Anaphylactic Shock: Or something else? Differential Diagnosis

Differential diagnoses of anaphylaxis (modified from [S2k guideline])

Respiratory System (J00-J99)

Bronchial asthma (without anaphylaxis) or status asthmaticus (persistent severe symptoms of an asthma attack over a 24-hour period; here: without involvement of other organs)
Vocal cord dysfunction (engl. Vocal Cord Dysfunction, VCD) – leading symptom of VCD: Abruptly occurring, dyspnea-inducing laryngeal obstruction (laryngeal constriction usually experienced in the cervical or upper tracheal region), usually during inspiration (inhalation), which can lead to dyspnea of varying intensity, inspiratory stridor (breath sounds on inhalation), no bronchial hyperresponsiveness (airway hypersensitivity in which the bronchi abruptly constrict), normal lung function; cause: Paradoxical intermittent glottis closure; especially in younger women.

Endocrine, nutritional, and metabolic disorders (E00-E90).

Hypoglycemia (low blood sugar).
Carcinoid tumor (synonyms: Carcinoid syndrome, neuroendocrine tumors, NET) – tumors originating in the neuroendocrine system; they are predominantly located in the appendix/ appendix appendix (appendiceal carcinoid) or in the bronchi (bronchial carcinoid); other localizations include the thymus (thymic carcinoid), ileum/rum (ileum carcinoid), rectum (rectal carcinoid), duodenum/duodenal carcinoid (duodenal carcinoid) and stomach (gastric carcinoid); typical symptoms are characterized by the triad diarrhea (diarrhea), flushing (flushing) and Hedinger syndrome (heart valve damage).
Thyrotoxic crisis – acute and life-threatening metabolic derailment; usually on the ground of existing hyperthyroidism (hyperthyroidism).

Skin and subcutaneous (L00-L99).

Urticarial diseases and hereditary/acquired angioneurotic edemaNote: In the physical forms of urticaria, intense exposure to the relevant trigger can lead to anaphylaxis.

Apoplexy (stroke)
Arrhythmias (cardiac arrhythmias (HRS))
Capillary leak syndrome (SCLS) – severe systemic disease caused by increased capillary permeability.
Hypertensive crisis (seizure-like increase in blood pressure to values > 200 mmHg).
Pulmonary embolism – occlusion of one or more pulmonary arteries by a thrombus (blood clot).

Neoplasms – tumor diseases (C00-D48).

Pheochromocytoma – neuroendocrine catecholamine-producing tumor of the chromaffin cells of the adrenal medulla (85% of cases) or sympathetic ganglia (15% of cases).

Psyche – Nervous System (F00-F99; G00-G99).

Anxiety disorders
Epilepsy – condition of repetitive seizures due to an underlying chronic process.
Hyperventilation (increased breathing beyond what is needed), especially with attacks
Globus syndrome (lat. Globus hystericus or globus pharyngis) or globus sensation (lump feeling) – mainly characterized by the feeling of having a lump in the throat with otherwise unobstructed swallowing act and possibly also worse breathing.
Munchausen syndrome (anaphylaxis as an artifact) – psychiatric clinical picture in which diseases are faked to achieve a secondary gain in illness.
Panic disorders
Somatoform disorders – form of mental illness that results in physical symptoms without physical findings to be collected

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)

Coma (without anaphylaxis).
Shock forms, other (see above).
Vagal syncope (= reflex syncope) – brief loss of consciousness (syncope) due to excessive vagal tone; the causes are varied.

Injuries, poisoning, and certain other consequences of external causes (S00-T98)

Histaminosis – e.g., fish poisoning (scombroid).
Multiple Chemical Sensitivity (MCV) – disorder that is a reaction of the central nervous system; it refers to a patient’s hypersensitivity to various chemicals and environmental pollutants.

Medication

Local anesthetics (i.v.) – drugs for local anesthesia.
Opiates (morphine)
Agents with disulfiram activity (inhibits acetaldehyde dehydrogenase and thus complete metabolic degradation of alcohol; e.g., griseofulvin, nifuratel, nitroimidazoles such as metronidazole, ketoconazole, sulfonylureas, and probably procarbazine).

Further