Anaphylaxis

Symptoms

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
• Nausea
• Vomiting
• Abdominal pain
• Diarrhea
• Dizziness
• Fainting
• 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.

The best way to understand anaphylaxis and the things that can trigger this severe allergic reaction is to see an allergist who will help you manage your condition.

Diagnosis

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 are specially trained 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. Talk with an allergist 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:

1. 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.
2. 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.
3. 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. Be sure to keep your epinephrine auto-injector up to date. If an expired auto-injector is the only one available in an emergency situation, administer it promptly anyway. Teachers and other caregivers should be informed of children who are at risk for anaphylaxis and know what to do in an allergic emergency.
4. 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.
5. 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.
6. Wear identification. Wear and/or carry identification or jewelry (bracelet or necklace) noting condition and offending allergens.
7. See a specialist. Allergists are specially trained to help you take control of your symptoms, conduct diagnostic tests and review treatment options so you can live the life you want.
8. Seek additional resources. Additional information on allergies and anaphylaxis is available on the ACAAI Web site or the Food Allergy Research & Education (FARE) at www.foodallergy.org.
9. In addition, helpful information can be found on the Food Allergy & Anaphylaxis Connection Team (FAACT) website www.FoodAllergyAwareness.org.