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©2013 UpToDate ® Print Email Triggers of anaphylaxis Allergen triggers (IgE-dependent immunologic mechanism) Foods, especially peanut, tree nut, shellfish, fish, milk, egg Insect stings (eg, Hymenoptera venom) and insect bites (eg, kissing bugs, mosquitoes) Medications (eg, beta-lactam antibiotics, some nonsteroidal antiinflammatory drugs [NSAIDs]) Biological materials, including allergens, allergen immunotherapy, monoclonal antibodies, vaccines to prevent infectious disease, and hormones (eg, progesterone) Natural rubber latex Food additives, including spices, insect-derived colorants (eg, carmine), and vegetable gums Inhalants (rare), eg, horse dander Human seminal fluid (rare) Occupational allergens (eg, stinging insects, natural rubber latex) Immunologic triggers (IgE-independent mechanism) IgG-dependent (rare) eg, to high molecular weight dextran, infliximab Coagulation system activation Idiopathic anaphylaxis Consider the possibility of a hidden or previously unrecognized trigger Consider the possibility of mastocytosis or a clonal mast cell disorder Non-immunologic triggers (direct activation of mast cells and basophils) Physical factors (eg, exercise*, cold, heat, sunlight/ultraviolet radiation) Medications (eg, opioids, some NSAIDs) Alcohol (ethanol) Any food, insect sting or bite, or medication or biological, can potentially trigger anaphylaxis. Novel or unusual allergen triggers are frequently described. These include foods such as vegetables, fruits, lupin flour, bird's nest soup, seal, whale, and kangaroo meats, and storage mite-contaminated flour. They also include saliva from kissing bugs, mosquitoes, pigeon ticks, green ants, and pharaoh ants, and venoms from jellyfish, scorpions, and snakes. Medications include taxanes, platins, and other chemotherapy drugs; biologic agents, including monoclonal antibodies such as rituximab, cetuximab, infliximab, and uncommonly, omalizumab. Other injectants and ingestants, including Botox, bee products, and herbal formulations are also implicated. Some triggers such as insect venoms, medications and radiocontrast media (such as nonsteroidal antiinflammatory drugs [NSAIDs]) act through more than one mechanism. * Usually involves a co-trigger such as a food, medication (eg, an NSAID), or exposure to cold air or water.