4. Anafilaksis_Deasy F

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    Biogenic amines(e.g., histamines)

    Lipid mediators(e.g., PAF, PGD2, LTC4)

    Vascular leak

    Broncho-constriction

    Broncho-constriction

    Intestinalhypermotility

    Inflammation

    Tissue

    damage

    Enzymes

    (e.g., tryptase)

    Cytokines(e.g., TNF)

    Lipid mediators(e.g., PAF, PGD2, LTC4)

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