II. Epidemiology: Anaphylaxis

  1. Incidence: 50 cases per 100,000 person-years
  2. Lifetime Prevalence: 0.05 to 2%
  3. Mortality: 1%

III. Risk Factors: Anaphylaxis

IV. Precautions

  1. Anaphylaxis is a life threatening condition that requires immediate ABC Management and Epinephrine injection IM
  2. Biphasic reactions occur in up to 20% of cases
    1. Second acute anaphylactic reaction despite no repeat exposure to the original allergen
    2. Second reaction may be delayed up to 8 hours later (24-72 hour delay has been reported in atypical cases)

V. Causes: Common

  1. Idiopathic
    1. See Urticaria
    2. Consider mastocytosis
  2. Hymenoptera Allergy (Bees, wasps, fire ants)
    1. See Insect sting
    2. Results in >50 fatal U.S. reactions per year
  3. Food Allergy (30% of anaphylactic episodes, especially in children under age 4 years)
    1. Cow's Milk
    2. Egg whites
    3. Fish
    4. Peanuts
    5. Tree nuts
    6. Sesame
    7. Food additives
    8. Shellfish
  4. Medications (most common in age over 55 years)
    1. Penicillin Allergy (75% of anaphylactic deaths)
    2. NSAIDs or Aspirin
    3. Radiographic Intravenous Contrast Material
    4. Allopurinol
    5. ACE Inhibitors
    6. Opioids
    7. Interferon
  5. Allergic Contact Dermatitis
    1. Latex Allergy
  6. Infection
    1. Echinococcus species (Hydatid Disease)
  7. Miscellaneous
    1. Animal dander

VI. Signs: Anaphylaxis typical presentation

  1. Urticaria and Angioedema (90% of cases)
  2. Respiratory distress, especially upper airway obstruction (70% of cases)
    1. Lower airway obstruction may occur, especially in Asthma
  3. Cardiovascular collapse with Hypotension (45% of cases)
  4. Gastrointestinal symptoms such as Vomiting (45% of cases)
  5. Neurologic symptoms such as Headache or Dizziness (15% of cases)

VII. Signs: Mild

  1. General
    1. Feeling impending doom
    2. Pruritus (uncommon without rash)
    3. Metallic Taste in mouth
  2. Naso-ocular
    1. Itchy nose or eyes
    2. Sneezing
    3. Clear, watery Eye Discharge or Nasal discharge
  3. Skin (occurs)
    1. Urticaria: Hives
    2. Angioedema: Facial swelling and Lip swelling

VIII. Signs: Moderate

  1. Neurologic
    1. Dizziness
    2. Weakness
  2. Gastrointestinal
    1. Nausea, Vomiting
    2. Bloody Diarrhea
    3. Abdominal Pain
    4. Fecal urgency or Incontinence
  3. Genitourinary
    1. Uterine cramps
    2. Urinary urgency or Incontinence

IX. Signs: Severe (Anaphylaxis)

  1. Airway Compromise
    1. Hoarseness or Dysphonia
    2. Stridor
    3. Inability to manage own secretions
    4. Airway posturing (sniffing position)
  2. Breathing Compromise
    1. Wheezing and bronchospasm
    2. Dyspnea
    3. Tachypnea
    4. Hypoxia
    5. Increased work of breathing
  3. Circulatory compromise
    1. Hypotension
    2. Tachycardia
    3. Hypoperfusion
    4. Syncope

X. Labs: Confirms diagnosis (do not rely on labs to make or treat acute episode)

  1. Serum histamine
    1. Requires special handling for accuracy
    2. Obtain first level within 1 hour of symptom onset
    3. Compare to baseline level
  2. Serum tryptase
    1. Levels rise 30 minutes after onset and peak at 1-2 hours
    2. Obtain level on presentation, in 1-2 hours and 24 hours after presentation

XI. Differential Diagnosis

XII. Diagnosis: Anaphylaxis

  1. High likelihood if ONE of the following three criteria present
  2. Criteria 1: Acute illness onset within minutes to hours AND
    1. Skin or mucosal effects (e.g. Hives, Pruritus, Flushing, swollen lips/Tongue/uvula) AND
    2. Respiratory distress (e.g. Dyspnea, bronchospasm) or cardiovascular collapse (e.g. Hypotension, Syncope)
  3. Criteria 2: Acute illness onset within minutes to hours after likely allergen exposure AND a least TWO of the following
    1. Skin or mucosal effects (e.g. Hives, Pruritus, Flushing, swollen lips/Tongue/uvula)
    2. Respiratory distress (e.g. Dyspnea, bronchospasm)
    3. Cardiovascular collapse (e.g. Hypotension, Syncope)
    4. Gastrointestinal symptoms persist (e.g. abdominal cramping, Vomiting)
  4. Criteria 3: Hypotension within minutes to hours after likely allergen exposure
    1. General: 30% decrease in systolic Blood Pressure
    2. See Hypotension
    3. See Pediatric Vital Signs for age specific cut-offs for low Blood Pressure
  5. Summary
    1. Anaphylaxis is present if allergen exposure and Hypotension or two compromised organ systems
  6. References
    1. Sampson (2006) Ann Emerg Med 47(4): 373-80 [PubMed]

XIII. Management: Emergency Department

  1. General Measures
    1. ABC Management
    2. Supplemental Oxygen
  2. Anaphylaxis with Airway Compromise
    1. Epinephrine is the mainstay of Anaphylaxis management and must not be delayed
      1. Administer within 5 minutes of presentation
        1. Surviving severe Anaphylaxis cases share rapid Epinephrine delivery in common
        2. Sampson (1992) N Engl J Med 327(6): 380-84 [PubMed]
      2. Narrow window of opportunity with Epinephrine
        1. Prior to complete airway obstruction and cardiovascular collapse
      3. EpinephrineVasoconstricts, bronchodilates and decreases airway edema
      4. Epinephrine IM is safe even in older patients and should not be withheld when Anaphylaxis criteria are met
        1. Kawano (2017) Resuscitation 112:53-8 +PMID:28069483 [PubMed]
    2. Epinephrine (1:1000 concentration = 1 mg/ml)
      1. Intramuscular dosing preferred over subcutaneous (due to more reliable and faster rise in blood levels)
        1. Typically injected in lateral thigh
      2. Repeat every 5 to 15 minutes prn up to 3 doses
      3. Cardiac monitoring required for repeat dosing
      4. Epinephrine via vial
        1. Adult: 0.5 mg (0.5 ml) of 1:1000 Epinephrine IM
        2. Child: 0.01 mg/kg (0.01 ml/kg) IM up to 0.3 mg (0.3 ml)
      5. Epinephrine Autoinjector (preferred if available, as reduces errors and speeds delivery)
        1. Adult and children over 30 kg or 66 pounds: 0.3 mg autoinjector
        2. Children under 30 kg or 66 pounds: 0.15 autoinjector
    3. Dirty Epinephrine Drip
      1. See Dirty Epinephrine Drip
    4. Unresponsive to Epinephrine
      1. Glucagon 3.5 to 5 mg IV if patient uses Beta-Blockers
        1. May repeat if no Blood Pressure response within 10 minutes
      2. Norepinephrine may also be considered
  3. Hypotension (due to vasodilitation and third spacing)
    1. Fluid Resuscitation with isotonic saline (NS, LR)
      1. Adult: 2 Liters Normal Saline
      2. Child: 10-20 ml/kg per bolus until Hypotension improves
      3. Large volumes may be required
    2. Pressors (e.g. Norepinephrine, Dopamine) may be required
    3. Consider Epinephrine by continuous IV infusion
  4. Respiratory distress
    1. Nebulized Beta adrenergic agonist (e.g. Albuterol)
      1. Consider for signs of lower airway obstruction
    2. Consider Endotracheal Intubation
  5. Urticaria, Pruritus or Flushing
    1. General: H1 Antagonists
      1. Not a first-line agent in Anaphylaxis management
      2. Use only as an adjunct to Epinephrine and ABC Management
      3. Effects are delayed 1-2 hours from delivery
      4. Does not reverse upper airway obstruction or improve Hypotension
    2. Diphenhydramine (Benadryl) every 6 hours prn
      1. Adult: 25-50 mg IM, IV, or PO
      2. Child: 1.25 mg/kg IM, IV or PO
  6. Severe or persistent symptoms not resolved in 30 min
    1. General: Corticosteroids
      1. Not a first-line agent in Anaphylaxis management
      2. Use only as an adjunct to Epinephrine and ABC Management
      3. Effects are delayed 6 hours from delivery
      4. Studies proving benefit are lacking
      5. Consider for prevention of biphasic reaction, protracted reaction or in comorbid Asthma with Wheezing
    2. Hydrocortisone 5 mg/kg IV
    3. Methylprednisolone (Solu-Medrol) every 6 hours
      1. Adult: 60-125 mg IV/IM
      2. Child: 0.5-1 mg/kg IV/IM
  7. Disposition
    1. Observation of moderate to severe reactions for 6-10 hours
      1. Minimum observation time is 3 hours
      2. Prolonged reaction or multiple Epinephrine doses may require 12-24 hour observation
    2. Delayed, biphasic reactions are uncommon
      1. Biphasic anaphylactic reactions were originally thought to occur several hours later in up to 20% of cases
      2. More recent data suggests biphasic reactions in 0.4% of cases
      3. Returning to the Emergency Department (bounce-back) for non-Anaphylaxis is common
        1. Rash or other allergic, non-anaphylactic symptoms prompts return in up to 6% of patients in first week
      4. References
        1. Grunau (2014) Ann Emerg Med 63(6):736-44 +PMID:24239340 [PubMed]
    3. Discharge medications
      1. See prevention recommendations below
      2. Epinephrine Autoinjector (e.g. epi-pen) prescription
      3. Corticosteroid: Prednisone 1-2 mg/kg/day up to 20-40 mg/day for 2-3 days
      4. H1 Blocker: Diphenhydramine (Benadryl) 1.25 mg/kg up to 25-50 mg/dose every 6 hours for 2-3 days
      5. H2 Blocker: Ranitidine (Zantac) 1-2 mg/kg/dose up to 150 mg twice daily for 2-3 days
        1. May improve Urticaria beyond H1 Blocker alone, but evidence is weak
        2. Fedorowicz (2012) Cochrane Database Syst Rev (3):CD008596 [PubMed]

XIV. Management: Home

  1. Epinephrine Autoinjector (EpiPen, Twinject, Adrenaclick)
    1. Administer at onset of anxaphylaxis symptoms and present immediately for medical care or call 911
  2. Diphenhydramine (Benadryl)
    1. Liquid has better absorption than tablets
    2. Adult: 25-50 mg orally every 6 hours for 3 days
    3. Child: 5 mg/kg/day orally divided every 6 hours (or 1.25 mg/kg per dose)
  3. Prednisone
    1. Corticosteroids most effective if started early
      1. Administer within 1-2 hours if possible
    2. Adult: 60 mg PO qd x3 days
    3. Child: 0.5-1 mg/kg/dose PO qd x3 days
  4. Cimetidine (Tagamet)
    1. Adult: 400 mg PO bid x3 days

XV. Prevention

  1. Medical Alert Bracelet should be worn
  2. Strict avoidance of allergen
  3. Epinephrine Autoinjector, home injectable devices (EpiPen, Twinject, Adrenaclick)
    1. Keep one in place where most of time spent
    2. Bring an injector when traveling
  4. Consider allergist referral
  5. Consider Skin Testing and Desensitization therapy
    1. Indicated if re-exposure is likely or unavoidable
  6. Clinic office administration of medications and injections
    1. Should include a policy to observe patient after injection for 20-30 minutes

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Ontology: anaphylaxis (C0002792)

Definition (GO) OBSOLETE. Extreme immunological sensitivity of the body or tissues to the reintroduction of an antigen. It is a form of anamnestic reaction and is accompanied by pathological changes in tissues or organs due to the release of pharmacologically active substances. [ISBN:0198506732]
Definition (NCI_NCI-GLOSS) A severe and sometimes life-threatening immune system reaction to an antigen that a person has been previously exposed to. The reaction may include itchy skin, edema, collapsed blood vessels, fainting, difficulty in breathing, and death.
Definition (NCI_FDA) Systemic anaphylaxis is the most dramatic example of an immediate hypersensitivity reaction; is uncommon and unexpected in nature and occasionally results in a fatal outcome.(CDRH)
Definition (NCI) Progression of anaphylaxis into systemic shock, which is characterized by significant reduction in tissue perfusion which leads to hypoxia and hypotension, and can lead to death if untreated.
Definition (PSY) Immunologic or allergic reaction to antigens such as drugs or foreign proteins to which a hypersensitivity has been established by previous contact.
Definition (CSP) a manifestation of immediate hypersensitivity in which exposure of a sensitized individual to a specific antigen or hapten results in urticaria, pruritis and angioedema, followed by vascular collapse and shock often accompanied by life threatening respiratory distress.
Definition (MSH) An acute hypersensitivity reaction due to exposure to a previously encountered ANTIGEN. The reaction may include rapidly progressing URTICARIA, respiratory distress, vascular collapse, systemic SHOCK, and death.
Concepts Pathologic Function (T046)
MSH D000707
ICD10 T78.2
SnomedCT 87467006, 157755003, 39579001
HL7 ANAPHYLAC
LNC LA7413-3
English Anaphylaxis, Shock, Anaphylactic, ANAPHYLACTIC REACTION, Anaphylactic Reaction, Anaphylactic Reactions, Anaphylactic shock, unspecified, Reaction, Anaphylactic, Reactions, Anaphylactic, Anaphylactic Shock, anaphylactic reaction, anaphylaxis (diagnosis), Systemic anaphylactic reaction, Anaphylaxis [Disease/Finding], Shock;anaphylactic, anaphylactic reactions, systemic anaphylaxis, allergic shock, Generalized anaphylaxis (disorder), Systemic anaphylaxis (disorder), ANAPHYLAXIS, ANAPHYLACTIC SHOCK, anaphylactic shock, SHOCK, ANAPHYLACTIC, Anaphylactic shock, Generalized anaphylaxis, Allergic shock, Anaphylactic reaction, Systemic anaphylaxis, Generalised anaphylaxis, Anaphylaxis (disorder), allergy; shock, shock; allergy, shock; anaphylactic, anaphylactic; shock, anaphylaxis
French ANAPHYLAXIE, CHOC ANAPHYLACTIQUE, Réaction anaphylactique systémique, Anaphylaxie systémique, REACTION ANAPHYLACTIQUE, Choc allergique, Anaphylaxie, Choc anaphylactique, Réaction anaphylactique
Portuguese ANAFILAXIA, Anafilaxia sistémica, Reacção anafiláctica sistémica, CHOQUE ANAFILACTICO, REACCAO ANAFILACTICA, Choque alérgico, Choque anafiláctico, Reacção anafiláctica, Anafilaxia, Choque Anafilático, Reação Anafilática
Spanish ANAFILAXIS, SHOCK ANAFILACTICO, Reacción anafiláctica sistémica, Anafilaxia sistémica, REACCION ANAFILACTICA, Anafilaxia, anafilaxis (trastorno), anafilaxia (trastorno), anafilaxis, anafilaxia, Shock alérgico, Choque Anafiláctico, shock anafiláctico, anafilaxia sistémica (concepto no activo), anafilaxia generalizada, anafilaxia sistémica, choque anafiláctico, Shock Anafiláctico, Anafilaxis, reacción anafiláctica, Reacción anafiláctica, Shock anafiláctico, Reacción Anafiláctica
German ANAPHYLAXIE, systemische anaphylaktische Reaktion, systemische Anaphylaxie, ANAPHYLAKTISCHE REAKTION, Anaphylaktischer Schock, nicht naeher bezeichnet, SCHOCK ANAPHYLAKTISCH, Allergischer Schock, anaphylaktische Reaktion, anaphylaktischer Schock, Anaphylaktische Reaktion, Anaphylaktischer Schock, Anaphylaxie, Schock, anaphylaktischer
Dutch systemische anafylactische reactie, anafylaxie, systemische anafylaxe, allergische schok, allergie; shock, anafylactisch; shock, shock; allergie, shock; anafylactisch, Anafylactische shock, niet gespecificeerd, anafylactische reactie, anafylactische shock, Anafylactische reactie, Anafylactische shock, Anafylaxie, Shock, anafylactische
Italian Anafilassi sistemica, Reazione anafilattica sistemica, Shock anafilattico, Reazione anafilattica, Shock allergico, Anafilassi
Japanese 全身性アナフィラキシー反応, アナフィラキシー反応, 全身性アナフィラキシー, ゼンシンセイアナフィラキシーハンノウ, アナフィラキシーショック, アナフィラキシー, ゼンシンセイアナフィラキシー, アナフィラキシーハンノウ, アナフィラキシー, アレルギー性ショック, アレルギーセイショック, アナフィラキシーショック, ショック-アナフィラキシー
Swedish Allergisk chock
Czech anafylaxe, Anafylaktická reakce, Anafylaktický šok, Systémová anafylaktická reakce, Anafylaxe, Systémová anafylaxe, Alergický šok, anafylaktický šok, anafylaktická reakce
Finnish Anafylaksia
Russian SHOK ANAFILAKTICHESKII, ANAFILAKSIIA, АНАФИЛАКСИЯ, ШОК АНАФИЛАКТИЧЕСКИЙ
Korean 상세불명의 아나필락시 쇼크
Croatian ANAFILAKSIJA
Polish Wstrząs anafilaktyczny, Anafilaksja
Hungarian Anaphylaxiás shock, Anaphylaxiás reakció, Systemás anaphylaxiás reakció, Systemás anaphylaxia, Allergiás sokk, Anaphylaxia
Norwegian Allergisk sjokk, Anafylaktisk reaksjon, Anafylaktisk sjokk, Anafylaksi

Ontology: Hypersensitivity (C0020517)

Definition (ICF) Functions of the body's response of increased sensitization to foreign substances, such as in sensitivities to different antigens.
Definition (ICF-CY) Functions of the body's response of increased sensitization to foreign substances, such as in sensitivities to different antigens.
Definition (GO) An inflammatory response to an exogenous environmental antigen or an endogenous antigen initiated by the adaptive immune system. [GOC:jal, ISBN:0781735149]
Definition (MEDLINEPLUS)

An allergy is a reaction by your immune system to something that does not bother most other people. People who have allergies often are sensitive to more than one thing. Substances that often cause reactions are

Normally, your immune system fights germs. It is your body's defense system. In most allergic reactions, however, it is responding to a false alarm. Genes and the environment probably both play a role.

Allergies can cause a variety of symptoms such as a runny nose, sneezing, itching, rashes, swelling, or asthma. Allergies can range from minor to severe. Anaphylaxis is a severe reaction that can be life-threatening. Doctors use skin and blood tests to diagnose allergies. Treatments include medicines, allergy shots, and avoiding the substances that cause the reactions.

NIH: National Institute of Allergy and Infectious Diseases

Definition (SCTSPA) Reacciones alérgicas conocidas a una(s) sustancia(s) en particular
Definition (SNOMEDCT_US) Known to have allergic reactions to particular substance(s)
Definition (SNOMEDCT_US) A pathological process initiated by exposure to a defined stimulus at a dose tolerated by normal persons. It may be the manifestation of a disposition to hypersensitivity.
Definition (SCTSPA) Proceso patológico iniciado por la exposición a un estímulo definido, en una dosis que toleran las personas normales. Puede ser la manifestación de una disposición a la hipersensibilidad.
Definition (NCI) An immune response that occurs following exposure to an innocuous antigen, but that does not require the presence of preformed antibodies to the antigen.
Definition (NCI_FDA) Hypersensitivity; a local or general reaction of an organism following contact with a specific allergen to which it has been previously exposed and to which it has become sensitized.
Definition (NCI_NCI-GLOSS) An exaggerated response by the immune system to a drug or other substance.
Definition (MSH) Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen.
Definition (CSP) state of previously immunized body in which tissue damage results from the immune response to a further dose of antigen.
Definition (HL7V3.0) <p>Hypersensitivity to an agent caused by an immunologic response to an initial exposure</p>
Concepts Pathologic Function (T046)
MSH D006967
ICD10 T78.4 , T78.40
SnomedCT 421961002, 106190000, 274211000, 418168000, 418925002, 157758001, 212998004, 127072000, 157754004, 257550005, 269284003, 269432007, 421668005, 91232002, 212999007, 282092005, 21957007, 418634005
HL7 ALG
LNC LP7756-2, LP31625-4, LP20697-6, MTHU020822, LA17771-9
English Allergic reaction, Allergy, Hypersensitivities, Allergy, unspecified, Hypersensitivity reaction, Allergy (disorder), Hypersensitivity reaction (disorder), HYSN, Allergic disorder, Allergic reaction NOS, Allergy disorder, hypersensitivity, hypersensitivity (symptom), allergic reaction, allergic reaction (diagnosis), Allergic reaction (NOS), Reaction allergic (NOS), Allergy NOS, Hypersensitivity NOS, Hypersensitivity reaction (NOS), Reaction hypersensitivity (NOS), Hypersensitivity symptom, Hypersensitivity reactions, Allergic reactions, Hypersensitivity [Disease/Finding], ALLERGY, Allergy., allergy, allergy disorders, hypersensitivity reactions, allergic disorder, allergic disorders, hypersensitivity symptoms, hypersensitivity symptom, allergies, allergic reactions, hypersensitivities, hypersensitivity reaction, Allergic disorders, Allergic state (disorder), Allergic reaction NOS (disorder), Disorder due to allergic reaction, Disorder due to allergic reaction (disorder), (Allergy, unspecified) or (hypersensitivity NOS), Allergic disorder (disorder), Allergy, unspecified (disorder), Allergic reaction (disorder), Immune hypersensitivity disorder (disorder), Disorder due to immune hypersensitivity reaction, (Allergy, unspecified) or (hypersensitivity NOS) (disorder), Immune hypersensitivity reaction (disorder), Immune hypersensitivity disorder, Hypersensitivity (finding), Allergic state, Hypersensitivity (qualifier value), Atopic AND/OR hypersensitivity state, Hypersensitivity, Allergies, Hypersensitivity Reaction, ALLERGIC REACTION, HYPERSENSITIVITY, Allergy/allergic reaction nos, hypersensitivity; reaction, allergic; reaction, reaction; allergic, reaction; hypersensitivity, Allergic reaction, NOS, Allergic state, NOS, Allergy, NOS, Hypersensitivity reaction, NOS, Allergic Disorders, Allergic reaction to substance, Allergic reaction to substance (disorder)
French HYPERSENSIBILITE, ALLERGIE, Réaction d'hypersensibilité, Réaction allergique, Allergie SAI, Hypersensibilité SAI, Réaction allergique SAI, Réaction d'hypersensibilité SAI, HYSN, Symptôme d'hypersensibilité, REACTION ALLERGIQUE, Allergie, Hypersensibilité
Portuguese HIPERSENSIBILIDADE, ALERGIA, Sintoma de hipersensibilidade, Reacção alérgica NE, Reacção alérgica, Hipersensibilidade NE, Alergia NE, Reacção de hipersensibilidade, Reacção de hipersensibilidade NE, REACCAO ALERGICA, Reação Alérgica, Alergia, Hipersensibilidade
Spanish HIPERSENSIBILIDAD, ALERGIA, reacción alérgica a una sustancia (trastorno), reacción alérgica a una sustancia, reacción de hipersensibilidad (trastorno), reacción de hipersensibilidad, Reacción alérgica, Reacción de hipersensibilidad (NEOM), Alergia NEOM, Hipersensibilidad NEOM, Síntoma de hipersensibilidad, Reacción alérgica NEOM, Reación de hipersensibilidad, Reacción de hipersensibilidad, Reacción alérgica (NEOM), alergia (trastorno), REACCION ALERGICA, trastorno de hpersensibilidad inmunológica (trastorno), trastorno de hpersensibilidad inmunológica, hipersensibilidad (hallazgo), trastorno alérgico, reacción alérgica, trastorno alérgico (trastorno), hipersensibilidad (calificador), hipersensibilidad, trastorno por reacción alérgica, reacción alérgica, SAI (trastorno), reacción alérgica, SAI, Allergic reaction NOS, estado atópico Y/O de hipersensibilidad, reacción por hipersensibilidad inmunológica, trastorno debido a reacción alérgica, trastorno de hipersensibilidad inmunológica (trastorno), trastorno de hipersensibilidad inmunológica, trastorno causado por reacción alérgica (trastorno), reacción por hipersensibilidad inmunológica (trastorno), alergia, no especificada, estado alérgico (trastorno), alergia, trastorno causado por reacción alérgica, trastorno por reacción inmunológica por hipersensibilidad, reacción alérgica (trastorno), alergia, no especificada (trastorno), trastorno inmunológico por hipersensibilidad, reacción de hipersensibilidad inmunológica (trastorno), estado alérgico, Reacción Alérgica, Alergia, Hipersensibilidad
German ALLERGIE, allergische Reaktion NNB, Uebersensibilitaetsreaktion, HYSN, Reaktion, allergisch (NNB), Ueberempfindlichkeit NNB, Uebersensibilitaetsreaktion (NNB), allergische Reaktion, allergische Reaktion (NNB), Uebersensibilitaetssymptom, Allergie NNB, ALLERGISCHE REAKTION, Allergie, nicht naeher bezeichnet, HYPERSENSIBILITAET, Ueberempfindlichkeit, Allergie, Hypersensitivität, Überempfindlichkeit
Dutch allergische reactie NAO, reactie allergisch (NAO), overgevoeligheidsreactie, allergische reactie (NAO), overgevoeligheid NAO, overgevoeligheidsreactie (NAO), allergie, reactie overgevoeligheid (NAO), hypersensitiviteitssymptoom, HYSN, allergie NAO, allergische reactie, Allergie/allergische reactie nao, allergisch; reactie, overgevoeligheid; reactie, reactie; allergisch, reactie; overgevoeligheid, Allergie, niet gespecificeerd, overgevoeligheid, Allergie, Overgevoeligheid
Italian Sintomo di ipersensibilità, Reazione da ipersensibilità (non specificata), Allergia, Allergia NAS, Reazione da ipersensibilità, Reazione di ipersensibilità (NAS), Reazione allergica, Reazione allergica (NAS), Reazione allergica NAS, Ipersensibilità NAS, Allergia (Specifica), Ipersensibilità
Japanese アレルギー反応, 過敏症状, 過敏症反応(NOS), 過敏症NOS, アレルギー反応(NOS), アレルギー反応NOS, アレルギーNOS, 過敏症反応, アレルギーNOS, カビンショウハンノウNOS, アレルギーハンノウNOS, カビンショウジョウ, カビンショウハンノウ, カビンショウNOS, カビンショウ, アレルギーハンノウ, アレルギー, アレルギー, 過敏症
Swedish Överkänslighet
Finnish Yliherkkyys
Russian GIPERSENSIBILIZATSIIA, ALLERGIIA, АЛЛЕРГИЯ, ГИПЕРСЕНСИБИЛИЗАЦИЯ
Czech Reakce přecitlivělosti, Alergická reakce, Alergie, Přecitlivělost NOS, HYSN, Alergie NOS, Reakce přecitlivělosti (NOS), Přecitlivělost, Alergická reakce NOS, Hypersensitivní syndrom, Alergická reakce (NOS), Hypersensitivní reakce (NOS), alergie, hypersenzitivita, přecitlivělost
Korean 상세불명의 알레르기
Croatian ALERGIJA
Polish Uczulenie, Reakcja alergiczna, Nadwrażliwość, Odczyn alergiczny, Alergia
Hungarian allergiás reakció, allergia k.m.n., Hypersensitivitási tünet, allergiás reakció (k.m.n.), HSYN, Allergiás reakció (k.m.n.), Túlérzékenységi reakció (k.m.n.), Hypersensitivitas k.m.n., Hypersensitivitas, Allergia, Hypersensitiv reakció (k.m.n.), allergiás reakció k.m.n., Hypersensitiv reakció
Norwegian Hypersensitivitet, Overfølsomhet, Allergi