Allergens (IgE-dependent immunologic mechanism) |
Foods, especially peanut, tree nut, crustacean shellfish, finned fish, cow's milk, hen's egg |
Insect stings (eg, Hymenoptera venom) and insect bites (eg, kissing bugs) |
Medications (eg, antibiotics, NSAIDs) |
Biologic materials, including allergen immunotherapy, monoclonal antibodies, chemotherapy agents, and vaccines* |
Natural rubber latex |
Food additives, including spices, insect-derived colorants (eg, carmine), and vegetable gums |
Inhalants (rare; eg, horse dander, cat dander, grass pollen) |
Human seminal fluid (rare trigger of anaphylaxis in women) |
Occupational allergens (eg, stinging insects, natural rubber latex) |
Immunologic triggers (IgE-independent mechanism) |
IgG dependent (rare; eg, to high-molecular-weight dextran, infliximab) |
Coagulation system activation (eg, heparin contaminated with oversulfated chondroitin sulfate) |
Idiopathic anaphylaxis |
Consider the possibility of a hidden or previously unrecognized trigger |
Consider the possibility of a mast cell activation syndrome, including systemic mastocytosis |
Nonimmunologic triggers (direct activation of mast cells and basophils) |
Physical factors (eg, exercise¶, cold, heat) |
Medications (eg, opioids, NSAIDs) |
Radiocontrast agents |
Alcohol (ethanol; may augment, rarely induces) |
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