Anaphylaxis: myths, facts and controversies - a practical guide

Key words: Anaphylaxis, Mucosal symptoms, Adrenaline, Reactions, Vaccinations

Anaphylaxis is a condition that produces great anxiety throughout the scientific community and that often causes a significant impairment of the quality of life of patients and their families. The present article critically reports all the (false) myths and controversies on anaphylaxis on the basis of scientific evidences and clinical practice in real life. In particular, it shows that anaphylaxis is not lethal and indeed in the majority of cases it is a self-limiting condition. It may manifest without cutaneous and mucosal symptoms (10- 20% of cases) or with a late onset of such symptoms. It is not always possible to identify a trigger factor nonetheless the diagnosis cannot be excluded in front of a compatible clinical picture. Adrenaline, the pivotal therapy for anaphylaxis, is not dangerous if correctly administered. Antihistamine and cortisone do not cure anaphylaxis and must not delay administration of adrenaline. Moreover, anaphylaxis is unpredictable and there are not absolute predictive factors. Many factors may lead to more severe reactions, however none of them is predictive of death risk. There are not absolute criteria for the prescription of self-injecting adrenaline, therefore it must be assessed case by case (considering patients and their families). Anyhow, the sole prescription of adrenaline is not life- saving. In general, anaphylaxis is not a contraindication for vaccinations and in particular the one for egg allergy is not a contraindication for MMR and flu vaccines.