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Comorbidities and concurrent medications that might impact the severity and treatment of anaphylaxis

Comorbidities

Asthma

Other pulmonary diseases (eg, COPD, interstitial lung disease)

Cardiovascular diseases (eg, ischemic heart disease, hypertensive vascular disease, cardiomyopathy)

Mast cell disorder (ie, systemic mastocytosis or mast cell activation syndrome)

Concurrently administered medications

Beta-adrenergic blockers*

Alpha-adrenergic blockers^¶

Angiotensin-converting enzyme (ACE) inhibitors^Δ

Angiotensin II receptor blockers^Δ

Tricyclic antidepressants^◊

Monoamine oxidase inhibitors^§

ADHD medications^¥ (eg, stimulants, such as methylphenidate and amphetamines)

Recreational use of cocaine^‡

COPD: chronic obstructive pulmonary disease; ADHD: attention deficit hyperactivity disorder.
* Beta-adrenergic blockers, administered orally or topically (eg, eye drops) may be associated with severe anaphylaxis and may also make anaphylaxis more difficult to treat by causing unopposed alpha-adrenergic effects, hypertension, and reduced bronchodilator response to the beta-adrenergic effects of endogenous or exogenous epinephrine.
¶ Alpha-adrenergic blockers may decrease the effects of endogenous or exogenous epinephrine at alpha-adrenergic receptors, potentially making patients less responsive to the alpha-adrenergic effects of epinephrine.
Δ Potential interference with endogenous compensatory responses.
◊ Potential increase in adverse effects of epinephrine because of prevention of epinephrine uptake at adrenergic receptors.
§ Potentiate epinephrine's effects by inhibiting its metabolism by monoamine oxidase.
¥ Side effects are similar to those of epinephrine.
‡ Potentiates epinephrine's effects, especially cardiovascular effects, by preventing its reuptake into adrenergic neurons.

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