Lessons from peculiar cases of anaphylaxis: why allergists should be prepared for the unexpected

¹Department of Experimental Medicine, Postgraduate School of Respiratory Medicine, Tor Vergata University of Rome, Rome, Italy
²Division of Pulmonology, S. Corona Hospital, Pietra Ligure, Italy
³Department of Clinical and Molecular Sciences, Marche Polytechnic University, Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti, Ancona, Italy
⁴Psychologist
⁵Allergy Unit, High Speciality San Giuseppe Moscati Hospital, Avellino, Italy
⁶Postgraduate School of Internal Medicine, University of Salerno, Salerno, Italy
⁷Division of Neurophysiology A. Cardarelli Hospital, Naples, Italy
⁸Allergy and Clinical Immunology,  G. Fucito Hospital and University Hospital, Salerno, Italy
⁹Allergy Unit, ASL (Sanitary District n°12), Caserta, Italy
¹⁰Department of Experimental Medicine, Unit of Respiratory Medicine, Tor Vergata University of Rome, Rome, Italy
¹¹ASL (Sanitary District), Avellino, Italy
¹²Unit of Allergology, Division of Internal Medicine, Fatebenefratelli Hospital, Benevento, Italy 

Summary
Anaphylaxis is the most severe systemic hypersensitivity reaction, it can be caused by a number of well identified triggers such as foods, drugs, stinging insects and facilitated by predisposing clinical conditions. However, sometimes anaphylaxis shows up with uncommon or peculiar characteristics which could delay diagnosis and therapeutic treatment. In this report we aimed to describe less accounted / difficult-to-approach shapes of anaphylaxis to facilitate clinicians to suspect these severe reactions even in uncommon conditions. We choose to present data on anaphylaxis regarding simulation, mode of exposure to sensitizing agents, pregnancy, exposure to animals, intimate behaviour, psychological stress and other situations.

Key words
Adverse drug reaction; allergen exposure; anaphylaxis; bronchial asthma; Can f 5; COVID-19 vaccines; dog allergen; hypersensitivity; intimate behaviour; oxytocine; polyethylene glycol (PEG); psychological stress.