Anaphylaxis

Overview:

Anaphylaxis is a severe allergic reaction. If you don't get treatment right away, it could be fatal. One of the primary causes of anaphylaxis is food allergies. Insect stings, drugs, and latex are additional causes.

Anaphylaxis can only be treated with epinephrine, which is administered as a shot into the thigh. A person experiencing anaphylaxis must go to the closest emergency room, even after receiving treatment. Most patients recover completely with timely care.

Your immune system overreacts to an allergen by releasing substances like histamine. Anaphylaxis symptoms include breathing difficulties, swelling, wheezing, and difficulty swallowing. Multiple body parts may be impacted simultaneously by an anaphylactic response.

Treatment typically involves an immediate injection of epinephrine (adrenaline) to reduce the allergic response, followed by antihistamines and corticosteroids to manage symptoms.

It’s crucial for individuals with known allergies to avoid triggers and carry an epinephrine auto-injector at all times. If you suspect someone is experiencing anaphylaxis, seek emergency medical help immediately.

Types of Anaphylaxis:

Anaphylaxis can be classified into different types based on the reaction patterns and triggers. Here are the main types:

Uniphasic Anaphylaxis: This is the most common type, in which symptoms rapidly worsen but resolve and do not return once treated.
Biphasic Anaphylaxis: This type involves an initial reaction followed by a second wave of symptoms several hours after the first has subsided. The second phase can occur 2 to 72 hours after the initial reaction and may be more severe.
Protracted Anaphylaxis: In rare cases, anaphylaxis can last for several hours or even days despite treatment with epinephrine and other medications.
Exercise-Induced Anaphylaxis: Physical activity can sometimes trigger anaphylaxis, especially if combined with other factors like food intake or medications.
It’s important to note that anaphylaxis requires immediate medical attention, and individuals with known allergies should always carry an epinephrine auto-injector. If you suspect someone is having an anaphylactic reaction, call emergency services right away.

Symptoms:

Anaphylaxis symptoms include itchy, pale, or flushed skin and hives. Low blood pressure, difficulty breathing, and a weak, rapid pulse could also occur. You might also experience nausea, vomiting, diarrhoea, lightheadedness, and fainting. The onset of symptoms typically occurs minutes after exposure to the allergen, but they may take up to 30 minutes to manifest.

The symptoms of anaphylaxis typically appear minutes after an allergen exposure. Anaphylaxis, however, can occasionally happen 30 minutes or more after exposure. Rarely, anaphylaxis may take hours to manifest. Among the symptoms and indicators are:

• Reactions on the skin, such as hives, itching, and pale or flushed skin

• Hypotension, or low blood pressure

• Breathing difficulties and wheezing can be brought on by tongue or throat swelling and airway constriction.

• A quick but feeble pulse

• Diarrhea, vomiting, or nausea

• Lightheadedness or fainting

Causes:

The causes of anaphylaxis are typically related to exposure to allergens, which can vary widely among individuals. Common causes include:

Foods: Such as peanuts, tree nuts, fish, shellfish, milk, eggs, and wheat.
Insect Stings: From bees, wasps, hornets, or fire ants.
Medications: Antibiotics like penicillin and non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, are especially important.
Latex: Found in some medical devices and gloves.
Exercise: In some cases, physical activity can trigger anaphylaxis, known as exercise-induced anaphylaxis.

Other less common causes may include certain preservatives like sulfites, contrast dyes used in imaging studies, and general anaesthesia. It’s important for individuals with known allergies to be aware of their triggers and to carry an epinephrine auto-injector for emergency use.

Risk factors:

Risk factors for anaphylaxis include:

Previous anaphylaxis: If you’ve had anaphylaxis once, your risk of having this serious reaction increases.
Allergies or asthma: Individuals with allergies or asthma may be more susceptible to anaphylaxis.
Other conditions: Certain conditions like heart disease or too many white blood cells (mastocytosis) can increase the risk.
Family history: A family history of anaphylaxis may also be a risk factor.

It’s important to manage these risk factors by avoiding known allergens, carrying an epinephrine auto-injector if prescribed, and being aware of the signs and symptoms of anaphylaxis to ensure prompt treatment.

Possible complication:

Anaphylaxis is a severe, potentially life-threatening allergic reaction that can occur rapidly. Complications from anaphylaxis can include:

Respiratory failure due to severe bronchospasm or laryngeal oedema leads to hypoxia and potential brain injury if prolonged.
Cardiovascular complications such as myocardial ischemia, arrhythmias, or cardiogenic shock, especially if there’s underlying heart disease.
Other organ dysfunction may result in conditions like kidney failure.
In rare cases, death if not treated promptly.

Immediate treatment with epinephrine is crucial, and individuals with known severe allergies should carry an epinephrine auto-injector and seek emergency medical care if they experience symptoms of anaphylaxis. Preventive measures include avoiding known allergens and wearing medical alert identification.

Prevention:

Preventing anaphylaxis involves avoiding known triggers and being prepared to treat an allergic reaction if it occurs. Here are some key strategies:

Avoid known allergens: Carefully avoid exposure to substances that have previously triggered an anaphylactic reaction.
Read labels: For food allergies, read food labels to avoid problem ingredients and inform restaurant staff about your allergies.
Carry emergency medication: Always carry an epinephrine auto-injector (like an EpiPen) and know how to use it.
Wear medical alert identification: This can inform others of your allergy in an emergency.
Have an action plan: Develop an anaphylaxis emergency action plan with your healthcare provider.
Consider long-term therapies: Discuss with your doctor if allergen immunotherapy or other treatments are appropriate for you.

Remember, anaphylaxis is a medical emergency, so even with preventive measures, it’s important to be prepared to act quickly if a reaction occurs. If you suspect anaphylaxis, use your epinephrine auto-injector and seek emergency medical care immediately.

When to see a doctor?

If you suspect anaphylaxis, it’s critical to seek immediate medical attention. Here are the signs that indicate you should see a doctor or go to the emergency room:

• Difficulty breathing, wheezing, coughing, or shortness of breath.

• Swelling of the nose, mouth, tongue, or throat.

• Skin reactions such as hives, flushed skin, or paleness.

• Gastrointestinal symptoms like severe vomiting or diarrhea.

• Cardiovascular symptoms such as chest pain, palpitations, or a weak and rapid pulse.

• Neurological symptoms like slurred speech, confusion, dizziness, or fainting.

Anaphylaxis is a severe condition that can worsen rapidly, so don’t wait to see if symptoms improve on their own. Use an epinephrine auto-injector if available, and call emergency services immediately. Even if symptoms seem to improve after the injection, you should still visit an emergency room to ensure they don’t return, as a second reaction, known as biphasic anaphylaxis, can occur. If you’re alone, make sure the door is unlocked for emergency responders, and if you’re with someone, have them take you to the nearest emergency room. Always carry an epinephrine auto-injector if you have a known severe allergy.

Diagnosis:

When it comes to prior allergic reactions, your healthcare provider may inquire about whether you have reacted to any of the following:

• Specific foods 

• Medications

• Stings of insects

• Latex 
  To support the diagnosis:

• A blood test may be administered to determine the level of tryptase, an enzyme that can increase for up to three hours following anaphylaxis.

• To help identify your trigger, blood or skin tests may be performed to check for allergies.

Anaphylaxis-like signs and symptoms are present in several illnesses. Your doctor may want to rule out other conditions.

Treatment:

The treatment of anaphylaxis is a medical emergency and requires immediate attention. Here are the steps typically taken:

Epinephrine Injection: The first line of treatment is an injection of epinephrine (adrenaline), which helps reduce the body’s allergic response.
Oxygen: To assist with breathing if there are respiratory complications.
Intravenous (IV) Antihistamines and Cortisone: To reduce inflammation of the air passages and improve breathing.
Beta-Agonist Medications: Such as albuterol, to relieve breathing symptoms.
Allergen Immunotherapy: For long-term treatment, especially if insect stings trigger anaphylaxis.

It’s crucial for individuals with known severe allergies to carry an epinephrine auto-injector (like an EpiPen) at all times and to seek hospital treatment immediately after use, even if symptoms appear to improve, due to the risk of biphasic anaphylaxis. Always consult with a healthcare provider for a personalized action plan and treatment options.

How to handle an emergency?

Move quickly if you are with someone who is experiencing an allergic reaction and exhibiting symptoms of shock. A weak, fast pulse, difficulty breathing, pale, cool, and clammy skin, confusion, and loss of consciousness should all be suspected. Take immediate action to:

Call an emergency medical help.
If there is an epinephrine autoinjector available, inject the patient by pressing it into their thigh.
Verify that the person is in a supine position and raise their legs.
Assess the patient's breathing and pulse. If required, perform cardiopulmonary resuscitation (CPR) or other first-aid procedures.

The autoinjector's use:
A lot of anaphylaxis-risk individuals carry an autoinjector. When pressed against the thigh, this device, which combines a syringe and a hidden needle, injects a single dose of medication. If you don't replace your expired epinephrine, it might stop functioning properly.

Using an autoinjector as soon as possible can prevent anaphylaxis from getting worse and possibly save your life. Make sure you understand how to operate the injector. Make sure those closest to you are also familiar with its use.

Additional information:

Long term treatment:

A course of allergy shots, also known as immunotherapy, may lessen the body's allergic response to insect stings that cause an anaphylactic reaction, thereby averting a potentially fatal reaction down the road.
Unfortunately, the underlying immune system disorder that can cause anaphylaxis in the majority of other cases is incurable. However, you can take precautions against future attacks and be ready for them should they happen.
Aim to avoid the things that trigger your allergies.
Keep self-administering epinephrine on hand. You can use an autoinjector to administer the medication to yourself in case of an anaphylactic attack.

How can I handle anaphylaxis the best I can?

If you are aware that you have severe allergies to certain foods or other items, get ready in advance:

Keep your injector close at hand: Always carry your epinephrine injection kit.
Possess ID: Carry a card with your allergy information on it or wear jewellery. This ID may save your life in an emergency.
Don't wait to inject: As soon as you come into contact with your allergen, use your epinephrine injection. Don't wait to observe if your response gets worse. 
Inform your suppliers: Inform your healthcare provider of any drug allergies you may have before any test or treatment. Dental care is a part of that.
Teach those you love: Inform your loved ones about your allergy and what triggers it. Ensure that they can identify the signs of anaphylaxis.