Anaphylaxis is a severe, extreme allergic reaction which is characterized by rapid swelling of the throat and can progress to inability to breathe, stopping of the heart, and death. Anaphylaxis is an allergic emergency and requires immediate attention. An anaphylactic reaction can happen within seconds of exposure to an allergen like an insect sting, a food, or a medicine. Normally, the immune system works to protect us from things that might do us harm, like bacteria or viruses. As part of this immune system, antibodies are produced which serve to catch things in the body that should not be there, like harmful bacteria. In anaphylaxis, the immune system drastically overreacts to an allergen. When the body comes in to contact that allergen, it has an almost immediate release of a flood of chemicals that cause the blood pressure to drop, the pulse to become weak and fast, and the airways to swell uncontrollably. Though anaphylaxis is very uncommon, the most common causes include: medications (especially penicillin), some foods (especially peanuts or other nuts, milk, eggs and shellfish), and insect stings and venom (from bees, fire ants, wasps, and yellow jackets). Less commonly, people can get anaphylaxis from some anesthesias, latex, or even exercise. Over time, allergic reactions can become more serious, especially with increased exposure to the offending agent. People with allergies or asthma are more likely to get anaphylaxis. It is very important to talk to your doctor about your allergies and the possibility of ever having anaphylaxis.
Hives or redness of skin, flushing or paleness of skin, cool skin, weak or fast pulse, difficulty breathing, wheezing, chest tightness, passing out or fainting, dizziness, itching or tingling of the mouth, swelling of lips, swelling of tongue, swelling of throat, swelling of face, weak or rapid pulse, nausea, vomiting, diarrhea
The diagnosis of anaphylaxis is based mostly on clinical history and physical exam and is usually made in an emergency room or another emergency setting. Some blood tests can be done to see if you are, in fact, having an anaphylactic reaction. However, treatment is never delayed by this testing. Finding the cause of the anaphylactic reaction is important after the initial episode has subsided. Your doctor or allergist will have many questions about your allergies and exposures leading up to the anaphylaxis. To find the cause of anahylaxis, an allergist may recommend a skin prick test. The skin prick test uses a set of tiny needles which inject very small amounts of allergen under the skin. If any of those areas become inflamed or swollen, the doctor can tell which allergens likely cause your allergies or anaphylaxis. Your physician will have you wait in the office after placing these allergens in the skin to monitor your reaction. Sometimes, a blood test can also be done to look for antibodies to common allergens. Your doctor may want to do some other testing to rule out other causes of your symptoms like fainting, mastocytosis (an immune disorder), diabetes, panic attacks, or problems with other parts of your body like your heart or lungs.
Prompt treatment of anaphylaxis is absolutely essential for survival. If you have an epinephrine autoinjector pen with you, this should be injected into the thigh as soon as possible. Emergency personnel should be called as soon as possible and, if needed, CPR (cardiopulmonary resuscitation) should be started. When emergency personnel arrive, you may need to be intubated (have a tube placed in the trachea which connects the mouth to the lungs to help you breathe). You may also require other measures like IV fluids or IV medications to help maintain your blood pressure. You will likely be put on oxygen (to help get more oxygen to your organs and tissues), other IV medications like antihistamines or cortisone (to decrease inflammation in your airways), steroids (to help decrease swelling and inflammation), and beta agonists like albuterol (to help decreasing swelling in the airways and make breathing easier). After the first attack resolves, your allergist will work with you (as described in the diagnosis section) to figure out the cause of the anaphylaxis if the cause is unclear. Your allergist or doctor will also prescribe an epinephrine autoinjector pen which you should carry with you at all times in case of an emergency. When symptoms of anaphylaxis begin, the injector is pressed against the thigh on top of the clothing and th button at the end is pushed which releases a needle into the muscle of the thigh to inject epinephrine (adrenalin). Be sure to check the expiration date on the injector regularly and change it as needed. Sometimes a series of allergy shots, called immunotherapy, can be used to decrease your body’s reaction to allergens to attempt to prevent future episodes of anaphylaxis. Anaphylaxis is an emergency. Any person with anaphylaxis should immediately seek emergency help by calling 911 or getting to the nearest emergency help.
