Source: American College of Allergy, Asthma, and Immunology
In most cases, people with allergies develop mild to moderate symptoms, such as watery eyes, a runny nose or a rash. But sometimes, exposure to an allergen can cause a life-threatening allergic reaction known as anaphylaxis. This severe reaction happens when an over-release of chemicals puts the person into shock. Allergies to food, insect stings, medications and latex are most frequently associated with anaphylaxis.
A second anaphylactic reaction, known as a biphasic reaction, can occur as long as 12 hours after the initial reaction.
Call 911 and get to the nearest emergency facility at the first sign of anaphylaxis, even if you have already administered epinephrine, the drug used to treat severe allergic reactions. Just because an allergic person has never had an anaphylactic reaction in the past to an offending allergen, doesn’t mean that one won’t occur in the future. If you have had an anaphylactic reaction in the past, you are at risk of future reactions.
Anaphylaxis symptoms occur suddenly and can progress quickly. The early symptoms may be mild, such as a runny nose, a skin rash or a “strange feeling.” These symptoms can quickly lead to more serious problems, including:
- Trouble breathing
- Hives or swelling
- Tightness of the throat
- Hoarse voice
- Abdominal pain
- Low blood pressure
- Rapid heart beat
- Feeling of doom
- Cardiac arrest
People who have had a severe allergic reaction are at risk for future reactions. Even if your first reaction is mild, future reactions might be more severe. That’s why it’s important to carry self-injectable epinephrine if you are at risk, and 911 should be dialed in the event of a very serious reaction.
Understanding anaphylaxis and the things that can trigger this severe allergic reaction will help you manage your condition.
If you have a history of allergies and/or asthma and have previously had a severe reaction, you are at greater risk for anaphylaxis.
Allergists have the training and expertise to review your history of allergic reactions, conduct diagnostic tests (such as skin-prick tests, blood tests and oral food challenges) to determine your triggers, review treatment options and teach avoidance techniques. Consultation with an allergist is recommended if:
- You’re unsure whether you have had an anaphylactic reaction.
- Your symptoms are recurring or are difficult to control.
- You’re having trouble managing your condition.
- More tests are needed to determine the cause of your reactions.
- Desensitization or immunotherapy could be helpful in your case.
- Daily medication is needed.
- You need intensive education on avoidance and anaphylaxis management.
- Other medical conditions complicate your treatment.
Management and Treatment
An anaphylactic reaction should be treated immediately with an injection of epinephrine (adrenaline). Doses, available by prescription, come in an auto-injector that should be kept with you at all times. Two injections may be necessary to control symptoms. Here are some tips for reducing the risk of anaphylaxis:
- Know your trigger. If you’ve had anaphylaxis, it’s very important to know what triggered the reaction. An allergist can review your medical history and, if necessary, conduct diagnostic tests. The most common triggers are:
- Food: including peanuts, tree nuts such as walnuts and pecans, fish, shellfish, cow’s milk and eggs.
- Latex: found in disposable gloves, intravenous tubes, syringes, adhesive tapes and catheters. Health care workers, children with spina bifida and genitourinary abnormalities and people who work with natural latex are at higher-risk for latex-induced anaphylaxis.
- Medication: including penicillin, aspirin and non-steroidal anti-inflammatory drugs such as ibuprofen, and anesthesia.
- Insect sting: with bees, wasps, hornets, yellow jackets and fire ants being the most likely to trigger anaphylaxis.
- Avoid your trigger. Avoidance is the most effective way to prevent anaphylaxis. An allergist can work with you to develop specific avoidance measures tailored specifically for your age, activities, occupation, hobbies, home environment and access to medical care. Here are some general avoidance techniques for common triggers:
- Food allergies. Be a label detective and make sure you review all food ingredient labels carefully to uncover potential allergens. When eating out, ask the restaurant how food is prepared and what ingredients are used. If you have a child with a history of anaphylaxis, it’s imperative to make sure that school personnel are informed of the child’s condition and a treatment plan is provided, including the administration of epinephrine.
- Medications. Make sure all of your doctors are aware of any reactions you’ve had to medications so that they can prescribe safe alternatives and alert you to other medications you may need to avoid. If there are no alternative medications, you may be a candidate for desensitization, a treatment that introduces a small dose of the medication you are allergic to. As your body becomes more tolerant to the medication, the dosage can be increased over time. While the treatment is effective, it’s only temporary and must be repeated if the medication is needed again in the future.
- Insect stings. To help prevent stinging insects, avoid walking barefoot in grass, drinking from open soft drink cans, wearing bright colored clothing with flowery patterns, sweet smelling perfumes, hairsprays and lotion during active insect season in late summer and early fall. An allergist can also provide a preventative treatment called venom immunotherapy (or venom allergy shots) for insect sting allergy. The treatment works by introducing gradually increasing doses of purified insect venom, and has been shown to be 90 to 98 percent effective in preventing future allergic reactions to insect stings.
- Be prepared. Prompt recognition of the signs and symptoms of anaphylaxis is critical. If you unexpectedly come into contact with your trigger, you should immediately follow the emergency plan outlined by your doctor including the self-administration of epinephrine. If there is any doubt about the reaction, it is generally better to administer the epinephrine. Teachers and other caregivers should be informed of children who are at risk for anaphylaxis and know what to do in an allergic emergency.
- Seek treatment. If a severe reaction does occur and epinephrine is administered, you should be transported to the nearest emergency facility by ambulance for additional monitoring.
- Tell family and friends. Family and friends should be aware of your condition, your triggers and know how to recognize anaphylactic symptoms. If you carry epinephrine, alert them to where you keep it and how to use it.
- Wear identification. Wear and/or carry identification or jewelry (bracelet or necklace) noting condition and offending allergens.
- See a specialist. Allergists have the training and expertise to review your allergy history, conduct diagnostic tests, review treatment options and teach avoidance steps.
- Seek additional resources. Additional information on allergies and anaphylaxis is anaphylaxis is available on the ACAAI Web site or the Food Allergy Research & Education (FARE) at www.foodallergy.org.
- In addition, helpful information can be found on the Food Allergy & Anaphylaxis Connection Team (FAACT) website www.FoodAllergyAwareness.org.
Be S.A.F.E. Action Guide
Allergists and emergency physicians have teamed up to create the Be S.A.F.E. action guide to help you remember steps to take during and after an allergic emergency.
Seek immediate medical help. Call 911 and get to the nearest emergency facility at the first sign of anaphylaxis, even if you have already administered epinephrine, the drug used to treat severe allergic reactions. If you have had an anaphylactic reaction in the past, you are at risk of future reactions.
Identify the Allergen. Think about what you might have eaten or come in contact with – food, insect sting, medication, latex – to trigger an allergic reaction. It is particularly important to identify the cause because the best way to prevent anaphylaxis is to avoid its trigger.
Follow up with a specialist. Ask your doctor for a referral to an allergist/immunologist, a physician who specializes in treating asthma and allergies. It is important that you consult an allergist for testing, diagnosis and ongoing management of your allergic disease.
Carry Epinephrine for emergencies. Kits containing fast-acting, self-administered epinephrine are commonly prescribed for people who are at risk of anaphylaxis. Make sure that you carry an epinephrine kit with you at all times, and that family and friends know of your condition, your triggers and how to use epinephrine. Consider wearing an emergency medical bracelet or necklace identifying yourself as a person at risk of anaphylaxis. Teachers and other caregivers should be informed of children who are at risk for anaphylaxis and know what to do in an allergic emergency.