Anaphylaxis: An Update on its Understanding and Management

Cristoforo      Incorvaia; Marina      Mauro; Valerio      Pravettoni; Stefano      Incorvaia; Gian      G. Riario-Sforza

Abstract

Anaphylaxis is the most concerning manifestation of hypersensitivity. Recent, thorough investigations on the pathophysiology of anaphylaxis achieved important advances in its understanding, regarding in particular the emerging role of mediators such as platelet activating factor (PAF) and sphyngosine 1 phosphate (S1P) and the improved knowledge on the actors of the signaling cascade, from the contact between the specific allergen and the IgE fixed on the Fc-epsilon-RI receptor to the opening of calcium channels. These advances may provide new diagnostic and therapeutical tools. In particular, a role for PAF and S1P as laboratory markers of anaphylaxis is likely to be developed, and innovative preventive strategies able to induce a negative signaling are currently under evaluation. Also, using well known preventive treatments, such as allergen specific immunotherapy may offer new perspectives for the management of patients at risk of potentially fatal reaction to foods. In fact, controlled studies demonstrated that sublingual immunotherapy is able to significantly increase the tolerance to the causative foods, fulfilling the need and protecting the allergic subject from anaphylaxis caused by accidental ingestion of small food amounts. The article also presented some promising patents on anaphylaxis.

Keywords: Anaphylaxis, mast cells, signaling cascade, mediators, PAF, S1P, tryptase, epinephrine, sublingual immunotherapy, anti-IgE