Allergy

What Is Anaphylaxis? Arm Yourself with These Facts

• Anaphylaxis is a life-threatening, often unexpected, allergic reaction that affects many parts of the body at once. Like other allergic reactions, anaphylaxis is the body’s overreaction to a foreign substance that ordinarily is harmless.
• Symptoms of anaphylaxis include hives, swelling and flushing, difficulty breathing and wheezing, a swelling of the tongue, throat and nose, dizziness and a dangerous drop in blood pressure, nausea and cramping.
• The symptoms can occur within minutes of exposure to the offending allergen but also can develop after 30 minutes or more. In some cases, a second or biphasic reaction may occur eight to 12 hours after the initial reaction. If symptoms develop quickly, the condition is more likely to be severe and potentially fatal.
• Patients who have a history of allergic conditions or have had a previous severe reaction are at greater risk for anaphylaxis.
• Identifying the cause of anaphylaxis requires a detailed history of all food and medication ingested before the reaction and a review of all activities including exercise and sex. While a patient’s history is often the most important tool, skin tests or challenge tests also may be performed to identify specific triggers, confirm a diagnosis or rule out other causes.
• Allergic reactions to food, latex, medication and insect stings are the most common causes of anaphylaxis. The condition can be triggered by exercise, seminal fluid and there also is a small risk of reaction to allergen imunotherapy.
• Food allergy accounts for 35% to 55% of anaphylactic reactions with peanuts, tree nuts, fish, milk and eggs being the most common.
• Up to 6.5% of the general population has a latex sensitivity with health care workers, children with spina bifida and genitourinary abnormalities, and workers with occupational exposures to latex at higher risk.
• Penicillin is the most common cause of drug-induced anaphylaxis followed by aspirin and non-steroidal anti-inflammatory drugs.
• If no cause of a reaction is determined, the condition is called idiopathic anaphylaxis.
• Heart attacks, anxiety disorders, seizure disorders and poisoning are some of the conditions that may be mistaken for anaphylaxis.
• Immediate emergency treatment is required for all patients who experience any anaphylactic symptoms.

Patients who have had an anaphylactic reaction should have a consultation. We can help you determine the risk for future reactions, take a detailed history, conduct diagnostic tests, review avoidance techniques and provide instruction on the self-administration of epinephrine.

Patient Tip Sheet for Anaphylaxis

Anaphylaxis is a rare, but potentially fatal allergic reaction, that requires immediate attention and treatment. If you have a history of allergies and/or asthma and have had a severe reaction, you are at greater risk for anaphylaxis and education is one of the most important steps you can take to manage your condition.

The American College of Allergy, Asthma and Immunology (ACAAI) suggests the following tips:

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.
• Latex. Before having any medical-surgical-dental procedure, it’s important to inform your doctor about your condition and make sure that the procedure is performed in a latex-safe environment. If possible, request that you be the first procedure for the day to further limit possible exposure. Health care workers who have a latex allergy should wear non-latex and powder-free gloves and have colleagues do the same.
• 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% 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.

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 (Medic Alert bracelet or necklace) noting condition and offending allergens. Medic Alert (888-633-4298 or www.medicalert.org) provides identification and medical information in emergencies and includes a 24-hour emergency response service.

7. See a specialist. Allergists have the training and expertise to review your allergy history, conduct diagnostic tests, review treatment options and teach avoidance steps. Consultation with a specialist is recommended if you:

• are unsure if you have had anaphylaxis
• experience recurring symptoms or symptoms that are difficult to control
• need additional assistance in managing your condition
• require additional tests to determine the cause of your reactions
• are a candidate for desensitization or immunotherapy
• require daily medication
• need intensive education on avoidance and anaphylaxis management
• have other conditions that complicate your anaphylaxis and its treatment

8. Seek additional resources. Additional information on allergies and anaphylaxis is anaphylaxis is available on the ACAAI Web site at www.acaai.org or the Food Allergy & Anaphylaxis Network (FAAN) at www.foodallergy.org.

Anaphylaxis Symptoms and Reactions

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.

Understanding anaphylaxis and the things that can trigger this severe allergic reaction will help you manage your condition. Ask an allergist for more information about testing, diagnosis and a disease management plan.