What is Anaphylaxis? Understanding a Severe Allergic Reaction

Anaphylaxis is a severe and potentially life-threatening allergic reaction that develops rapidly and requires immediate medical attention. It can be triggered by various allergens, including foods, medications, insect stings, and latex. Recognizing anaphylaxis and knowing how to respond is crucial, as prompt action can be life-saving. If you suspect that you or someone around you is experiencing anaphylaxis, it is critical to call emergency services immediately.

Recognizing the Symptoms of Anaphylaxis

Anaphylactic reactions occur very quickly, typically within minutes of exposure to the allergen. The symptoms can manifest in various ways, often affecting multiple body systems simultaneously. Early recognition of these symptoms is vital for timely intervention.

Common symptoms of anaphylaxis include:

Respiratory Distress: Difficulty breathing, rapid breathing, wheezing, persistent coughing, or noisy breathing. You might feel short of breath or as though your airway is constricting.
Swelling: Swelling of the throat, tongue, lips, or face. This swelling can obstruct the airway, making it difficult to breathe and swallow.
Voice Changes: Hoarseness or tightness in the throat can indicate swelling in the upper airway.
Circulatory Issues: Feeling dizzy, lightheaded, or faint; sudden confusion; or loss of consciousness. The skin may feel cold and clammy to the touch.
Skin Reactions: While not always present, a rash, hives, or itching can occur. The skin may also become pale, blue, or grey, particularly around the lips and tongue. In individuals with darker skin tones, these color changes might be more noticeable on the palms of the hands and soles of the feet.
Gastrointestinal Symptoms: Nausea, vomiting, diarrhea, or abdominal cramps may also occur, although these are less specific to anaphylaxis and may not be present in all cases.

When to Seek Immediate Medical Help: Calling Emergency Services

In situations where anaphylaxis is suspected, time is of the essence. Call your local emergency number immediately if any of the following critical signs are present:

Sudden Swelling: Rapid onset of swelling in the lips, mouth, throat, or tongue.
Severe Breathing Difficulty: Breathing very rapidly, struggling to breathe, gasping for air, feeling like you are choking, or experiencing significant wheezing.
Throat Closure: A sensation of tightness in the throat or difficulty swallowing.
Color Changes: Blue, grey, or pale discoloration of the skin, tongue, or lips. Remember that on brown or black skin, these changes might be easier to see on the palms or soles.
Neurological Changes: Sudden confusion, drowsiness, dizziness, or loss of consciousness.
Unresponsiveness: If someone faints and cannot be easily awakened.
In Infants and Children: Limpness, floppiness, unresponsiveness, or unusual behavior. Their head may slump, and they may have difficulty focusing or lifting their head.

Even if a rash is also present, the symptoms listed above are indicators of a serious allergic reaction requiring immediate hospital treatment.

Responding to Anaphylaxis: Immediate Actions

If you believe you or someone nearby is having an anaphylactic reaction, take these crucial steps:

Administer Epinephrine (if available): If an epinephrine auto-injector (like an EpiPen or Auvi-Q) is available, use it immediately. Follow the instructions provided with the specific injector device. Epinephrine is the first-line treatment for anaphylaxis and can rapidly reverse the symptoms.
Call Emergency Services: After administering epinephrine, or if no epinephrine is available, call emergency services immediately. Clearly state that you suspect anaphylaxis.
Position the Person Correctly: Have the person lie down flat. If they are having trouble breathing, they can raise their legs slightly. If breathing is severely compromised, help them sit up slightly, or raise their shoulders. Pregnant individuals should lie on their left side.
Remove the Allergen (if possible and safe): If the reaction is due to an insect sting and the stinger is still visible in the skin, try to remove it carefully. Avoid squeezing the venom sac.
Second Dose of Epinephrine (if needed): If symptoms do not improve within 5 to 15 minutes after the first epinephrine injection, a second dose may be administered if another auto-injector is available.

Crucially, do not allow the person to stand or walk, even if they start to feel better. Anaphylaxis can be biphasic, meaning symptoms can return hours later, even after initial improvement.

Hospital Treatment for Anaphylaxis

Anaphylaxis requires immediate hospital treatment to ensure the reaction is fully managed and to monitor for any delayed reactions. Hospital treatments may include:

Epinephrine Administration: Further doses of epinephrine may be given via injection or intravenously (IV) drip.
Oxygen Therapy: Oxygen will be administered to support breathing.
Intravenous Fluids: Fluids given through an IV drip help to support blood pressure and circulation.
Monitoring: Continuous monitoring of vital signs is essential.

Hospital stays for anaphylaxis typically range from 2 to 12 hours but may be longer depending on the severity and response to treatment. Before discharge, patients are usually provided with two epinephrine auto-injectors and comprehensive education on how and when to use them. Referral to an allergy specialist for further testing and management advice is also common.

Preventing Anaphylaxis: Proactive Measures

For individuals at risk of anaphylaxis, preventative measures are essential for managing their allergies and minimizing the risk of future reactions.

Proactive Steps to Take:

Allergen Avoidance: Strictly avoid known allergens. This includes careful food label reading, informing restaurant staff about allergies, and avoiding environments where exposure to insect stings or other allergens is likely.
Carry Epinephrine Auto-Injectors: Always carry two epinephrine auto-injectors. Ensure they are readily accessible and not expired.
Regularly Check Expiration Dates: Monitor the expiration dates of epinephrine auto-injectors and obtain replacements before they expire.
Practice with a Trainer: Use a trainer auto-injector (available from the manufacturer) to practice the correct administration technique.
Educate Others: Inform family, friends, colleagues, and caregivers about the allergy, how to recognize anaphylaxis, and how to use the epinephrine auto-injector.
Use Epinephrine at the First Sign: Administer epinephrine if anaphylaxis is suspected, even if symptoms seem mild. Early intervention is critical.
Medical Alert Jewelry: Wear medical alert jewelry, such as a bracelet or necklace, indicating the allergy. This provides crucial information to first responders in an emergency.

Things to Avoid:

Extreme Temperatures: Do not expose epinephrine auto-injectors to extreme heat or cold, such as leaving them in direct sunlight or in a refrigerator. Store them at room temperature as directed.

Common Causes of Anaphylaxis

Anaphylaxis is triggered by an allergic reaction to a specific substance. Common triggers include:

Foods: Peanuts, tree nuts, milk, eggs, fish, shellfish, wheat, and soy are among the most common food allergens causing anaphylaxis. Sesame allergy is also increasingly recognized.
Medications: Antibiotics (like penicillin), nonsteroidal anti-inflammatory drugs (NSAIDs), and certain anesthetic agents are known to cause anaphylaxis.
Insect Stings: Venom from bee, wasp, hornet, and yellow jacket stings can trigger severe reactions.
Latex: Latex, found in some medical gloves, balloons, and other products, can cause anaphylaxis in sensitive individuals.
Anesthesia: While less common, anesthetic agents used during surgery can sometimes induce anaphylaxis.

In some instances, the cause of anaphylaxis remains unknown, termed idiopathic anaphylaxis.

Understanding anaphylaxis, its symptoms, and appropriate responses is vital for anyone with allergies and those around them. Being prepared and acting quickly can make a life-saving difference.