Mediators of anaphylaxis.

Anaphylaxis is a life-threatening condition closely linked to IgE activation of mast cells with subsequent release of preformed mediators, including histamine, neutral proteases (tryptase and chymase), and proteoglycans (eg, heparin) from intracellular granules. These factors participate in the development of classic symptoms involving the skin, respiratory tract, circulation, and gastrointestinal system. Release of these granules is followed quickly by increased synthesis from membrane arachidonic acid of prostaglandins and leukotrienes that have an additional role in clinical symptoms. Thereafter, mast cells release numerous chemokines and cytokines that initiate recruitment and activation of additional inflammatory cells, including basophils, eosinophils, and Th2 cells.