Disseminated Intravascular Coagulation in Anaphylaxis

 

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Abstract

Anaphylaxis is a life-threatening condition that involves severe cutaneous, respiratory, and cardiovascular symptoms. Disseminated intravascular coagulation (DIC) is an acquired, widespread activation of coagulation that can be caused by infectious conditions (e.g., sepsis) and noninfectious conditions. The onset of DIC following anaphylaxis is not commonly known, and information regarding the pathomechanism linking anaphylaxis to DIC is scarce. Further, demographic and clinical data in anaphylaxis-induced DIC are still missing to this day. Triggered by a case of anaphylaxis-induced DIC that seamlessly transitioned to lethal sepsis-induced DIC, we aimed to characterize the patient population affected by anaphylaxis-induced DIC by performing a review of existing literature and expand the discussion to underlying mechanisms. The overall mortality of the patient cohort (n = 30) identified by the literature review was 50%. All patients that died either suffered a bleeding event or a thrombotic event. The majority of patients (n = 25/30; 83%) had bleeding events; thrombotic events were only reported in nonsurvivors (n = 9/15 or 60% of nonsurvivors; vs. n = 0/15 in survivors; p < 0.001). Nonsurvivors of anaphylaxis-induced DIC were on average 25 years older than survivors (p = 0.068). In conclusion, DIC can complicate anaphylaxis and is expected to contribute to poor microvascular perfusion after anaphylaxis. Particularly, elderly patients with known cardiovascular disease and patients who develop thrombotic events are susceptible to lethal outcomes. As a rare and largely uncharacterized disease entity, further research is needed to investigate the link between DIC and anaphylaxis and to potentially identify better treatment strategies.

Publication History

Article published online:
29 November 2023

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• References

• 1 Bochner BS, Lichtenstein LM. Anaphylaxis. N Engl J Med 1991; 324 (25) 1785-1790
  CrossrefPubMedGoogle Scholar
• 2 Gando S, Saitoh D, Ogura H. et al; Japanese Association for Acute Medicine Disseminated Intravascular Coagulation (JAAM DIC) Study Group. Natural history of disseminated intravascular coagulation diagnosed based on the newly established diagnostic criteria for critically ill patients: results of a multicenter, prospective survey. Crit Care Med 2008; 36 (01) 145-150
  CrossrefPubMedGoogle Scholar
• 3 Saito S, Uchino S, Hayakawa M. et al; Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study group. Epidemiology of disseminated intravascular coagulation in sepsis and validation of scoring systems. J Crit Care 2019; 50: 23-30
  CrossrefPubMedGoogle Scholar
• 4 Matsuda T. Clinical aspects of DIC—disseminated intravascular coagulation. Pol J Pharmacol 1996; 48 (01) 73-75
  PubMedGoogle Scholar
• 5 Siegal T, Seligsohn U, Aghai E, Modan M. Clinical and laboratory aspects of disseminated intravascular coagulation (DIC): a study of 118 cases. Thromb Haemost 1978; 39 (01) 122-134
  Article in Thieme ConnectPubMedGoogle Scholar
• 6 Adelborg K, Larsen JB, Hvas AM. Disseminated intravascular coagulation: epidemiology, biomarkers, and management. Br J Haematol 2021; 192 (05) 803-818
  CrossrefPubMedGoogle Scholar
• 7 Hunt BJ. Bleeding and coagulopathies in critical care. N Engl J Med 2014; 370 (09) 847-859
  CrossrefPubMedGoogle Scholar
• 8 Gando S, Levi M, Toh CH. Disseminated intravascular coagulation. Nat Rev Dis Primers 2016; 2: 16037
  CrossrefPubMedGoogle Scholar
• 9 Suzuki K, Wada H, Imai H, Iba T, Thachil J, Toh CH. Subcommittee on Disseminated Intravascular Coagulation. A re-evaluation of the D-dimer cut-off value for making a diagnosis according to the ISTH overt-DIC diagnostic criteria: communication from the SSC of the ISTH. J Thromb Haemost 2018; 16 (07) 1442-1444
  CrossrefPubMedGoogle Scholar
• 10 Cusick W, Leuci D, Viscarello RR, Rodis JF. Anaphylactoid syndrome of pregnancy after intracervical dinoprostone for cervical ripening: a report of 3 cases. J Reprod Med 2005; 50 (03) 225-228
  PubMedGoogle Scholar
• 11 Bourgain C, Pauti MD, Fillastre JP. et al. [Massive poisoning by African bee stings]. Presse Med 1998; 27 (22) 1099-1101
  PubMedGoogle Scholar
• 12 Farrar SC, Gherman RB. Serum tryptase analysis in a woman with amniotic fluid embolism. A case report. J Reprod Med 2001; 46 (10) 926-928
  PubMedGoogle Scholar
• 13 Hoste S, Van Aken H, Stevens E. Tranexamic acid in the treatment of anaphylactic shock. Acta Anaesthesiol Belg 1991; 42 (02) 113-116
  PubMedGoogle Scholar
• 14 Rajendiran C, Puvanalingam A, Thangam D. et al. Stroke after multiple bee sting. J Assoc Physicians India 2012; 60: 122-124
  PubMedGoogle Scholar
• 15 Zamani N. Bee sting and cerebral infarction; a mystic relationship. J Assoc Physicians India 2014; 62 (07) 653
  PubMedGoogle Scholar
• 16 Lalli AF. Contrast media reactions: data analysis and hypothesis. Radiology 1980; 134 (01) 1-12
  CrossrefPubMedGoogle Scholar
• 17 Adams B, Roboubi B, Henshaw R. Acute onset of vancomycin anaphylaxis with disseminated intravascular coagulation in an orthopedic patient despite prior repeated exposure. Am J Orthop 2015; 44 (12) E523-E525
  PubMedGoogle Scholar
• 18 Baillard C, Korinek AM, Galanton V. et al. Anaphylaxis to rocuronium. Br J Anaesth 2002; 88 (04) 600-602
  CrossrefPubMedGoogle Scholar
• 19 Baumgartner-Bonnevay C, Choquet-Kastylevsky G, Putet G, Bleyzac N, Vial T, Descotes J. [Anaphylactic shock associated with ceftriaxone therapy in a newborn]. Arch Pediatr 2002; 9 (10) 1050-1052
  PubMedGoogle Scholar
• 20 Bernini JC, Timmons CF, Sandler ES. Acute basophilic leukemia in a child. Anaphylactoid reaction and coagulopathy secondary to vincristine-mediated degranulation. Cancer 1995; 75 (01) 110-114
  CrossrefPubMedGoogle Scholar
• 21 Borahay MA, Harirah HM, Olson G, Kilic GS, Karipcin S, Hankins GD. Disseminated intravascular coagulation, hemoperitoneum, and reversible ischemic neurological deficit complicating anaphylaxis to prophylactic antibiotics during cesarean delivery: a case report and review of literature. AJP Rep 2011; 1 (01) 15-20
  Article in Thieme ConnectPubMedGoogle Scholar
• 22 Chatterji RS, Roy ND. Disseminated intravascular coagulation following multiple bee stings (a case report). Med J Armed Forces India 1994; 50 (01) 67-68
  CrossrefPubMedGoogle Scholar
• 23 Darwish R, Vaziri ND, Gupta S. et al. Focal renal cortical necrosis associated with zomepirac. Am J Med 1984; 76 (06) 1113-1117
  CrossrefPubMedGoogle Scholar
• 24 Endoh T, Yagihashi A, Sasaki M, Watanabe N. Ceftizoxime-induced hemolysis due to immune complexes: case report and determination of the epitope responsible for immune complex-mediated hemolysis. Transfusion 1999; 39 (03) 306-309
  CrossrefPubMedGoogle Scholar
• 25 Farhat E, Tegg E, Mohammed S, Grzechnik E, Favaloro EJ. Not as sweet as honey: a rare case of an apparent factor V “inhibitor” in association with bee sting anaphylaxis. Am J Hematol 2018; 93 (07) 965-970
  CrossrefPubMedGoogle Scholar
• 26 Gawlik R, Rymarczyk B, Rogala B. A rare case of intravascular coagulation after honey bee sting. J Investig Allergol Clin Immunol 2004; 14 (03) 250-252
  PubMedGoogle Scholar
• 27 George P, Pawar B, Calton N, Mathew P. Wasp sting: an unusual fatal outcome. Saudi J Kidney Dis Transpl 2008; 19 (06) 969-972
  PubMedGoogle Scholar
• 28 Gupta A. Acute fatal stroke associated with honeybee sting. Case report. J Neurol Neuromedicine 2020; 5 (01) 18-21
  CrossrefPubMedGoogle Scholar
• 29 Inal MT, Memis D, Top H. et al. Late-onset pulmonary edema and disseminated intravascular coagulation due to latex anaphylaxis. Aesthetic Plast Surg 2010; 34 (03) 394-396
  CrossrefPubMedGoogle Scholar
• 30 Jung JW, Jeon EJ, Kim JW. et al. A fatal case of intravascular coagulation after bee sting acupuncture. Allergy Asthma Immunol Res 2012; 4 (02) 107-109
  CrossrefPubMedGoogle Scholar
• 31 Lasser EC, Lang JH, Lyon SG, Hamblin AE. Changes in complement and coagulation factors in a patient suffering a severe anaphylactoid reaction to injected contrast material: some considerations of pathogenesis. Invest Radiol 1980; 15 (06) S6-S12
  CrossrefPubMedGoogle Scholar
• 32 Luzzati R, Giacomazzi D, Franchi F, Barcobello M, Vento S. Life-threatening, multiple hypersensitivity reactions induced by rifampicin in one patient with pulmonary tuberculosis. South Med J 2007; 100 (08) 854-856
  CrossrefPubMedGoogle Scholar
• 33 Navaradnam P, Suganthan N, Kumanan T, Sujanitha V, Mayorathan U. Kounis syndrome and multiorgan failure following multiple wasp stings. Cureus 2021; 13 (04) e14606
  PubMedGoogle Scholar
• 34 Prieto-García A, Pérez-David E, Devesa C. et al. Fatal anaphylaxis caused by gadolinium due to beta-tryptase-induced hemorragic diathesis. J Allergy Clin Immunol Pract 2017; 5 (05) 1433-1434
  CrossrefPubMedGoogle Scholar
• 35 Ratnoff OD, Nossel HL. Wasp sting anaphylaxis. Blood 1983; 61 (01) 132-139
  CrossrefPubMedGoogle Scholar
• 36 Roizen MF, Rodgers GM, Valone FH. et al. Anaphylactoid reactions to vascular graft material presenting with vasodilation and subsequent disseminated intravascular coagulation. Anesthesiology 1989; 71 (03) 331-338
  CrossrefPubMedGoogle Scholar
• 37 Smith PL, Kagey-Sobotka A, Bleecker ER. et al. Physiologic manifestations of human anaphylaxis. J Clin Invest 1980; 66 (05) 1072-1080
  CrossrefPubMedGoogle Scholar
• 38 Smith VT. Anaphylactic shock, acute renal failure, and disseminated intravascular coagulation. Suspected complications of zomepirac. JAMA 1982; 247 (08) 1172-1173
  CrossrefPubMedGoogle Scholar
• 39 Stack K, Pryor L. Significant traumatic intracranial hemorrhage in the setting of massive bee venom-induced coagulopathy: a case report. Wilderness Environ Med 2016; 27 (03) 405-408
  CrossrefPubMedGoogle Scholar
• 40 v DR, Bodepudi SK, Krishna M. V DR. Disseminated intravascular coagulation after multiple honeybee stings. Natl Med J India 2014; 27 (03) 141-143
  PubMedGoogle Scholar
• 41 Woehlck HJ, Johnson CP, Roza AM, Gottschall JL, Brumwell M, Cronin DC. Anaphylaxis on reperfusion during liver transplantation with coagulopathy. Anesth Analg 2012; 115 (03) 522-525
  CrossrefPubMedGoogle Scholar
• 42 Wright PJ, Shortland JR, Stevens JD, Parsons MA, Watkins J. Fatal haemopathological consequences of general anaesthesia. Br J Anaesth 1989; 62 (01) 104-107
  CrossrefPubMedGoogle Scholar
• 43 de Souza R, Short T, Campbell D, Taylor M. Another case of anaphylaxis and fibrinolysis. Anaesth Intensive Care 2005; 33 (01) 143-144
  PubMedGoogle Scholar
• 44 De Souza RL, Short T, Warman GR, Maclennan N, Young Y. Anaphylaxis with associated fibrinolysis, reversed with tranexamic acid and demonstrated by thrombelastography. Anaesth Intensive Care 2004; 32 (04) 580-587
  CrossrefPubMedGoogle Scholar
• 45 Iqbal A, Morton C, Kong KL. Fibrinolysis during anaphylaxis, and its spontaneous resolution, as demonstrated by thromboelastography. Br J Anaesth 2010; 105 (02) 168-17
  CrossrefPubMedGoogle Scholar
• 46 Koami H, Sakamoto Y, Furukawa T, Imahase H, Iwamura T, Inoue S. Utility of rotational thromboelastometry for the diagnosis of asymptomatic hyperfibrinolysis secondary to anaphylaxis. Blood Coagul Fibrinolysis 2016; 27 (04) 450-453
  CrossrefPubMedGoogle Scholar
• 47 Lombardini C, Helia RE, Boehlen F, Merlani P. “Heparinization” and hyperfibrinogenolysis by wasp sting. Am J Emerg Med 2009; 27 (09) 1176.e1-1176.e3
  CrossrefPubMedGoogle Scholar
• 48 Mazzi G, Raineri A, Lacava E, De Roia D, Santarossa L, Orazi BM. Primary hyperfibrinogenolysis in a patient with anaphylactic shock. Haematologica 1994; 79 (03) 283-285
  PubMedGoogle Scholar
• 49 Mong JS, Ooi CK. Transient coagulopathy due to wasp sting: a case report. J Emerg Med 2017; 52 (04) e115-e116
  CrossrefPubMedGoogle Scholar
• 50 Parashchanka A, Wyffels PA, Van Limmen JG, Wouters PF. Anaphylactic shock and hyperfibrinolysis measured with thromboelastography. Acta Anaesthesiol Belg 2011; 62 (04) 207-211
  PubMedGoogle Scholar
• 51 Truong HT, Browning RM. Anaphylaxis-induced hyperfibrinolysis in pregnancy. Int J Obstet Anesth 2015; 24 (02) 180-184
  CrossrefPubMedGoogle Scholar
• 52 Kini PG, Baliga M, Bhaskaranand N. Severe derangement of the coagulation profile following multiple bee stings in a 2-year-old boy. Ann Trop Paediatr 1994; 14 (02) 153-155
  CrossrefPubMedGoogle Scholar
• 53 Marturano F, Giacomino L, Sensi E, Bortone B. Anaphylaxis-induced coagulation disorders and serum procalcitonin elevation. Minerva Anestesiol 2023; 89 (03) 233-235
  CrossrefPubMedGoogle Scholar
• 54 Wang JL, Shen EY, Ho MY. Isolated prolongation of activated partial thromboplastin time following wasp sting. Acta Paediatr Taiwan 2005; 46 (03) 164-165
  PubMedGoogle Scholar
• 55 Ogawa Y, Grant JA. Mediators of anaphylaxis. Immunol Allergy Clin North Am 2007; 27 (02) 249-260 , vii
  CrossrefPubMedGoogle Scholar
• 56 Sala-Cunill A, Björkqvist J, Senter R. et al. Plasma contact system activation drives anaphylaxis in severe mast cell-mediated allergic reactions. J Allergy Clin Immunol 2015; 135 (04) 1031-1043.e6
  CrossrefPubMedGoogle Scholar
• 57 Saito H. Contact factors in health and disease. Semin Thromb Hemost 1987; 13 (01) 36-49
  Article in Thieme ConnectPubMedGoogle Scholar
• 58 Brown NJ, Gainer JV, Stein CM, Vaughan DE. Bradykinin stimulates tissue plasminogen activator release in human vasculature. Hypertension 1999; 33 (06) 1431-1435
  CrossrefPubMedGoogle Scholar
• 59 Prieto-García A, Zheng D, Adachi R. et al. Mast cell restricted mouse and human tryptase·heparin complexes hinder thrombin-induced coagulation of plasma and the generation of fibrin by proteolytically destroying fibrinogen. J Biol Chem 2012; 287 (11) 7834-7844
  CrossrefPubMedGoogle Scholar
• 60 van der Linden PW, Hack CE, Struyvenberg A. et al. Controlled insect-sting challenge in 55 patients: correlation between activation of plasminogen and the development of anaphylactic shock. Blood 1993; 82 (06) 1740-1748
  CrossrefPubMedGoogle Scholar
• 61 Stack MS, Johnson DA. Human mast cell tryptase activates single-chain urinary-type plasminogen activator (pro-urokinase). J Biol Chem 1994; 269 (13) 9416-9419
  CrossrefPubMedGoogle Scholar
• 62 Pejler G, Karlström A. Thrombin is inactivated by mast cell secretory granule chymase. J Biol Chem 1993; 268 (16) 11817-11822
  CrossrefPubMedGoogle Scholar
• 63 Guilarte M, Sala-Cunill A, Luengo O, Labrador-Horrillo M, Cardona V. The mast cell, contact, and coagulation system connection in anaphylaxis. Front Immunol 2017; 8: 846
  CrossrefPubMedGoogle Scholar
• 64 Steffel J, Akhmedov A, Greutert H, Lüscher TF, Tanner FC. Histamine induces tissue factor expression: implications for acute coronary syndromes. Circulation 2005; 112 (03) 341-349
  CrossrefPubMedGoogle Scholar
• 65 Ezzelarab MB, Ekser B, Azimzadeh A. et al. Systemic inflammation in xenograft recipients precedes activation of coagulation. Xenotransplantation 2015; 22 (01) 32-47
  CrossrefPubMedGoogle Scholar
• 66 Hojima Y, Cochrane CG, Wiggins RC, Austen KF, Stevens RL. In vitro activation of the contact (Hageman factor) system of plasma by heparin and chondroitin sulfate E. Blood 1984; 63 (06) 1453-1459
  CrossrefPubMedGoogle Scholar
• 67 Brunnée T, Reddigari SR, Shibayama Y, Kaplan AP, Silverberg M. Mast cell derived heparin activates the contact system: a link to kinin generation in allergic reactions. Clin Exp Allergy 1997; 27 (06) 653-663
  CrossrefPubMedGoogle Scholar
• 68 Lieberman P. Middleton's allergy: Principles and practice. Book. 2009. ;(7th edition)
  Google Scholar
• 69 Brown SG, Stone SF, Fatovich DM. et al. Anaphylaxis: clinical patterns, mediator release, and severity. J Allergy Clin Immunol 2013; 132 (05) 1141-1149.e5
  CrossrefPubMedGoogle Scholar
• 70 Morcos SK. Review article: acute serious and fatal reactions to contrast media: our current understanding. Br J Radiol 2005; 78 (932) 686-693
  CrossrefPubMedGoogle Scholar
• 71 Eaton S, Tsay HM, Yost F, Tweedle MF. Assays for plasma complement activation by x-ray contrast media. Invest Radiol 1990; 25 (07) 789-792
  CrossrefPubMedGoogle Scholar
• 72 Gonsette RE, Delmotte P. In vivo activation of serum complement by contrast media: a clinical study. Invest Radiol 1980; 15 (06) S26-S28
  CrossrefPubMedGoogle Scholar
• 73 Hoffmeister HM, Fuhrer G, Platten HP, Heller W. [Complement activation after the intravascular administration of contrast media: a comparison between ionic and nonionic x-ray contrast media]. Röfo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr 1987; 147 (06) 673-675
  PubMedGoogle Scholar
• 74 Cogen FC, Norman ME, Dunsky E, Hirshfeld J, Zweiman B. Histamine release and complement changes following injection of contrast media in humans. J Allergy Clin Immunol 1979; 64 (04) 299-303
  CrossrefPubMedGoogle Scholar
• 75 Vik H, Froysa A, Sonstevold A, Toft K, Stov PS, Ege T. Complement activation and histamine release following administration of roentgen contrast media. Acta Radiol Suppl 1995; 399: 83-89
  CrossrefPubMedGoogle Scholar
• 76 Laroche D, Aimone-Gastin I, Dubois F. et al. Mechanisms of severe, immediate reactions to iodinated contrast material. Radiology 1998; 209 (01) 183-190
  CrossrefPubMedGoogle Scholar
• 77 Lieberman P. Anaphylactoid reactions to radiocontrast material. Clin Rev Allergy 1991; 9 (3-4): 319-338
  CrossrefPubMedGoogle Scholar
• 78 Napolov IuK, Bolotova EN, Shimanovskiĭ NL. [The complement-activating action of modern x-ray contrast agents]. Eksp Klin Farmakol 1998; 61 (02) 60-64
  PubMedGoogle Scholar
• 79 Kolb WP, Lang JH, Lasser EC. Nonimmunologic complement activation in normal human serum induced by radiographic contrast media. J Immunol 1978; 121 (04) 1232-1238
  CrossrefPubMedGoogle Scholar
• 80 Szebeni J. Hypersensitivity reactions to radiocontrast media: the role of complement activation. Curr Allergy Asthma Rep 2004; 4 (01) 25-30
  CrossrefPubMedGoogle Scholar
• 81 Foley JH. Examining coagulation-complement crosstalk: complement activation and thrombosis. Thromb Res 2016; 141 (Suppl. 02) S50-S54
  CrossrefPubMedGoogle Scholar
• 82 Muhlfelder TW, Niemetz J, Kreutzer D, Beebe D, Ward PA, Rosenfeld SI. C5 chemotactic fragment induces leukocyte production of tissue factor activity: a link between complement and coagulation. J Clin Invest 1979; 63 (01) 147-150
  CrossrefPubMedGoogle Scholar
• 83 Gill P, Jindal NL, Jagdis A, Vadas P. Platelets in the immune response: revisiting platelet-activating factor in anaphylaxis. J Allergy Clin Immunol 2015; 135 (06) 1424-1432
  CrossrefPubMedGoogle Scholar
• 84 Choi IH, Ha TY, Lee DG. et al. Occurrence of disseminated intravascular coagulation (DIC) in active systemic anaphylaxis: role of platelet-activating factor. Clin Exp Immunol 1995; 100 (03) 390-394
  CrossrefPubMedGoogle Scholar
• 85 Imura Y, Terashita Z, Nishikawa K. Possible role of platelet activating factor (PAF) in disseminated intravascular coagulation (DIC), evidenced by use of a PAF antagonist, CV-3988. Life Sci 1986; 39 (02) 111-117
  CrossrefPubMedGoogle Scholar
• 86 Vadas P, Gold M, Perelman B. et al. Platelet-activating factor, PAF acetylhydrolase, and severe anaphylaxis. N Engl J Med 2008; 358 (01) 28-35
  CrossrefPubMedGoogle Scholar
• 87 Grafeneder J, Ettl F, Warenits AM. et al. Multi-phasic life-threatening anaphylaxis refractory to epinephrine managed by extracorporeal membrane oxygenation (ECMO): a case report. Front Allergy 2022; 3: 934436
  CrossrefPubMedGoogle Scholar
• 88 Clement O, Dewachter P, Mouton-Faivre C. et al; investigators of the CIRTACI study. Immediate hypersensitivity to contrast agents: the French 5-year CIRTACI Study. EClinicalMedicine 2018; 1: 51-61
  CrossrefPubMedGoogle Scholar
• 89 van der Linden PW, Hack CE, Poortman J, Vivié-Kipp YC, Struyvenberg A, van der Zwan JK. Insect-sting challenge in 138 patients: relation between clinical severity of anaphylaxis and mast cell activation. J Allergy Clin Immunol 1992; 90 (01) 110-118
  CrossrefPubMedGoogle Scholar
• 90 Paton WD. Histamine release by compounds of simple chemical structure. Pharmacol Rev 1957; 9 (02) 269-328
  PubMedGoogle Scholar
• 91 Peachell PT, Morcos SK. Effect of radiographic contrast media on histamine release from human mast cells and basophils. Br J Radiol 1998; 71 (841) 24-30
  CrossrefPubMedGoogle Scholar
• 92 Assem ES, Bray K, Dawson P. The release of histamine from human basophils by radiological contrast agents. Br J Radiol 1983; 56 (669) 647-652
  CrossrefPubMedGoogle Scholar
• 93 Krause W, Niehues D. Biochemical characterization of x-ray contrast media. Invest Radiol 1996; 31 (01) 30-42
  CrossrefPubMedGoogle Scholar
• 94 Lasser EC. Basic mechanisms of contrast media reactions. Theoretical and experimental considerations. Radiology 1968; 91 (01) 63-65
  CrossrefPubMedGoogle Scholar
• 95 Lukasiewicz A, Lebkowska U, Galar M. Effect of iodinated low-osmolar contrast media on the hemostatic system after intraarterial and intravenous contrast administration. Adv Med Sci 2012; 57 (02) 341-347
  CrossrefPubMedGoogle Scholar
• 96 Heptinstall S, White A, Edwards N. et al. Differential effects of three radiographic contrast media on platelet aggregation and degranulation: implications for clinical practice?. Br J Haematol 1998; 103 (04) 1023-1030
  CrossrefPubMedGoogle Scholar
• 97 Pumphrey RS. Fatal anaphylaxis in the UK, 1992-2001. Novartis Found Symp 2004; 257: 116-128 , discussion 128–132, 157–160, 276–285
  CrossrefPubMedGoogle Scholar
• 98 Mullins RJ, Wainstein BK, Barnes EH, Liew WK, Campbell DE. Increases in anaphylaxis fatalities in Australia from 1997 to 2013. Clin Exp Allergy 2016; 46 (08) 1099-1110
  CrossrefPubMedGoogle Scholar
• 99 Pastorello EA, Borgonovo L, Preziosi D. et al. Basal tryptase high levels associated with a history of arterial hypertension and hypercholesterolemia represent risk factors for severe anaphylaxis in Hymenoptera venom-allergic subjects over 50 years old. Int Arch Allergy Immunol 2021; 182 (02) 146-152
  CrossrefPubMedGoogle Scholar
• 100 Motosue MS, Bellolio MF, Van Houten HK, Shah ND, Campbell RL. Risk factors for severe anaphylaxis in the United States. Ann Allergy Asthma Immunol 2017; 119 (04) 356-361.e2
  CrossrefPubMedGoogle Scholar
• 101 Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal anaphylaxis: mortality rate and risk factors. J Allergy Clin Immunol Pract 2017; 5 (05) 1169-1178
  CrossrefPubMedGoogle Scholar
• 102 Clark S, Wei W, Rudders SA, Camargo Jr CA. Risk factors for severe anaphylaxis in patients receiving anaphylaxis treatment in US emergency departments and hospitals. J Allergy Clin Immunol 2014; 134 (05) 1125-1130
  CrossrefPubMedGoogle Scholar
• 103 Squizzato A, Hunt BJ, Kinasewitz GT. et al. Supportive management strategies for disseminated intravascular coagulation. An international consensus. Thromb Haemost 2016; 115 (05) 896-904
  Article in Thieme ConnectPubMedGoogle Scholar
• 104 Goss JE, Chambers CE, Heupler Jr FA. Laboratory Performance Standards Committee of the Society for Cardiac Angiography and Interventions. Systemic anaphylactoid reactions to iodinated contrast media during cardiac catheterization procedures: guidelines for prevention, diagnosis, and treatment. Cathet Cardiovasc Diagn 1995; 34 (02) 99-104 , discussion 105
  CrossrefPubMedGoogle Scholar
• 105 Schopp JG, Iyer RS, Wang CL. et al. Allergic reactions to iodinated contrast media: premedication considerations for patients at risk. Emerg Radiol 2013; 20 (04) 299-306
  CrossrefPubMedGoogle Scholar
• 106 Boehm T, Reiter B, Ristl R. et al. Massive release of the histamine-degrading enzyme diamine oxidase during severe anaphylaxis in mastocytosis patients. Allergy 2019; 74 (03) 583-593
  CrossrefPubMedGoogle Scholar
• 107 Kaliner M, Shelhamer JH, Ottesen EA. Effects of infused histamine: correlation of plasma histamine levels and symptoms. J Allergy Clin Immunol 1982; 69 (03) 283-289
  CrossrefPubMedGoogle Scholar
• 108 Kovanen PT, Kaartinen M, Paavonen T. Infiltrates of activated mast cells at the site of coronary atheromatous erosion or rupture in myocardial infarction. Circulation 1995; 92 (05) 1084-1088
  CrossrefPubMedGoogle Scholar
• 109 Kounis NG. Kounis syndrome (allergic angina and allergic myocardial infarction): a natural paradigm?. Int J Cardiol 2006; 110 (01) 7-14
  CrossrefPubMedGoogle Scholar

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