol. Feb 1997;355(2):224-9. [Medline].

  73. Sicherer SH. Food allergy. Lancet. Aug 31 2002;360(9334):701-10. [Medline].

  74. Sicherer SH, Simons FE. Quandaries in prescribing an emergency action plan and self-injectable epinephrine for first-aid management of anaphylaxis in the community. J Allergy Clin Immunol. Mar 2005;115(3):575-83. [Medline].

  75. Simons FE. First-aid treatment of anaphylaxis to food: focus on epinephrine. J Allergy Clin Immunol. May 2004;113(5):837-44. [Medline].

  76. Smith PL, Kagey-Sobotka A, Bleecker ER, Traystman R, Kaplan AP, Gralnick H. Physiologic manifestations of human anaphylaxis. J Clin Invest. Nov 1980;66(5):1072-80. [Medline].

  77. Sorensen HT, Nielsen B, Ostergaard Nielsen J. Anaphylactic shock occurring outside hospitals. Allergy. May 1989;44(4):288-90. [Medline].

  78. Steffel J, Akhmedov A, Greutert H, Luscher TF, Tanner FC. Histamine induces tissue factor expression: implications for acute coronary syndromes. Circulation. Jul 19 2005;112(3):341-9. [Medline].

  79. van der Linden PW, Struyvenberg A, Kraaijenhagen RJ, Hack CE, van der Zwan JK. Anaphylactic shock after insect-sting challenge in 138 persons with a previous insect-sting reaction. Ann Intern Med. Feb 1 1993;118(3):161-8. [Medline].

  80. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. Feb 10 2005;352(6):539-48. [Medline].

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Further Reading

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Keywords

anaphylaxis, systemic allergic reaction, anaphylactic reaction, anaphylactoid reaction, allergic reaction, allergies, peanut allergy, latex allergy, shellfish allergy, hypersensitivity reaction, food allergy, insect sting, Hymenoptera venom, wasp sting, bee sting, yellow jacket sting, hornet sting, penicillin allergy, radiocontrast hypersensitivity, cardiovascular collapse, laryngeal edema, atopy, atopic disease, fire ant sting, immunotherapy, platelet activating factor, PAF, anaphylactic shock, EpiPen, epipen, food allergies, bee allergy, bee sting allergy

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Contributor Information and Disclosures

Author

Stephen F Kemp, MD, FACP, Professor of Medicine, Associate Professor of Pediatrics, Director of Allergy and Immunology Fellowship Program, Departments of Medicine and Pediatrics, Associate Director of Division of Clinical Immunology and Allergy, Department of Medicine, University of Mississippi Medical Center; Consultant in Allergy and Immunology, Medical Service, G V (Sonny) Montgomery Veterans Affairs Medical Center
Stephen F Kemp, MD, FACP is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Physicians, American Federation for Medical Research, American Medical Association, Association of Subspecialty Professors, Joint Council of Allergy, Asthma and Immunology, Mississippi State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Dey LP Honoraria Speaking and teaching; Verus Pharmaceuticals Consulting fee Consulting; Pfizer Consulting fee Endpoint Committee; Intelliject None Consulting

Coauthor(s)

G William Palmer, MD, Consulting Staff, Shoreline Allergy and Asthma Associates
G William Palmer, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology
Disclosure: Nothing to disclose.

Medical Editor

Stephen C Dreskin, MD, PhD, Director of Allergy, Asthma, and Immunology Practice, Professor of Medicine, Departments of Internal Medicine and Immunology, University of Colorado Health Sciences Center
Stephen C Dreskin, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association for the Advancement of Science, American Association of Immunologists, American Association of Neuropathologists, American Association of Ophthalmic Pathologists, American Association of Oral and Maxillofacial Surgeons, American College of Allergy, Asthma and Immunology, Clinical Immunology Society, and Joint Council of Allergy, Asthma and Immunology
Disclosure: Genentech Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Samuel R Marney, Jr, MD, Director, Associate Professor, Department of Internal Medicine, Division of Allergy and Immunology, Vanderbilt University School of Medicine
Samuel R Marney, Jr, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Physicians, and Tennessee Medical Association
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michael A Kaliner, MD, Clinical Professor of Medicine, George Washington University School of Medicine; Chief, Section of Allergy and Immunology, Washington Hospital Center; Medical Director, Institute for Asthma and Allergy
Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, and Association of American Physicians
Disclosure: Abbott Consulting fee Consulting; Alcon Consulting fee Consulting; Glaxo Consulting fee Consulting; Greer Consulting fee Consulting; Sanofi Consulting fee Consulting; Schering Consulting fee Consulting; Teva  Consulting; Meda Honoraria Speaking and teaching

 
 
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