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Mechanistically, an overwhelming amount of clinical and experimental evidence indicates that the predominant form of human anaphylaxis is immunoglobulin E (IgE) dependent. The most common allergens inducing anaphylactic reactions are found in foods (e.g. peanuts, tree nuts, fish or shellfish), drugs (e.g antibiotics, nonsteroidal anti-inflammatory drugs, chemotherapeutic agents) or animal venoms (e.g. insect stings, snake bites). Antigen-mediated cross-linking of allergen-specific IgE bound to the high-affinity IgE receptor (FcεRI) on mast cells and basophils induces cellular degranulation and the immediate release of various preformed (e.g. histamine, tryptase, carboxypeptidase A, and proteoglycans), or de novo synthesized (e.g. prostaglandins, leukotrienes, platelet-activating factor and cytokines) soluble mediators.
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