Identifying & Treating Anaphylaxis

Rapid response is essential

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Anaphylaxis -- also known as allergic shock -- is a life-threatening emergency that people with asthma and/or allergies need to be aware of. Being able to identify the symptoms of anaphylaxis, and then know how to respond to them quickly, is an essential skill. This is especially true if you know that you have food allergies or stinging insect allergies, as those are the two factors most likely to trigger anaphylaxis.

Anaphylaxis can happen to anyone, but of course, it's more likely to occur in people who have allergic disease, including asthma. It's also important to know that asthma can increase the risk of death from anaphylaxis.

Understanding Anaphylaxis

As mentioned above, anaphylaxis is also known as allergic shock or the most severe form of an allergy attack. Luckily, it is fairly rare, occurring in only about 5% of the population. It can strike at any time and without any warning. Even if you have never had a severe allergic reaction before, you are still just as much at risk. You can even have an anaphylactic reaction to something that didn't bother you in the past, or that just caused a mild reaction.

Anaphylaxis symptoms sometimes start out a lot like those of an asthma attack, including wheezing and an uncontrollable cough. This similarity can delay recognition that fast, emergency care is needed.

Because allergic shock seems like an asthma attack, people often try to "fix" it by taking some puffs of a quick-relief inhaler. But that doesn't work, and the condition quickly escalates into a life-threatening situation. Survival is often dependent on getting a shot of epinephrine –- immediately.

Knowing What to Do Is Crucial

But it's not all doom and gloom. You CAN take steps to protect yourself from suffering harm, even if an anaphylactic reaction should occur. With the right plan, there is no reason in the world why you cannot live a healthy, active life.

There are 3 strategies for keeping anaphylaxis from becoming a problem. They include knowledge, prevention and protection, each of which we'll examine more closely in the following sections.

Step 1. Knowledge of What Might Happen Gives You Power

First, start with learning all you can about anaphylaxis, what causes it, how to stop it, and what tools are needed to combat it. Once you've educated yourself, begin teaching your family, friends, and possibly even your co-workers what you have learned, so that everyone will be on the same page and prepared to take the right actions.

If you have allergies that have led to hives or anaphylaxis, you need to make sure you have an epi pen. If it is your child that has had that type of reaction than everyone at home and anyone your child spends time with needs access to an epi pen and knowledge about how to use it correctly.

If you need an epi pen it should be carried by you or a responsible adult at all times.

This means that it needs to go with your child on field trips, to sleepovers, and anywhere you or your child may be. You never know when you might be exposed to something that could trigger a reaction. People around you or your child need to be trained about what to do in an emergency. One of the common things I see in practice is that I prescribed an epi pen to someone and then, when needed, the pen is not available or someone does not know how to use it.

Epi Pen comes in two sizes- EpiPen (for anyone over 66 kilograms) and EpiPen Jr. (for anyone lee than66 kilograms). You do not want to store them in extremes of hot or cold (e.g. Glove box in your care) and you need to periodically check the expiration date.

If you ever use your EpiPen you should still call 911 and be evaluated by health care personnel. Finally, if you need to travel you should bring your EpiPen in your check on luggage-- it will not do you any good in your checked bag! They are also allowed by TSA.

Here are some additional specific things you should know:

Common anaphylaxis triggers. Food allergies are one of the most common cause of anaphylaxis. Allergies to peanuts and tree nuts are common culprits. But other allergies can also lead to allergic shock, including those to stinging insects, such as wasps, hornets, honeybees and fire ants. Latex is another possibility. You may have heard that healthcare workers are sometimes allergic to disposable gloves, but latex is also used in balloons, so sensitive people can go into allergic shock after playing with balloons, even if they've never been allergic to them before.

Common anaphylaxis symptoms. It's also important that you know how to recognize an anaphylaxis episode when it does begin. Early detection is essential if serious complications are to be avoided. Anaphylaxis is a severe allergic reaction that affects two or more parts of your body at the same time, regardless of where the actual exposure was. For example, the allergic reaction might begin after a bee sting on the hand but can go on to affect the whole body. This is called a systemic reaction.

Symptoms often begin with the skin, in the form of a rash or hives. Then, they may progress to throat swelling, wheezing, and other signs of distress. But symptoms don't always occur in this sequence. Sometimes, anaphylaxis starts with a bang with the most severe symptoms. It's impossible to predict which way it will go.

Here is a complete list of possible anaphylaxis symptoms:

  • Skin symptoms – Rash, hives, itching
  • Airways – wheezing, shortness of breath, throat swelling & tightness, coughing, hoarseness, chest tightness, stuffy, runny nose, trouble swallowing; itchy mouth/throat
  • Stomach – nausea, abdominal pain & cramps, vomiting, diarrhea
  • Circulation – paleness or blue skin color, weak pulse, feeling dizzy or lightheaded, shock
  • Other – having a feeling of "impending doom," red, itchy, watery eyes, headache

To extend your learning even further, you might explore the many resources at The Food Allergy & Anaphylaxis Network website, in particular, their anaphylaxis page.

The next step in your defense against anaphylaxis is to try to avoid contact with possible triggers. This is not necessarily as easy as it sounds, though. Nut allergies can be especially severe. Even tiny amounts of nuts used in the preparation of foods behind the scenes can be enough to set off an intense allergic reaction.

So, one strategy is to learn how to avoid situations where nuts or other food triggers might be. Reading food labels can help. So can asking questions about how food is prepared and what's in it. Don't share foods with others unless you know exactly what's in the food and how it was prepared. Move away if anyone nearby is eating one of your food triggers.

Another trigger you may need to watch out for are stinging insects. If you are sensitive to insects, then it's important to know where and when to look for them, and how to avoid them safely.

As mentioned earlier, latex can also trigger anaphylaxis in sensitive people. Besides balloons, latex can be found in rubber bands, bicycle handgrips, pacifiers, and even rain boots.

Step 3. Protection: Fast Response & Effective Treatment Are Critical

Knowing all about anaphylaxis and how to avoid reactions go a long way toward keeping you safe from anaphylaxis. But, no matter how careful you are, there is still a chance that you may experience anaphylaxis at some point. So, it's important that you know what to do if anaphylaxis does happen.

The Food Allergy & Anaphylaxis Network teaches the "3 Rs for Treating Anaphylaxis":

  • Recognize symptoms.
  • React quickly.
  • Review what happened so you can figure out ways to prevent it from reoccurring in the future.

You'll also need to know how / when to use epinephrine for anaphylaxis. This will require you to have auto-injectable epinephrine on hand at all times. It also requires you to know how to use it or to make sure people close to you know how to use it.

Sometimes people are reluctant to give epinephrine injections when anaphylaxis emergencies arise. But, keep in mind that when you weigh the risks of giving an injection unnecessarily against the possibility of death from delaying treatment for anaphylaxis, there is no question as to the right way to go. The treatment of anaphylaxis may not be able to wait until you get to the ER or even until emergency workers arrive at your location. When anaphylaxis begins, epinephrine needs to be given immediately.

Practicing giving the injection can be helpful when you lack confidence. One thing to keep in mind is that the best place to give epinephrine is in the front of the thigh, right through clothing if necessary.

As an added precaution, people who are known to have anaphylactic reactions should wear a MedicAlert bracelet.


"Tips to Remember: What is anaphylaxis?." 2007

"Fact Sheet: Food Allergies and Reactions." 

"What medication is used to treat an anaphylactic reaction?" 

Scott H. Sicherer, F. Estelle R. Simons, and the Section on Allergy and Immunology. "Self-injectable Epinephrine for First-Aid Management of AnaphylaxisPediatrics, Mar 2007; 119: 638 - 646.

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