Anaphylaxis in the 21st century: phenotypes, endotypes, and biomarkers

Abstract

Teodorikez Wilfox Jimenez-Rodriguez,1–3 Marlene Garcia-Neuer,1 Leila A Alenazy,1,4 Mariana Castells1 1Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 2Allergy Section, Alicante General University Hospital, Alicante, Spain; 3PhD Program in Public Health, Medical and Surgical Sciences, Miguel Hernandez University, Alicante, Spain; 4Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia Abstract: Anaphylaxis is the most serious of all allergic reactions and can be fatal. The diagnosis is frequently delayed, and misdiagnosis often occurs with asthma or urticaria. Biomarkers such as tryptase are not routinely checked, and appropriate treatment with epinephrine is not administered in a majority of cases, increasing the risk of poor outcomes. The objective of this review is to provide a better understanding of the pathophysiology of anaphylaxis with a description of phenotypes, endotypes, and biomarkers available in both the clinical and research settings. Expanding knowledge with regard to the presentation, causes, and triggers for anaphylaxis among health care providers will improve its diagnosis and management, increase patient safety, and decrease morbidity and mortality. Keywords: anaphylaxis, hypersensitivity reactions, tryptase, autoimmune progesterone dermatitis, epinephrine, precision medicine

Keywords

• Anaphylaxis
• Hypersensitivity reactions
• Tryptase
• Autoimmune progesterone dermatitis
• Epinephrine
• Precision medicine.