Table 3

Differential diagnosis of anaphylaxis1 2 9 12 25 28 52 54 59

Common diagnoses

  • Acute exacerbation of asthma

  • Syncope, CVA, epilepsy

  • Panic attack

  • Aspiration

  • CVS pathology (MI, PE)

  • Shock (hypovolaemic, cardiogenic, septic, etc)

Excessive endogenous histamine

  • Systemic or indolent mastocytosis

  • Basophilic leukaemia

Food related syndromes (‘restaurant syndromes’)

  • Scombroid fish poisoning

  • Food poisoning

Flushing syndromes

  • Menopause related

  • Medullary thyroid carcinoma

  • Carcinoid syndrome

  • Pheochromocytoma

  • Autonomic epilepsy

  • Red man syndrome (vancomycin)

  • Other drugs: niacin, bromocriptine

‘Pseudo-anaphylaxis’

  • Hyperventilation

  • Vocal cord dysfunction

  • Munchausen's (by proxy) syndrome

Other

  • HAE

  • ACE inhibitor induced angioedema

  • (ruptured) hydatid cyst

  • CVA, cerebrovascular accident; CVS, cardiovascular system; HAE, hereditary angioedema; MI, myocardial infarction; PE, pulmonary embolism.