Clinical presentation of anaphylaxis as an adverse event following immunisation (AEFI) using Brighton Collaboration Case Definition (BCCD). The table shows the reported symptoms and signs of anaphylaxis in the seven cases meeting BCCD with number of reports in brackets. The table is divided into major and minor Brighton criteria and all BCCD criteria are listed for completeness, even where no cases met the criteria5
| Major | Minor | |
|---|---|---|
| Dermatological and mucosal | Generalised angioedema (2) Local angioedema (1) Rash and pruritus (1) Generalised erythema (2) Generalised hives (5) | Local hives (1)* Hives at injection site (1) Generalised pruritus without skin rash (0) Generalised prickle sensation (0) Red and itchy eyes (0) |
| Cardiovascular | Shock (1)† Hypotension (2)‡ | A reduced peripheral circulation as indicated by the combination of at least 2 of: tachycardia (2); prolonged capillary refill (1); decreased consciousness (2) |
| Respiratory | Upper airway angioedema (1) Wheeze (1) Respiratory distress (1) Stridor (0) | Sneezing (1) Sensation of throat closure (1) Dyspnoea (3) Cough (1) Hoarse voice (0) |
| Gastroenterological | Not applicable | Nausea (1) Vomiting (1) Diarrhoea (0) Abdominal pain (0) |
| Laboratory | Not applicable | Raised serum tryptase (1)§ |
↵* Localised hives were present in one case, but were not contributory to the BCCD.
↵† A clinical diagnosis of uncompensated shock was indicated by the combination of at least three of the following: tachycardia; capillary refill time >3 s; reduced central pulse volume; decreased level of consciousness or loss of consciousness.
↵‡ Respiratory distress was defined by the presence of two or more of the following: tachypnoea; increased use of accessory respiratory muscles (sternocleidomastoid, intercostal, etc); recession; cyanosis; grunting.
↵§ A test for Mast Cell Tryptase (MCT)was only performed in one case, where it was raised 5 h after the reaction.