Anaphylaxis

 
Anaphylaxis is a severe type of allergic reaction that can be life threatening.
This fact sheet provides general information about anaphylaxis, how to recognize it, and how to manage it.  We hope that this material helps you better understand the nature of anaphylaxis. Please keep in mind that this information is not meant to take the place of medical advice from your physician.
 

 Omar, a 32-year-old salesman, took penicillin to treat strep throat. An hour after taking the first pill, he developed a red, itchy rash, felt dizzy, and passed out. He was taken to the emergency department where he was treated successfully with shots of epinephrine and other medications.

 A bee stung 15–year-old Terry. Within five minutes, she felt hot and flushed and began to have difficulty breathing. Very quickly, she felt dizzy and nauseated. Her mother immediately drove her to the family physician, who successfully treated her in the office.

 At least 12 times over the last two years, Jimmy, a 42-yearold construction worker, had a raised itchy rash, along with nausea, vomiting, and diarrhea. He also passed out with these episodes. None of these events were found to be related to taking medication, eating certain foods, or getting stung by an insect. Jimmy now carries a self-injectable epinephrine device, using it at the first sign of these familiar symptoms. In most cases, it prevents another episode.

 

What is an allergy?

An allergy is an adverse reaction from an immune response to something that contacts the body, is inhaled, or ingested. The reactions include sneezing, wheezing, cough, itching, skin rashes, stomach pain, diarrhea, or even a fall in blood pressure, which can cause dizziness or passing out. With proper management and education, people with allergies can lead healthy, normal lives.
 

What is anaphylaxis?

Anaphylaxis (pronounced anna-fi-lack-sis) is the term used to describe a severe, potentially life-threatening allergic reaction. These reactions include the breathing problems and low blood pressure described above. An anaphylactic reaction usually occurs within minutes after contact with an allergen. Occasionally, the episodes occur without an obvious trigger (so-called “idiopathic” anaphylaxis). Anaphylaxis is generally considered to be a medical emergency. Without speedy treatment, an anaphylactic reaction can cause death.
 

 What are common triggers for anaphylaxis?

For the most part, anaphylaxis develops in response to one of several kinds of triggers.
 
Medications. Common culprits are penicillin and other antibiotics; aspirin and aspirin-related products; muscle relaxants; used in surgery; and certain substances injected intravenously for special X-ray studies called radiocontrast media (RCM).
 
Foods. The most common foods that can trigger anaphylaxis are peanuts or other legumes, tree nuts, fish, shellfish and, especially in children, milk, and eggs.
 
Insect stings. One sting from a bee, wasp, yellow jacket, hornet, or fire ant can lead to anaphylaxis in sensitive individuals. Bites from the “kissing bug” and deer fly may also cause a reaction.
 
Exercise. In some people, exercise such as running can bring on anaphylaxis, sometimes only if food is ingested before the exercise.
 
Latex. In patients who have become allergic to latex, if gloves or other medical devices containing latex come in contact with internal body surfaces such as during surgery, this can cause anaphylaxis.
 

What are the signs or symptoms of anaphylaxis?

When anaphylaxis occurs, it may affect the skin, respiratory tract, gastrointestinal tract and/or cause a drop in blood pressure. Signs or symptoms of this severe allergic response may include a few to many of the following:
 
• Skin: flushing, swelling, itching, hives
• Respiratory: “hay fever”-like symptoms (red, watery, itchy eyes; stuffy, runny, itchy nose; sneezing); throat swelling symptoms (change in voice, difficulty swallowing, difficulty breathing); asthma symptoms (cough, wheeze, chest tightness/shortness-of-breath)
• Gastrointestinal: nausea, vomiting, diarrhea, cramps
• Low blood pressure: light headedness, passing out
 

How is anaphylaxis diagnosed?

Skin tests can confirm the degree of sensitivity to certain allergens that may trigger anaphylaxis. In a skin test, the skin is pricked with a tiny amount of the suspected allergen; however, individuals known to have severe reactions to specific allergens can experience anaphylaxis even with the skin test. In such cases, your physician may order blood tests to look for the presence and level of IgE antibodies.

 

What is the treatment for anaphylaxis?

Immediate medical treatment is necessary to treat anaphylaxis. Treatment should begin at the first signs or symptoms of an anaphylactic reaction.

Epinephrine, also known as adrenaline, is given by injection. If given immediately, an epinephrine injection may make the difference between a saved life and a fatality.

Other medications generally are given along with epinephrine to treat a severe allergy reaction. These might include antihistamines, corticosteroids, bronchodilators, and oxygen; however, none of these acts as quickly to reduce the symptoms of anaphylaxis as epinephrine does.

 

Guidelines for treating anaphylaxis

•   Always carry injectable epinephrine if you know you are susceptible to severe allergic reactions. Promptly inject the medication at the first sign of an anaphylactic reaction. Don’t wait for symptoms to become serious or out of control.

• Seek medical care immediately — even if you feel better — because symptoms can recur.

• You also may want to take antihistamines and steroids as prescribed by your physician to relieve symptoms.

 

Are there ways to help prevent anaphylaxis?

Yes. The best way to prevent anaphylaxis is to strictly avoid exposure to substances known to have caused an anaphylactic reaction for you in the past.

 

Know your medications

•   Tell your physician about specific medications that have caused an allergic response for you. Describe your symptoms and the length of time for the reaction to occur and resolve.

•   Make sure your physician knows the names of every single medication you currently take. Some medications are related or similar to those that cause your reactions and could cause a similar reaction (called a “cross reaction”).

•   Be familiar with both the generic name and all the trade names of medications that cause you to have an anaphylactic reaction. Be aware of ingredients in a combination product. Read drug information carefully.

•   If you take medications known as beta-blockers, you may experience a particularly severe or hard-to-treat episode of anaphylaxis. Patients prone to anaphylaxis should generally not be on beta-blockers and should ask their physicians about using alternative medications.

•   Take oral mediations rather than a shot when possible. This lessens the severity of the reaction. If your physician gives you a shot (for anything), wait at least 20 minutes before leaving. If you do have a reaction, you can get prompt treatment.

 

Know your foods

• Be careful about everything you eat if you have a known food allergy.

• Check ingredients on all food labels.

•   Ask restaurant staff how food is prepared. Find out whether your order will be cooked near or with other foods.

•   Tell your host or hostess in advance about your food allergy. Ask whether the foods will be prepared with or near foods that cause your allergic reactions. Be prepared to bring your own food if necessary.

•   Be alert for cross-reactions with other foods. People with allergies to one type of shellfish, for instance, may also be allergic to other types.

 

Know your environment (stinging insects)

•   If you react to insect stings, try to be aware of the presence or location of stinging insects when you are outside.

•   Look and smell as little like a flower as possible. Avoid perfume and bright colored clothes.

• Check around your home (or vacation home) for insect nests. Have someone else eliminate insect nests as soon as they are discovered.

• Avoid going barefoot as you may step on a stinging insect.

• Do not leave soda cans unattended outdoors as stinging insects may crawl inside.

In addition to these preventive measures be sure you always do the following:

•   Wear a Medic Alert bracelet or necklace to let others know of your allergy in an emergency.

• Keep a card in your wallet or purse that explains your allergy.

•   Carry your emergency epinephrine with you at all times.

 

Who should treat anaphylaxis?

Seek immediate medical treatment for anaphylaxis at an emergency care center or emergency department of the hospital. If you have had allergy episodes that required emergency treatment, it is time to see a specialist. Allergists/immunologists or pulmonologists (who specialize in the treatment of lung diseases) are specialists who treat asthma. Those who have completed training in those specialties are usually called board-certified or board- eligible.

 

Does health insurance cover treatment for anaphylaxis?

Check with your health insurance carrier about provisions for treatment of anaphylaxis. Some things you may want to find out might include:

• What emergency treatment is covered? What about coverage for use of an ambulance?

•   What coverage is offered for pre-existing conditions?

•   Do you need a referral to an allergy specialist?

•   What medications are not covered by your plan?

•   What coverage exists for injectable epinephrine?

 

The information provided in this fact sheet should not be a substitute for seeking responsible, professional medical care.

 

Reprinted with permission from “Asthma and Allergy Answers,” the patient education library developed by the Asthma and Allergy Foundation of America.