There may be a prodrome such as a rash around the mouth, itchy tongue, lips, or mouth, that may cause the individual to seek atttenntion prior to the development of more serious symptoms. At different times, patients will have a different reaction with the same contact. May be dose related. Diagnosis Usually can make the diagnosis based on the history and physical symptoms and findings Lab evaluation of little benefit Common precipitators of anaphylactic reaction Foods Eggs, milk, soy- often outgrow Nuts, fish, shellfish Often there are cross reactivity among different foods within groups. It is advisable to avoid all nuts if you are allergic to peanuts unless oral challenges are negative.
Avoidance is often difficult.
Some foods are labeled under different names and may not be noticed. Also, certain foods have ingredients added that the patient is unaware of. This is especially common in baked goods that contain nuts. Additives are not common causes of anaphylaxis Stings- bees, wasps, fire ants. Must differentiate from localized reaction because if it is true anaphylaxis, immunotherapy may be indicated.