Unraveling the Diagnosis of Kiwifruit Allergy: Usefulness of Current Diagnostic Tests.

OBJECTIVES: To determine the usefulness of the in vitro and in vivo methods used in the diagnosis of kiwifruit allergy and to specifically assess the impact of seed proteins on sensitivity. METHODS: We performed skin prick tests (SPTs) using various commercial extracts, homemade pulp, and seed extracts and prick-prick tests with kiwifruit on 36 allergic patients. The presence of specific IgE (sIgE) was assessed using the ImmunoCAP (kiwifruit extract), ELISA (Act d 1, Act d 2), ISAC, and FABER assays. Immunoblotting of seed extract was carried out, and a single-blind oral food challenge was performed with whole seeds in seed-sensitized individuals. RESULTS: The prick prick test with kiwifruit demonstrated the highest diagnostic capacity (81.8% sensitivity and 94.1% specificity) among the in vivo tests. The sIgE levels measured using ImmunoCAP (kiwifruit extract) showed a similar sensitivity to that of global ISAC and FABER (63.9%, 59.5%, and 58.3%, respectively). Act d 1 was the major allergen. Sensitization to Act d 1 was associated with positive sIgE results to whole kiwifruit extract detected by ImmunoCAP (P<.000). A positive SPT result to kiwifruit seeds was associated with severe symptoms induced by kiwifruit (P=.019) as a marker of advanced disease, but not with clinically relevant sensitization. Challenge testing with kiwifruit seeds performed on 8 seed-sensitized patients yielded negative results. CONCLUSION: Sensitization to Act d 1 is associated with a positive result in conventional diagnostic techniques, whereas kiwifruit seed sensitization does not increase the sensitivity of the diagnostic techniques evaluated.

Feasibility of Utilizing Stable-Isotope Dimethyl Labeling in Liquid Chromatography⁻Tandem Mass Spectrometry-Based Determination for Food Allergens-Case of Kiwifruit.

Stable-isotope dimethyl labeling is a highly reactive and cost-effective derivatization procedure that could be utilized in proteomics analysis. In this study, a liquid chromatography- tandem mass spectrometry in multiple reaction monitoring mode (LC-MS-MRM) platform for the quantification of kiwi allergens was first developed using this strategy. Three signature peptides for target allergens Act d 1, Act d 5, and Act d 11 were determined and were derivatized with normal and deuterated formaldehyde as external calibrants and internal standards, respectively. The results showed that sample preparation with the phenol method provided comprehensive protein populations. Recoveries at four different levels ranging from 72.5-109.3% were achieved for the H-labeled signature peptides of Act d 1 (SPA1-H) and Act d 5 (SPA5-H) with precision ranging from 1.86-9.92%. The limit of quantification (LOQ) was set at 8 pg mL-1 for SPA1-H and at 8 ng mL-1 for SPA5-H. The developed procedure was utilized to analyze seven kinds of hand-made kiwi foods containing 0.0175-0.0515 mg g-1 of Act d 1 and 0.0252-0.0556 mg g-1 of Act d 5. This study extended the applicability of stable-isotope dimethyl labeling to the economical and precise determination of food allergens and peptides.

Newly acquired kiwi fruit allergy after bone marrow transplantation from a kiwi-allergic donor.

BACKGROUND: The phenomenon of allergy transfer from an allergic donor to a non-allergic recipient via hematopoietic cell transplantation has been described by several reports. However, it could not yet been conclusively shown that allergic reaction of the recipient is elicited by the donor's cells. OBJECTIVES: In the case of a 46-year-old male patient who - for the first time in his life - had two episodes of oral allergic syndrome upon kiwi consumption after having received myeloablative hematopoietic stem cell transplantation (HCT) from his kiwi-allergic sister, we aimed to clarify the origin of allergen reactive cells in the donor. We not only intended to demonstrate if allergy was transferred by HCT but also to present an experimental workup for the analysis of allergy transfer by HCT. METHODS: Allergic sensitization to kiwi in recipient and donor was proven by ImmunoCAP. Furthermore, origin of peripheral blood mononuclear cells (PBMCs) was analyzed by chromosomal fluorescence in situ hybridization (FISH). To confirm allergic reaction and activation of hematopoietic cells by customized kiwi extract, we performed basophil activation test from whole blood as well as T cell proliferation assays from purified PBMCs of both recipient and donor. RESULTS: Basophil activation upon kiwi extract was demonstrated in both recipient and donor. Besides, we showed proliferation of CD4(+) T cells after incubation with kiwi extract. FISH analysis proved that hematopoietic cells of the male recipient completely originated from the female donor. CONCLUSION: Exemplified in this patient, we show for the first time that allergy transfer is mediated by the donor's cells. Moreover, our experimental approach using customized kiwi extract to prove contribution of kiwi-specific T and B cells in both kiwi-allergic recipient and donor could serve as a model approach for future studies.

Contact urticaria on eczematous skin by kiwifruit allergy. In vivo component-resolved diagnosis.

BACKGROUND: Kiwifruit allergy has been responsible for a variety of clinical manifestations, ranging from mild reactions, such as localised oral symptoms, to severe systemic symptoms, such as anaphylaxis. No cases of isolated contact urticaria (ICU) due to IgE-mediated allergy to kiwifruit have been reported in the literature so far. Here we describe the first three cases of ICU due to kiwi and we hypothesise about a kiwifruit allergen not described yet. METHODS: Using the available in vivo allergy tests, we performed a component-resolved diagnosis to detect the allergen involved. All the patients underwent prick-by-prick with raw and boiled kiwi pulp and latex glove, skin prick test with commercial extracts of kiwifruit, birch, latex, palm profilin and peach lipid transfer protein, rub test with raw and boiled kiwi and oral food challenges with the raw fruit. RESULTS: We found that, in our patients, the kiwifruit allergen responsible for ICU is thermolabile, gastrosensitive, and it does not show any of the most common kiwi-attributed cross-reactivity (latex, birch, profiling and lipid transfer protein). None of the 13 kiwifruit allergens already known shows all these features. CONCLUSIONS: Kiwifruit allergy can also occur with ICU, probably due to a native protein that is not yet identified. In this case the elimination diet is not required.

Characterization of the allergenic potential of proteins: an assessment of the kiwifruit allergen actinidin.

Assessment of the potential allergenicity (IgE-inducing properties) of novel proteins is an important challenge in the overall safety assessment of foods. Resistance to digestion with pepsin is commonly measured to characterize allergenicity, although the association is not absolute. We have previously shown that specific IgE antibody production induced by systemic [intraperitoneal (i.p.)] exposure of BALB/c strain mice to a range of proteins correlates with allergenic potential for known allergens. The purpose of the present study was to explore further the utility of these approaches using the food allergen, actinidin. Recently, kiwifruit has become an important allergenic foodstuff, coincident with its increased consumption, particularly as a weaning food. The ability of the kiwifruit allergen actinidin to stimulate antibody responses has been compared with the reference allergen ovalbumin, and with the non-allergen bovine haemoglobin. Haemoglobin was rapidly digested by pepsin whereas actinidin was resistant unless subjected to prior chemical reduction (reflecting intracellular digestion conditions). Haemoglobin stimulated detectable IgG antibody production at relatively high doses (10%), but failed to provoke detectable IgE. In contrast, actinidin was both immunogenic and allergenic at relatively low doses (0.25% to 1%). Vigorous IgG and IgG1 antibody and high titre IgE antibody responses were recorded, similar to those provoked by ovalbumin. Thus, actinidin displays a marked ability to provoke IgE, consistent with allergenic potential. These data provide further encouragement that in tandem with analysis of pepsin stability, the induction of IgE after systemic exposure of BALB/c strain mice provides a useful approach for the prospective identification of protein allergens.

Kiwifruit allergy across Europe: clinical manifestation and IgE recognition patterns to kiwifruit allergens.

BACKGROUND: Kiwifruit is a common cause of food allergy. Symptoms range from mild to anaphylactic reactions. OBJECTIVE: We sought to elucidate geographic differences across Europe regarding clinical patterns and sensitization to kiwifruit allergens. Factors associated with the severity of kiwifruit allergy were identified, and the diagnostic performance of specific kiwifruit allergens was investigated. METHODS: This study was part of EuroPrevall, a multicenter European study investigating several aspects of food allergy. Three hundred eleven patients with kiwifruit allergy from 12 countries representing 4 climatic regions were included. Specific IgE to 6 allergens (Act d 1, Act d 2, Act d 5, Act d 8, Act d 9, and Act d 10) and kiwifruit extract were tested by using ImmunoCAP. RESULTS: Patients from Iceland were mainly sensitized to Act d 1 (32%), those from western/central and eastern Europe were mainly sensitized to Act d 8 (pathogenesis-related class 10 protein, 58% and 44%, respectively), and those from southern Europe were mainly sensitized to Act d 9 (profilin, 31%) and Act d 10 (nonspecific lipid transfer protein, 22%). Sensitization to Act d 1 and living in Iceland were independently and significantly associated with severe kiwifruit allergy (odds ratio, 3.98 [P = .003] and 5.60 [P < .001], respectively). Using a panel of 6 kiwifruit allergens in ImmunoCAP increased the diagnostic sensitivity to 65% compared with 20% for skin prick tests and 46% ImmunoCAP using kiwi extract. CONCLUSION: Kiwifruit allergen sensitization patterns differ across Europe. The use of specific kiwifruit allergens improved the diagnostic performance compared with kiwifruit extract. Sensitization to Act d 1 and living in Iceland are strong risk factors for severe kiwifruit allergy.

Kiwifruit: our daily prescription for health.

Kiwifruit are unequalled, compared with other commonly consumed fruit, for their nutrient density, health benefits, and consumer appeal. Research into their health benefits has focussed on the cultivars Actinidia deliciosa 'Hayward' (green kiwifruit) and Actinidia chinensis 'Hort 16A', ZESPRI(®) (gold kiwifruit). Compared with other commonly consumed fruit, both green and gold kiwifruit are exceptionally high in vitamins C, E, K, folate, carotenoids, potassium, fibre, and phytochemicals acting in synergy to achieve multiple health benefits. Kiwifruit, as part of a healthy diet, may increase high-density lipoprotein cholesterol, and decrease triglycerides, platelet aggregation, and elevated blood pressure. Consuming gold kiwifruit with iron-rich meals improves poor iron status, and green kiwifruit aids digestion and laxation. As a rich source of antioxidants, they may protect the body from endogenous oxidative damage. Kiwifruit may support immune function and reduce the incidence and severity of cold or flu-like illness in at-risk groups such as older adults and children. However, kiwifruit are allergenic, and although symptoms in most susceptible individuals are mild, severe reactions have been reported. While many research gaps remain, kiwifruit with their multiple health benefits have the potential to become part of our "daily prescription for health."

Anaphylactic shock due to kiwifruit.

A 44-year-old male patient was admitted to our emergency department (ED) with an episode of severe anaphylaxis displaying generalized urticaria and dyspnea 1 hour after consuming a kiwifruit. Initially, the patient reported discrete itching of his abdominal skin and was in moderate respiratory distress. The patient's wheal response and itch were attenuated 30 minutes after emergency treatment with intravenous antianaphylaxis drugs. However, he had symptoms of the chest distress, dizzy, and dysphoria. His vital signs exacerbated. After sufficient antianaphylaxis treatment, the patient's anaphylaxis shock symptoms had not been significantly improved. We reviewed the history. The patient had eaten a full fresh kiwifruit, so there may be some kiwifruit pulp left in the patient's stomach. After self-induced vomiting, the patient's clinical condition gradually improved without any changes in dosage of dopamine. After another 10 hours of observation and preventive therapy training, the patient was discharged. Cases of patients with anaphylactic reaction to kiwifruit and dragon fruit have not been reported yet. In the ED, it is easy to overlook the prolonged exposure to allergen in patients with oral allergy syndrome. If the patient has consumed much food or drugs to cause the allergic reaction, self-induced vomiting or gastric lavage to clean allergen may be useful.

Allergy to kiwi: is component-resolved diagnosis in routine clinical practice really impossible?

BACKGROUND: Kiwi allergy is frequent and can be the result of sensitization to a number of allergens showing different physicochemical characteristics. Component-resolved diagnosis of kiwi allergy is still unavailable in routine clinical practice. OBJECTIVE: To investigate whether component resolved-diagnosis of kiwi allergy can be, at least in part, carried out by a proper combination of routinely available diagnostic tools. METHODS: 63 adults with plant food allergy were studied 36 were kiwi-allergic while 27 were kiwi-tolerant and served as controls. Patients and controls underwent SPT with commercial peach and kiwi extracts, and with aprofilin-enriched date palm pollen extract (all by ALK-Abellò), and the measurement of IgE to birch, kiwi, and natural rubber latex. RESULTS: The in-vitro test showed poor sensitivity and specificity, as it scored positive in about 50% of patients and controls irrespective of clinical allergy to kiwi. The kiwi SPT showed overall poor sensitivity; however, it scored negative in all subjects with pollen food-allergy syndrome, was weakly positive in some lipid transfer protein-hypersensitive/kiwi tolerant subjects and in one latex-sensitized subject, and strongly positive in all subjects with primary kiwi sensitization. CONCLUSION: SPT with this commercial kiwi extract sensitively and specifically detects patients reacting to specific kiwi allergens. This can be useful to detect patients that are at risk of potentially severe reactions, particularly in case of co-sensitization to labile allergens, while we wait that the whole spectrum of kiwi allergens becomes available for routine in-vitro testing.

Kiwifruit Act d 11 is the first member of the ripening-related protein family identified as an allergen.

BACKGROUND: Kiwifruit is an important cause of food allergy. A high amount of a protein with a molecular mass compatible with that of Bet v 1 was observed in the kiwifruit extract. OBJECTIVE: To identify and characterize kirola, the 17-kDa protein of green kiwifruit (Act d 11). METHODS: Act d 11 was purified from green kiwifruit. Its primary structure was obtained by direct protein sequencing. The IgE binding was investigated by skin testing, immunoblotting, inhibition tests, and detection by the ISAC microarray in an Italian cohort and in selected Bet v 1-sensitized Austrian patients. A clinical evaluation of kiwi allergy was carried out. RESULTS: Act d 11 was identified as a member of the major latex protein/ripening-related protein (MLP/RRP) family. IgE binding to Act d 11 was shown by all the applied testing. Patients tested positive for Act d 11 and reporting symptoms on kiwifruit exposure were found within the Bet v 1-positive subset rather than within the population selected for highly reliable history of allergic reactions to kiwifruit. Epidemiology of Act d 11 IgE reactivity was documented in the two cohorts. IgE co-recognition of Act d 11 within the Bet v 1-like molecules is documented using the microarray IgE inhibition assay. CONCLUSIONS: Act d 11 is the first member of the MLP/RRP protein family to be described as an allergen. It displays IgE co-recognition with allergens belonging to the PR-10 family, including Bet v 1.

Compliance, tolerability and safety of two antioxidant-rich diets: a randomised controlled trial in male smokers.

It has been suggested that antioxidants attenuate oxidative stress and prevent oxidative stress-related diseases. Paradoxically, randomised controlled trials (RCT) using pharmacological doses of antioxidant supplements have demonstrated harmful effects in smokers. The aim of the present study was to test the compliance, tolerability and safety of two food-based antioxidant-rich diets in smokers. One of the diets provided antioxidants at levels similar to that used in RCT using supplements which previously have generated harmful effects. The present study followed a randomised, parallel-arm dietary intervention for 8 weeks (n 102) in male smokers (age ≥ 45 years). Participants were randomised to either antioxidant-rich diet, kiwi fruit or control groups. The antioxidant-rich foods provided about 300 mmol antioxidants/week from a wide range of plant-based food items. The kiwi fruit group consumed three kiwi fruits/d. Compliance to both diets was good. Only mild, undesirable events were reported by a minority of the participants. The safety of both diets was demonstrated as no potentially harmful or pro-oxidative effects were observed. In the antioxidant-rich diet group, the mean intake of antioxidants increased from 30 mmol/d at baseline to 62 mmol/d during the intervention. In conclusion, we have demonstrated that male smokers can comply with two food-based antioxidant-rich diets. Furthermore, the present study is the first to demonstrate the tolerability and safety of dietary antioxidants at levels similar to dosages provided in RCT using supplements. Such diets may be useful in future studies investigating whether dietary antioxidants may reduce oxidative stress and related diseases.

Component-resolved diagnosis of kiwifruit allergy with purified natural and recombinant kiwifruit allergens.

BACKGROUND: Kiwifruit is one of the most common causes of food allergic reactions. Component-resolved diagnostics may enable significantly improved detection of sensitization to kiwifruit. OBJECTIVE: To evaluate the use of individual allergens for component-resolved in vitro diagnosis of kiwifruit allergy. METHODS: Thirty patients with a positive double-blind placebo-controlled food challenge to kiwifruit, 10 atopic subjects with negative open provocation to kiwifruit, and 5 nonatopic subjects were enrolled in the study. Specific IgE to 7 individual allergens (nAct d 1-5 and rAct d 8-9) and allergen extracts was measured by ImmunoCAP. RESULTS: The diagnostic sensitivities of the commercial extract and of the sum of single allergens were 17% and 77%, respectively, whereas diagnostic specificities were 100% and 30%. A combination of the kiwi allergens Act d 1, Act d 2, Act d 4, and Act d 5 gave a diagnostic sensitivity of 40%, whereas diagnostic specificity remained high (90%). Exclusion of the Bet v 1 homolog recombinant (r) Act d 8 and profilin rAct d 9 from this allergen panel reduced sensitivity to 50% but increased specificity to 40%. Kiwifruit-monosensitized patients reacted more frequently (P < .001) with Act d 1 than polysensitized patients, whereas the latter group reacted more frequently with rAct d 8 (P = .004). CONCLUSION: Use of single kiwifruit allergen ImmunoCAP increases the quantitative test performance and diagnostic sensitivity compared with the commercial extract. Bet v 1 homolog and profilin are important allergens in pollen-related kiwifruit allergy, whereas actinidin is important in monoallergy to kiwifruit, in which symptoms are often more severe.

Radionuclide concentration in tea, cabbage, orange, kiwi and soil and lifetime cancer risk due to gamma radioactivity in Rize, Turkey.

BACKGROUND: In this study, the activity concentrations of (232) Th, (238) U, (40) K and (137) Cs were measured in tea, cabbage, orange, kiwi and soil samples collected from different stations using gamma spectrometry with a high-purity germanium detector. RESULTS: The average activity concentrations of (232) Th, (238) U, (40) K and (137) Cs were found to be 8.2 ± 1.8, 17.3 ± 3.3, 465.8 ± 11.8 and 20.9 ± 3.8 Bq kg(-1) in food samples, and 72.4 ± 9.8, 51.1 ± 8.3, 229.3 ± 14.7 and 312.9 ± 11.5 Bq kg(-1) in farm soils, respectively. The internal effective dose to individuals and excess lifetime cancer risk from the consumption of the food type radioactivity ranged between 11.7 and 53.6 µSv y(-1) and between 0.05 × 10(-3) and 0.24 × 10(-3) , respectively. The annual external gamma effective dose and excess lifetime cancer risk in the farms due to soil radioactivity ranged between 94.1 and 139.8 µSv y(-1) and between 0.43 × 10(-3) and 0.64 × 10(-3) , respectively. The mean transfer factors of (232) Th, (238) U, (40) K and (137) Cs, from the soil to vegetables and fruit were 0.57, 0.32, 2.12 and 0.04, respectively. CONCLUSION: Annual effective gamma doses were found to be higher than the world's average in soil samples. The excess lifetime cancer risks were only found higher than the world's average in soil samples.

The effect of digestion and pH on the allergenicity of kiwifruit proteins.

It is suggested that patients with oral allergy syndrome (OAS) respond to pepsin-sensitive allergens, and systemic reactors identify pepsin-resistant allergens. We sought to assess the digestibility of kiwifruit proteins in simulated gastric fluid (SGF), and to compare the immunogenicity of the digests in patients with isolated oral and systemic reactions to kiwifruit. In addition, the effect of pH on digestibility of kiwifruit proteins was investigated. The in vitro resistance of kiwifruit proteins to digestion was determined using SGF. G-immunoglobulin (IgE) binding to digested proteins was investigated by Western blotting using sera from children and adults (aged 5-72 yr) with systemic reactions and patients with isolated oral symptoms. To determine whether pH conditions influence digestion of kiwifruit extracts, digestion at pHs 1.5-7 were compared by SDS-PAGE. Patients with systemic reactions showed IgE binding to digestion-resistant allergens, but patients with oral symptoms reacted only to digestion-labile allergens. An increase in pH from 1.5 to 2.5 significantly reduced pepsin breakdown of kiwifruit allergens. Immunoreactive digested protein fragments were detectable by immunoblot but not Coomassie stain. This study confirms a difference in the lability of food allergens recognized by patients with systemic reactions and those with OAS. Pepsin digestion of kiwifruit proteins was impaired by hypoacidic conditions suggesting that patients with hypoacidic gastric conditions are at increased risk of systemic absorption of allergens. The data indicate that commonly used methods for predicting allergenicity of novel proteins using Coomassie stains may be flawed.

[Prevalence of sensitization and allergy to kiwi fruit (Actinidia deliciosa) in adults with allergic diseases]. / Prevalencia de sensibilización y alergia al kiwi (Actinidia deliciosa) en adultos con enfermedades alérgicas.

BACKGROUND: The kiwi fruit (Actinidia deliciosa) is a food that has been recognized for its allergenic capability for more than 30 years. In general, kiwi allergy is characterized by local discomfort, but systemic reactions such as rash, angioedema, rhinitis, conjunctivitis or anaphylaxis can be triggered. OBJECTIVE: To determine the prevalence of sensitization and allergy to kiwi in adults with allergic diseases. METHODS: By means of a cross-sectional, retrolective study, data corresponding to 370 patients aged ≥16 years were analyzed. RESULTS: 226 patients had positive skin reaction against aeroallergens. The prevalence of food sensitization was 84/226 (37.2%; 95 % CI = 31.1 to 43.6). Overall, the prevalence of sensitization to kiwi fruit was 15/226 (6.6%; 95% CI = 3.9 to 10.7), and of kiwi allergy, 2/15 (13.3%; 95% CI = 2.5 to 39.1); one patient had symptoms consistent with oral allergy syndrome, and another, gastrointestinal and cutaneous manifestations. CONCLUSION: The prevalence of sensitization to kiwi fruit is not a rare event; in contrast, symptoms related to its consumption are uncommon.

Antecedentes: El kiwi (Actinidia deliciosa) es un alimento reconocido por su capacidad alergénica desde hace más de 30 años. Por lo general, la alergia al kiwi se caracteriza por molestias locales, pero pueden desencadenarse reacciones sistémicas como urticaria, angioedema, rinitis, conjuntivitis o anafilaxia. Objetivo: Determinar la prevalencia de sensibilización y alergia al kiwi en adultos con enfermedades alérgicas. Métodos: Mediante un estudio transversal se analizaron los datos correspondientes a 370 pacientes ≥ 16 años de edad. Resultados: Tuvieron reacción cutánea positiva contra aeroalérgenos 226/370 pacientes. La prevalencia de sensibilización a alimentos fue 84/226 (37.2 %; IC 95 % = 31.1 a 43.6 %). En general, la prevalencia de sensibilización al kiwi fue de 15/226 (6.6 %; IC 95 % = 3.9 a 10.7 %) y de alergia al kiwi de 2/226 (0.9 %; IC 95 % = 0.03% a 3.4 %), un paciente tuvo síntomas compatibles con síndrome de la alergia oral y otro, manifestaciones gastrointestinales y cutáneas. Conclusión: La prevalencia de sensibilización al kiwi no es un evento raro; en contraste, los síntomas relacionados con el consumo del fruto son poco frecuentes.

Atrial Fibrillation in Anaphylaxis.

BACKGROUND: The relationship between anaphylaxis and cardiovascular events has been reported in the past. While skin and respiratory symptoms are usually the most common and the first to appear, cardiovascular complications play a key role and represent the leading cause of death in anaphylaxis. METHODS: We report 3 episodes of atrial fibrillation triggered by anaphylaxis. Allergy and cardiology studies were performed. In both patients, the etiological agent was identified: Anisakis simplex hypersensitivity and food allergy. RESULTS: The heart is the source and target of chemical mediators released during an allergic reaction. In the heart, there are plenty of mast cells, and they are predominantly located around the coronary adventitia and in close contact with small vessels in the muscle wall. The release of mediators can influence ventricular function, heart rate, and coronary artery tone. Anaphylaxis can trigger any kind of arrhythmia. In these cases, the very interesting point of discussion was: which should be first, treating anaphylaxis or cardiac events? The other controversial point was the use of epinephrine, the first line of treatment for anaphylaxis. Recommendations about epinephrine in cardiac patients during an anaphylactic event are still a major dilemma. CONCLUSIONS: We emphasize the importance of the priority of establishing protocols between cardiologist and allergist in treatment of cardiac complications during anaphylaxis, and we warn about the correct diagnosis of arrhythmias in anaphylaxis in order to treat them as soon as possible, to prevent other consequences and complications.