Exposure to an allergen can sometimes cause a life-threatening allergic reaction known as anaphylaxis. Allergies to food, insect stings, medications and latex are most frequently indicated. In most cases, people with allergies develop mild to moderate symptoms, such as watery eyes, a runny nose or a rash. But sometimes, a severe reaction happens when an over-release of chemicals puts the person into shock.
Occasionally, a biphasic reaction with a delayed anaphylactic reaction, can occur as long as 12 hours after the initial reaction.
If you have epinephrine you should immediately use it and Call 911 and get to the nearest emergency facility at the first sign of anaphylaxis. You need to be monitored even if you have already administered epinephrine. 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 and should carry injectable epinephrine with you
Anaphylactic symptoms can occur suddenly and progress quickly. Initially 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
- Low blood pressure
- Rapid heart beat
- Feeling of doom
- Cardiac arrest
- Abdominal pain
Even if your first reaction is mild, future reactions might be more severe. People who have had a severe allergic reaction are at risk for future reactions. 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.
Having a severe reaction and a history of allergies and/or asthma puts you at greater risk for anaphylaxis. We will help you identify your triggers by reviewing your history of allergic reactions, conducting diagnostic tests (such as skin-prick tests, blood tests and oral food challenges) to determine your triggers, and reviewing treatment options and teaching avoidance techniques.
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, so it is advisable to always have two available. The available devices have the needle hidden to allow for easier use.
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. The most common triggers are:
- Insect sting: with bees, hornets, yellow jackets, wasps, and fire ants being the most likely to trigger anaphylaxis.
- 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.
- Avoid your trigger. 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. Avoidance is the most effective way to prevent anaphylaxis.
Here are some general avoidance techniques for common triggers:
- Food allergies. Review all food ingredient labels carefully to uncover potential allergens. If you can’t put a label on it, don’t eat it. When eating out, ask the restaurant how food is prepared and what ingredients are used. Let them know you have a life threatening allergy and generally the manager will come talk to you. 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 it is a commonly prescribed medicine you should consider wearing a medical identification bracelet to alert people to your condition.
- 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. We 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. If you unexpectedly come into contact with your trigger, you should immediately follow the emergency action plan outlined by us. Prompt recognition of the signs and symptoms of anaphylaxis is critical. If ii is warranted the self-administration of epinephrine is of crucial importance. 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. We will ensure you have a copy of your action plan uploaded to the patient portal for you to download. We will also send to your school if relevant.
- Seek treatment. If epinephrine is administered, call 911 (do not drive to the ER). The paramedics should be activated for evaluation, additional treatment if required, transport if needed and additional monitoring. If you are feeling better, then start to get worse, use your second dose of epinephrine. If you are not better in five minutes after the first dose, then use the second dose. If you have asthma, it would be wise to use albuterol as well.
- Tell family and friends. Family and friends should be aware of your condition, triggers and know how to recognize anaphylactic symptoms. If you carry epinephrine, alert them to where you keep it and how to use it. Take your epinephrine demonstrator to them so they can see it and get comfortable with it.
- Wear identification. Wear and/or carry identification or jewelry (bracelet or necklace) noting condition and offending allergens.
- 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 foodallergy.org.