Kofaktoren der anaphylaxie

Anaphylaxis is caused by degranulation of mast cells or basophils. On a single-cell level degranulation is assumed to be an on/off phenomenon, i. e., the cell degranulates (on) or not (off). However, the clinical presentation of allergic reactions of the immediate type differs and shows many intermediate stages. Whether activation of mast cells or basophils leads to symptoms of anaphylaxis depends on the individual sensitization status, the allergen dose, the way of allergen application, and the presence of possible co-factors. The knowledge of relevant co-factors of anaphylaxis is indispensable for understanding clinical reaction patterns. Co-factors differ with regard to origin, mode of action, and functional clinical consequences. Most co-factors of anaphylaxis have been well known for years, however, it is still unclear how they exactly modulate the "trigger threshold" of anaphylaxis. Important co-factors are drugs (such as nonsteroidal antiphlogistics, β-blockers, or ACE inhibitors) and exercise. Other co-factors are physical stimuli such as high or low temperature, alcohol, psychological stress, menstruation, or microbial factors. This review gives a short survey of important co-factors of anaphylaxis, provides insight into the clinics of co-factor-related anaphylaxis, and shortly describes the diagnostic approach.