Acute onset = minutes to a few hours
Criteria for diagnosis - one or more of the following:
(1) acute onset of an illness with symptom complex 1 (see below)
(2) acute onset of symptom complex 2 (see below) after exposure to a likely allergen
(3) acute onset of a reduced systolic blood pressure after exposure to a known allergen for patient
Symptom complex 1 - both of the following:
(1) at least one of the following
(1a) skin involvement (generalized hives, pruritus, flushing)
(1b) mucous membrane involvement (swollen lips, swollen tongue, swollen uvula)
(2) at least one of the following:
(2a) respiratory compromise (dyspnea, wheezing, bronchospasm, stridor, reduced peak expiratory flow, hypoxemia)
(2b) reduced systolic blood pressure, collapse, syncope, incontinence or other symptom of end-organ dysfunction
Symptom complex 2 - 2 or more of the following
(1) skin or mucous membranes (as above)
(2) respiratory compromise (as above)
(3) reduced blood pressure (as above)
(4) persistent gastrointestinal tract symptoms (cramping, abdominal pain, vomiting)
Reduced systolic blood pressure is indicated by one of the following:
(1) blood pressure < 70% of baseline systolic blood pressure
(2) age 1 to 12 months AND < 70 mm Hg
(3) age 1 to 10 years AND < (70 + (2 * age)
(4) age >= 11 AND < 90 mm Hg
Limitations:
• Treudler et al found that the criteria may not perform as well as others for the recognition of severe, immediate reactions.
