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■ Patients on β-blockers are at risk for refractory hypotension and pro-

longed symptoms.

■ Anaphylactoid reaction

■ Antigen→direct mast cell degranulation without IgE involvement.

■ Presents in a similar manner but usually not as severe

SYMPTOMS/EXAM

■ Early or mild: Lump in throat, dizziness, nausea and vomiting, skin warmth

and flushing

■ Hypotension

■ Tachycardia

■ Stridor, angioedema

■ Respiratory distress, bronchospasm

■ Urticaria

TREATMENT

■ Airway management

■ Epinephrine

RESUSCITATION

TABLE 1.17. CDC Criteria for the Diagnosis of TSS and STSS

CDC Criteria for TSS

Fever > 38.9ºC (102ºF).

Rash

(Diffuse, blanching, erythematous with desquamation occurring approximately 1–2 wks later)

Hypotension with SBP < 90 mmHg

Evidence of involvement of ≥3 organ systems (GI, muscular, mucus membranes, renal,

hepatic, CNS, hematologic)

Absence of serologic evidence of:

Rocky Mountain spotted fever

Leptospirosis

Measles

Hepatitis B

Antinuclear antibody

Positive VDRL

Monospot

CDC Criteria for STSS

Isolation of group A streptococcus (CSF, surgical wound, throat, blood)

Hypotension with SBP < 90 mmHg.

Involvement≥2 organ systems

Anaphylaxis: Mast cell

degranulation from IgE

response.

Anaphylactoid reaction:

Direct mast cell degranulation

(no IgE).