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Anaphylaxis

Anaphylaxis

Definition

Anaphylaxis is a severe, sudden, and potentially fatal allergic reaction to a foreign substance or antigen that affects multiple systems of the body.

Description

Anaphylaxis is a severe, whole-body allergic reaction. After initial exposure to a substance such as wasp sting toxin, the allergic child's immune system becomes sensitized to that allergen. On a subsequent exposure to the specific allergen, an allergic reaction, which can involve a number of different areas of the body, occurs. Anaphylaxis is thought to result from antigen-antibody interactions on the surface of mast cells, connective tissue cells that are believed to contain a number of regulatory, or mediator, chemicals. Specifically, an immunoglobulin antibody protein, IgE, is produced in response to the presence of the allergen. IgE binds to the mast cells, causing them to suddenly release a number of chemicals, including histamine, heparin, serotonin, and bradykinin. Once released, these chemicals produce the bodily reactions that characterize anaphylaxis: constriction of the airways, causing wheezing and difficulty in breathing; and gastrointestinal symptoms, such as abdominal pain , cramps, vomiting , and diarrhea . Shock can occur when the released histamine causes the blood vessels to dilate, which lowers blood pressure; histamine also causes fluids to leak from the bloodstream into the tissues, lowering the blood volume. Pulmonary edema can result from fluids leaking into the alveoli (air sacs) of the lung.

Substances that can trigger an anaphylactic reaction include:

  • insect stings from hornets, wasps, yellow jackets, honey bees, or fire ants
  • medications, including penicillin, cephalosporin, anesthetics, streptokinase, and others
  • foods (ingesting even tiny amounts or simply being near the offending food), including peanuts, tree nuts (such as walnuts or almonds), fish, shellfish, eggs, milk, soy, and wheat
  • vaccines, including allergy shots and egg- and gelatin-based vaccines
  • hormones, including insulin and possibly progesterone
  • rubber latex products
  • animal and human proteins, including seminal fluid and horse serum (which is used as snake anti-venom)

Anaphylactoid (meaning "anaphylactic-like") reactions are similar to those of true anaphylaxis but do not require an IgE immune reaction. These are usually caused by direct stimulation of the mast cells. The same chemicals as with anaphylaxis are released, with the same effects, so the symptoms are treated the same way. However, an anaphylactoid reaction can occur on initial exposure to an allergen as well as on subsequent exposures, since no sensitization is required.

There is also a rare kind of food allergy, called exercise-induced allergy, that is caused by eating a specific food and then exercising. It can produce itching , lightheadedness, hives , and anaphylaxis. The offending food does not cause a reaction without exercise , and, alternately, exercise does not cause a reaction without ingesting the food beforehand.

Demographics

Although likely an underestimate, about 10,000 cases of anaphylaxis occur per year in North America, with about 750 fatalities a year. The exact prevalence of anaphylaxis is unknown, because milder reactions may be attributed to asthma attacks or sudden cases of hives, and more serious or fatal episodes might be reported as heart attacks, as the initial symptoms of hives, asthma, and swollen throat can fade quickly.

Causes and symptoms

The symptoms of anaphylaxis may occur within seconds of exposure, or be delayed 15 to 30 minutes and sometimes even an hour or more later, if the allergen is aspirin or other similar drugs. The sooner the symptoms occur after exposure, the more severe the anaphylactic reaction is likely to be.

The first symptoms of an anaphylactic reaction are associated with the skin: flushing (warmth and redness), itching (often in the groin or armpits), and hives. These symptoms are often accompanied by anxiety ; a rapid, irregular pulse; and a sense of impending doom. Then the throat and tongue swell, the voice becomes hoarse, and swallowing and breathing become labored. Symptoms of rhinitis or asthma may also occur, causing a runny nose, sneezing, wheezing, and abnormal high-pitched breathing sounds, further worsening the breathing problems. Gastrointestinal effects may also develop, including vomiting, diarrhea, and stomach cramps. The child may be confused and have slurred speech. In about 25 percent of the cases, the chemicals flooding the blood stream will cause a generalized opening of capillaries (tiny blood vessels), resulting in a drop in blood pressure, lightheadedness, and even a loss of consciousness, which are typical symptoms of anaphylactic shock. The child may exhibit blueness of the skin (cyanosis), lips, or nail beds.

After the original symptoms occur, there are three possible outcomes:

  • The symptoms may be mild and fade spontaneously or be quickly ended by administering emergency medication. The anaphylactic episode is over for that particular exposure.
  • After initial improvement, the symptoms may reoccur after four to 12 hours (a late phase recurrent reaction) and require additional treatment and monitoring. Late phase reactions occur in about 10 percent of cases.
  • The reaction may be persistent and severe, requiring extensive medical treatment and hospitalization . This condition occurs in about 20 percent of cases.

When to call the doctor

The child should be given immediate emergency care, if possible, and then taken to the emergency room or the local emergency number (e.g., 911) should be called if symptoms of anaphylaxis develop.

Diagnosis

A child having an anaphylactic reaction will exhibit typical symptoms of anaphylaxis, such as hives and swelling of the eyes or face, blue skin from lack of oxygen, or pale skin from shock. The airway may be blocked, and the child may be wheezing as well as confused and weak. The pulse will be rapid and the blood pressure may be low. Anaphylaxis is an emergency condition that requires immediate professional medical attention.

Once a child has had an anaphylactic reaction, an allergist should be consulted to identify the specific allergen that caused the reaction. The allergist will take a detailed medical history and use blood or skin tests to identify the allergen. The allergist will ask about activities that the child participated in before the event, food and medications the child may have ingested, and whether the child had contact with any rubber products.

Treatment

Because of the severity of these reactions, treatment must begin immediately. The most common emergency treatment involves injection of epinephrine (adrenaline) to stop the release of histamines and relax the muscles of the respiratory tract. The injection is given in the outer thigh and can be administered through light fabric such as trousers, skirts, or stockings. Heavier clothing may have to be removed prior to the injection. After the injection, emergency services or 911 should be called immediately. A child with known severe allergic reactions should be carrying an allergy kit with epinephrine; if not, treatment will have to be delayed until emergency personnel can provide the required medication. For reactions to insect stings or allergy shots, a tourniquet should be placed between the puncture site and the heart; the tourniquet should be released every 10 minutes. If the child is conscious, he or she should lie down and elevate the feet. If trained, the parents or others present should administer CPR if the child stops breathing or does not have a pulse. After 10 to 15 minutes, if symptoms are still significant, another dose of epinephrine can be injected. Even after the reaction subsides, the child should still be taken to the emergency room immediately and monitored for three to four hours, since symptoms can redevelop. Other treatments may be given by medical personnel, including oxygen, intravenous fluids, breathing medications, and possibly more epinephrine. The epinephrine may make the child feel shaky and have a rapid, pounding pulse, but these are normal side effects and are only dangerous to those with heart problems. Steroids and antihistamines may also be given but are usually not as helpful initially as epinephrine. However, they may be useful in preventing a recurrent delayed reaction.

If the child is being treated with beta blocker medications commonly used to treat high blood pressure, angina, thyroid disorders, migraines, or glaucoma, it may be difficult to reverse an anaphylactic reaction.

Prognosis

Anaphylaxis is a severe disorder that has a poor prognosis without prompt treatment. Symptoms are usually resolved with appropriate therapy; therefore, immediate emergency care is essential.

Prevention

For children with known reactions to antibiotics , foods, insect stings, specific foods, or any of the allergens that can induce an anaphylactic reaction, avoidance of the symptom-inducing agent is the best form of prevention.

Specific avoidance measures that are recommended include:

Drugs/medications:

  • Parents should advise healthcare personnel of the childs allergies .
  • Parents should ask the doctor whether prescribed medications could contain the drug(s) to which the child is allergic.
  • The child should take all medications by mouth, if possible, since the risk of anaphylaxis is greater with injections.
  • Any child should stay in a doctors office or near medical care for a period of time after receiving injections of an antibiotic or vaccine.

Insect stings:

  • The child should avoid areas where insects breed and live.
  • The child should not wear bright clothing, perfume, hair spray, or lotions that might attract insects.
  • If possible the child should wear long sleeves, long trousers, and shoes when out of doors.

Food:

  • The child must be instructed to never again eat that kind of food that causes an anaphylactic reaction.
  • Parents should carefully read all ingredient labels of foods that the child might eat and be aware of the different terms used for various foods, such as caseinate for milk or albumin for eggs.
  • Parents should ask about ingredients in foods while eating out with the child, bring safe substitutes from home, and bring an allergy kit.
  • Parents should be aware of possible cross-contamination, such as when an ice cream scoop is used for Rocky Road ice cream, which contains peanuts, and then for vanilla ice cream.
  • School kitchen personnel should be notified of the childs condition.
  • The child should avoid eating foods that might cross-react with foods that the child is allergic to, for example, if the child is allergic to shrimp, the child may also be allergic to crab or lobster.
  • When traveling to other countries, parents should learn the appropriate words for foods that trigger their childs allergy; in addition, parents can request that air carriers serve peanut-free snacks to all passengers when their child is traveling; also the child should avoid eating airline meals.

Latex:

  • The child should avoid all latex rubber products.
  • If the child has to be hospitalized, the parents should alert the hospital personnel to the childs allergy to latex.
  • A child with a latex allergy may also have allergies to kiwi fruit, passion fruit, papayas, bananas, avocados, figs, peaches, nectarines, plums, tomatoes, celery, and chestnuts.

In addition, children with a history of allergic reactions should carry an emergency kit containing injectable epinephrine and chewable antihistamine and be instructed in its use. A child who is not prepared to deal with an anaphylactic reaction is at an increased risk of dying. The allergy kit should include simple instructions on when and how to use the kit; sterilizing swabs to cleanse the skin before and after the injection; epinephrine in a preloaded syringe, as prescribed by the childs doctor in doses appropriate for children; and antihistamine tablets. The expiration date on the medications in the allergy kit should be checked and medications replaced as needed. Also, the epinephrine solution should be clear; if it is pinkish brown, it should be discarded and replaced.

There are many brands of allergy kits. The simplest kit to use is the Ana-kit, which contains a sterile syringe preloaded with two doses of epinephrine with a stop between. Another commonly used kit is the Epi-Pen, which carries a single self-injecting, spring-loaded syringe of epinephrine. Two Epi-Pen kits should be carried, so that two doses are available. Allergy kits should be kept at home, school, and day care ; and the school administrator, teachers, and friends should be made aware of the childs allergies. Adults associated with the child should be trained in giving an injection and have a plan to transport the child to the hospital. Older children should be taught to give self-injections. Children at risk for anaphylaxis should also wear a Medic Alert bracelet or necklace or carry a medical emergency card with them at all times that clearly describes their allergy.

A consultation with an allergist can help to identify the substances that trigger the reaction; the allergist can also provide information on how to best avoid the triggering substance. The allergist may also be able to give allergy shots to children with wasp, yellow jacket, hornet, honey bee, or fire ant allergies. These shots provide 90 percent protection against the first four insect reactions, but less protection against fire ant reactions. Premedication is also helpful in preventing anaphylaxis from x-ray dyes; also there may be alternative dyes available for use that are less likely to cause reactions. Desensitization to medications has also been successful in some cases. The process involves gradually increasing the amount of medication given under controlled conditions. The procedure has worked for sensitivities to penicillin, sulfa drugs, and insulin.

The risk of anaphylaxis sometimes diminishes over time if there are no repeated exposures or reactions. However, the child at risk should also expect the worst and be prepared with preventive medication.

Parental concerns

Parents caring for children who are at risk for life-threatening anaphylactic reactions may experience high stress levels, for they have to maintain vigilance in order to protect the child while creating a sense of normalcy as the child grows up. Parents can reduce their stress by using social support groups, accepting their childs condition, and maintaining a positive attitude.

KEY TERMS

Allergen A foreign substance that provokes an immune reaction or allergic response in some sensitive people but not in most others.

Allergy A hypersensitivity reaction in response to exposure to a specific substance.

Epinephrine A hormone produced by the adrenal medulla. It is important in the response to stress and partially regulates heart rate and metabolism. It is also called adrenaline.

Immunoglobulin E (IgE) A type of protein in blood plasma that acts as an antibody to activate allergic reactions. About 50% of patients with allergic disorders have increased IgE levels in their blood serum.

See also Allergies.

Resources

BOOKS

Barber, Marianne S. The Parents Guide to Food Allergies: Clear and Complete Advice from the Experts on Raising Your Food-Allergic Child. New York: Owl Books, 2001.

Coss, Linda Marienhoff. How to Manage Your Childs Life-Threatening Food Allergies: Practical Tips for Daily Life. Lake Forest, CA: Plumtree Press, 2004.

Jevon, Philip. Anaphylaxis: A Practical Guide. London, UK: Butterworth-Heinemann, 2004.

Smith, Nicole. Allie the Allergic Elephant: A Childrens Story of Peanut Allergies. San Francisco: Jungle Communications, 2002.

ORGANIZATIONS

American Academy of Allergy, Asthma, and Immunology. 611 E. Wells Street, Milwaukee, WI 53202. Web site: <www.aaaai.org>

Food Allergy and Anaphylaxis Network. 10400 Eaton Place, Suite 107, Fairfax, VA 220302208. Web site: <www.foodallergy.org>

WEB SITES

American College of Allergy, Asthma, and Immunology. Available online at <http://allergy.mcg.edu> (accessed October 10, 2004).

Judith Sims

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Anaphylaxis

Anaphylaxis

Definition

Anaphylaxis is a rapidly progressing, life-threatening allergic reaction.

Description

Anaphylaxis is a type of allergic reaction, in which the immune system responds to otherwise harmless substances from the environment. Unlike other allergic reactions, however, anaphylaxis can kill. Reaction may begin within minutes or even seconds of exposure, and rapidly progress to cause airway constriction, skin and intestinal irritation, and altered heart rhythms. In severe cases, it can result in complete airway obstruction, shock, and death.

Causes and symptoms

Causes

Like the majority of other allergic reactions, anaphylaxis is caused by the release of histamine and other chemicals from mast cells. Mast cells are a type of white blood cell and they are found in large numbers in the tissues that regulate exchange with the environment: the airways, digestive system, and skin.

On their surfaces, mast cells display antibodies called IgE (immunoglobulin type E). These antibodies are designed to detect environmental substances to which the immune system is sensitive. Substances from a genuinely threatening source, such as bacteria or viruses, are called antigens. A substance that most people tolerate well, but to which others have an allergic response, is called an allergen. When IgE antibodies bind with allergens, they cause the mast cell to release histamine and other chemicals, which spill out onto neighboring cells.

The interaction of these chemicals with receptors on the surface of blood vessels causes the vessels to leak fluid into surrounding tissues, causing fluid accumulation, redness, and swelling. On the smooth muscle cells of the airways and digestive system, they cause constriction. On nerve endings, they increase sensitivity and cause itching.

In anaphylaxis, the dramatic response is due both to extreme hypersensivity to the allergen and its usually systemic distribution. Allergens are more likely to cause anaphylaxis if they are introduced directly into the circulatory system by injection. However, exposure by ingestion, inhalation, or skin contact can also cause anaphylaxis. In some cases, anaphylaxis may develop over time from less severe allergies.

Anaphylaxis is most often due to allergens in foods, drugs, and insect venom. Specific causes include:

  • Fish, shellfish, and mollusks
  • Nuts and seeds
  • Stings of bees, wasps, or hornets
  • Papain from meat tenderizers
  • Vaccines, including flu and measles vaccines
  • Penicillin
  • Cephalosporins
  • Streptomycin
  • Gamma globulin
  • Insulin
  • Hormones (ACTH, thyroid-stimulating hormone)
  • Aspirin and other NSAIDs
  • Latex, from exam gloves or condoms, for example.

Exposure to cold or exercise can trigger anaphylaxis in some individuals.

KEY TERMS

ACTH Adrenocorticotropic hormone, a hormone normally produced by the pituitary gland, sometimes taken as a treatment for arthritis and other disorders.

Antibody An immune system protein which binds to a substance from the environment.

NSAIDs Non-steroidal antiinflammatory drugs, including aspirin and ibuprofen.

Tracheostomy tube A tube which is inserted into an incision in the trachea (tracheostomy) to relieve upper airway obstruction.

Symptoms

Symptoms may include:

  • Urticaria (hives )
  • Swelling and irritation of the tongue or mouth
  • Swelling of the sinuses
  • Difficulty breathing
  • Wheezing
  • Cramping, vomiting, or diarrhea
  • Anxiety or confusion
  • Strong, very rapid heartbeat (palpitations )
  • Loss of consciousness.

Not all symptoms may be present.

Diagnosis

Anaphylaxis is diagnosed based on the rapid development of symptoms in response to a suspect allergen. Identification of the culprit may be done with RAST testing, a blood test that identifies IgE reactions to specific allergens. Skin testing may be done for less severe anaphylactic reactions.

Treatment

Emergency treatment of anaphylaxis involves injection of adrenaline (epinephrine) which constricts blood vessels and counteracts the effects of histamine. Oxygen may be given, as well as intravenous replacement fluids. Antihistamines may be used for skin rash, and aminophylline for bronchial constriction. If the upper airway is obstructed, placement of a breathing tube or tracheostomy tube may be needed.

Prognosis

The rapidity of symptom development is an indication of the likely severity of reaction: the faster symptoms develop, the more severe the ultimate reaction. Prompt emergency medical attention and close monitoring reduces the likelihood of death. Nonetheless, death is possible from severe anaphylaxis. For most people who receive rapid treatment, recovery is complete.

Prevention

Avoidance of the allergic trigger is the only reliable method of preventing anaphylaxis. For insect allergies, this requires recognizing likely nest sites. Preventing food allergies requires knowledge of the prepared foods or dishes in which the allergen is likely to occur, and careful questioning about ingredients when dining out. Use of a Medic-Alert tag detailing drug allergies is vital to prevent inadvertent administration during a medical emergency.

People prone to anaphylaxis should carry an "Epi-pen" or "Ana-kit," which contain an adrenaline dose ready for injection.

Resources

OTHER

The Meck Page. February 20, 1998. http://www.merck.com.

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Robinson, Richard. "Anaphylaxis." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. 31 May. 2016 <http://www.encyclopedia.com>.

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Anaphylaxis

Anaphylaxis

Anaphylaxis is a violent allergic reaction of the whole body which can result in death. During anaphylaxis, the allergic person's throat swells so much that she or he cannot breath, while internal organs may start to shutdown. The immune system's attempt to rid the body of a particular substance actually turns against the body itself.

When research on the immune system was progressing in the 1800s, most scientists thought that the body's reactions to invaders were always protective. While researching experimental smallpox innoculations in 1798, Edward Jenner (1749-1823) observed that patients given a second shot often suffered violent reactions. Despite this risk, people were more afraid of the disease than possible inoculation side effects. Jenner's experimentation, which included inoculating subjects with both cowpox and smallpox, eventually led to the development of a successfuland safesmallpox vaccine.

The first complete study and description of negative immune responses was produced by two Frenchmen, physiologist Charles Richet and physician Paul Portier (1866-1962). During a scientific cruise on the yacht of Prince Albert of Monaco (a small principality on the Mediterranean Sea), Albert suggested that Portier and Richet study the poison (toxin) produced by the tentacles of the Portuguese man-of-war, a jelly-fish. Back in France, the two men continued their studies with extracts of toxin from a sea anemone (a flower-like marine creature). While looking for a toxic dose level, they injected dogs with sea anemone venom. Dogs that survived were given time to recover and then reinjected. Richet expected that the first exposure to the toxin would create a certain amount of immunity in the dogs, the same way that getting a virus gives someone immunity to another encounter with the same disease. Instead, the initial exposure made the dogs hypersensitive. A second, much smaller dose of toxin quickly killed them. Since this result was the opposite of a protective immune response, or prophylaxis, Richet named the hypersensitive reaction anaphylaxis. Richet's identification of anaphylaxis won him the 1913 Nobel Prize for medicine.

After further research, it was discovered that many substances people are allergic to, particularly foods and toxins from animals (such as bee venom), can cause strong reactions. This knowledge provided a valuable warning to physicians engaged in serum (anti-poison) therapy. The researchers began checking patients for possible sensitization before injecting potentially toxic amounts of serum. Those patients with an initially severe reaction to an allergen (or allergy-causing agent) were advised to carry epinephrine (an artificial hormone) to inject immediately if they had a severe reaction.

[See also Hormone ]

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Anaphylaxis

Anaphylaxis

Anaphylaxis is a severe allergic reaction. The symptoms appear rapidly and can be life threatening.

The symptoms of anaphylaxis include the increased output of fluid from mucous membranes (e.g., passages lining the nose, mouth, and throat), skin rash (e.g., hives), itching of the eyes, gastrointestinal cramping, and stiffening of the muscles lining the throat and trachea. As a result of the latter, breathing can become difficult. These symptoms do not appear in every case. However, some sort of skin reaction is nearly always evident.

Anaphylaxis results from the exposure to an antigen with which the individual has had previous contact, and has developed a heightened sensitivity to the antigen. Such an antigen is also known as an allergen. The allergen binds to the specific immune cell (e.g., immunoglobulin E, also known as IgE) that was formed in response to the initial antigen exposure. IgE is also associated with other specific cells of the immune system that are called basophils and mast cells. The basophils and mast cells react to the binding of the allergen- IgE complex by releasing compounds that are known as mediators (e.g, histamine , prostaglandin D2, trypase). Release of mediators does not occur when IgE alone binds to the basophils or mast cells.

The release of the mediators triggers the physiological reactions. For example, blood vessels dilate (become larger in diameter) and fluid can pass across the blood vessel wall more easily. Because the immune system is sensitized to the particular allergen, and because of the potent effect of mediators, the development of symptoms can be sudden and severe. A condition called anaphylactic shock can ensue, in which the body's physiology is so altered that failure of functions such as the circulatory system and breathing can occur. For example, in those who are susceptible, a bee sting, administration of a penicillin-type of antibiotic, or the ingestion of peanuts can trigger symptoms that can be fatal if not addressed immediately. Those who are allergic to bee stings often carry medication with them on hikes.

Anaphylaxis occurs with equal frequency in males and females. No racial predisposition towards anaphylaxis is known. The exact number of cases is unknown, because many cases of anaphylaxis are mistaken for other conditions (e.g., food poisoning). However, at least 100 people die annually in the United States from anaphylactic shock.

See also Allergies; Immunoglobulins and immunoglobulin deficiency syndromes

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anaphylaxis

anaphylaxis (ăn´əfəlăk´sĬs), hypersensitive state that may develop after introduction of a foreign protein or other antigen into the body tissues. When an anaphylactic state exists, a second dose of the same protein (commonly an antibiotic such as penicillin, or certain insect venoms) will cause a violent allergic reaction. Anaphylaxis results from the production of specific antibodies in the tissues in very high concentration; the violent reaction is produced by the neutralization of antigens by the antibodies. The histamines released during the reaction are thought to cause the most damage, i.e., severe vasodilation and loss of capillary fluid, resulting in circulatory collapse. Other symptoms include urticaria or edema, choking, coughing, shock, and loss of consciousness. Death may occur within 5 to 10 min if no medical help is available. Anaphylaxis differs from immunity; in immunity, antibodies circulate in the blood and neutralize antigens without producing a violent reaction. See also allergy; serum sickness.

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anaphylaxis

anaphylaxis (ană-fil-aks-iss) n. an emergency condition resulting from an abnormal and immediate allergic response to a substance to which the body has become intensely sensitized. It results in flushing, itching, nausea and vomiting, swelling of the mouth and tongue and airway enough to often cause obstruction, wheezing, a sudden drop in blood pressure, and even sudden death. In this extreme form it is called anaphylactic shock. Treatment, which must be given immediately, consists of adrenaline (epinephrine) injection, oxygen with possible advanced support of the airway, intravenous fluids, intravenous corticosteroids, and antihistamines.
anaphylactic adj.

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"anaphylaxis." A Dictionary of Nursing. 2008. Encyclopedia.com. 31 May. 2016 <http://www.encyclopedia.com>.

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anaphylaxis

anaphylaxis An abnormal immune response that occurs when an individual previously exposed to a particular antigen is re-exposed to the same antigen. Anaphylaxis may follow an insect bite or the injection of a drug (such as penicillin). It is caused by the release of histamine and similar substances and may produce a localized reaction or a more generalized and severe one, with difficulty in breathing, pallor, or drop in blood pressure, unconsciousness, and possibly heart failure and death. See also allergy.

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anaphylaxis

an·a·phy·lax·is / ˌanəfəˈlaksis/ • n. (also an·a·phy·lac·tic shock / -ˈlaktik/ ) Med. an extreme, often life-threatening, allergic reaction to an antigen (e.g., a bee sting) to which the body has become hypersensitive following an earlier exposure. DERIVATIVES: an·a·phy·lac·tic / -ˈlaktik/ adj.

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"anaphylaxis." The Oxford Pocket Dictionary of Current English. 2009. Retrieved May 31, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O999-anaphylaxis.html

anaphylaxis

anaphylaxisglacis, Onassis •abscess •anaphylaxis, axis, praxis, taxis •Chalcis • Jancis • synapsis • catharsis •Frances, Francis •thesis • Alexis • amanuensis •prolepsis, sepsis, syllepsis •basis, oasis, stasis •amniocentesis, anamnesis, ascesis, catechesis, exegesis, mimesis, prosthesis, psychokinesis, telekinesis •ellipsis, paralipsis •Lachesis •analysis, catalysis, dialysis, paralysis, psychoanalysis •electrolysis • nemesis •genesis, parthenogenesis, pathogenesis •diaeresis (US dieresis) • metathesis •parenthesis •photosynthesis, synthesis •hypothesis, prothesis •crisis, Isis •proboscis • synopsis •apotheosis, chlorosis, cirrhosis, diagnosis, halitosis, hypnosis, kenosis, meiosis, metempsychosis, misdiagnosis, mononucleosis, myxomatosis, necrosis, neurosis, osmosis, osteoporosis, prognosis, psittacosis, psychosis, sclerosis, symbiosis, thrombosis, toxoplasmosis, trichinosis, tuberculosis •archdiocese, diocese, elephantiasis, psoriasis •anabasis • apodosis •emphasis, underemphasis •anamorphosis, metamorphosis •periphrasis • entasis • protasis •hypostasis, iconostasis

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"anaphylaxis." Oxford Dictionary of Rhymes. 2007. Encyclopedia.com. 31 May. 2016 <http://www.encyclopedia.com>.

"anaphylaxis." Oxford Dictionary of Rhymes. 2007. Encyclopedia.com. (May 31, 2016). http://www.encyclopedia.com/doc/1O233-anaphylaxis.html

"anaphylaxis." Oxford Dictionary of Rhymes. 2007. Retrieved May 31, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O233-anaphylaxis.html

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