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Summary Article: Anaphylaxis: Life-Threatening Allergies
from Health Reference Series: Allergies Sourcebook
Section 13.1 Signs of Anaphylaxis

Text in this section is excerpted from “Anaphylaxis,” National Institute of Allergy and Infectious Diseases (NIAID), April 23, 2015.

What Is Anaphylaxis

Anaphylaxis is a serious allergic reaction that involves more than one organ system (for example, skin, respiratory tract, and/or gastrointestinal tract). It can begin very rapidly, and symptoms may be severe or life-threatening.

Causes

The most common causes of anaphylaxis are reactions to foods (especially peanuts), medications, and stinging insects. Other potential triggers include exercise and exposure to latex. Sometimes, anaphylaxis occurs without an identifiable trigger. This is called idiopathic anaphylaxis.

Symptoms

Anaphylaxis includes a wide range of symptoms that can occur in many combinations and may be difficult to recognize. Some symptoms are not life-threatening, but the most severe ones restrict breathing and blood circulation.

Many of the body's organs can be affected:

  • Skin—itching, hives, redness, swelling

  • Nose—sneezing, stuffy nose, runny nose

  • Mouth—itching, swelling of the lips or tongue

  • Throat—itching, tightness, difficulty swallowing, swelling of the back of the throat

  • Chest—shortness of breath, cough, wheeze, chest pain, tightness

  • Heart—weak pulse, passing out, shock

  • Gastrointestinal (GI) tract—vomiting, diarrhea, cramps

  • Nervous system—dizziness or fainting

How soon after exposure will symptoms occur?

Symptoms can begin within minutes to hours after exposure to the allergen. Sometimes the symptoms go away, only to return anywhere from 8 to 72 hours later. When you begin to experience symptoms, seek immediate medical attention because anaphylaxis can be life-threatening.

How do you know if a person is having an anaphylactic reaction?

Anaphylaxis is likely if a person experiences two or more of the following symptoms within minutes to several hours after exposure to an allergen:

  • Hives, itchiness, or redness all over the body and swelling of the lips, tongue, or back of the throat

  • Trouble breathing

  • Severe GI symptoms such as abdominal cramps, diarrhea, or vomiting

  • Dizziness or fainting (signs of a drop in blood pressure)

If you are experiencing symptoms of anaphylaxis, seek immediate treatment and tell your healthcare professional if you have a history of allergic reactions.

Timing

An anaphylactic reaction can occur as any of the following:

  • A single reaction that occurs immediately after exposure to the allergen and gets better with or without treatment within minutes to hours. Symptoms do not recur later in relation to that episode.

  • A double reaction. The first reaction occurs within minutes or hours. The initial symptoms seem to go away but later reappear in a second reaction, which typically occurs 8 to 72 hours after the first reaction.

  • A single, long-lasting reaction that continues for hours or days.

Treatment

If you or someone you know is having an anaphylactic episode, health experts advise using an auto-injector, if available, to inject epinephrine into the thigh muscle, and calling 9-1-1 if you are not in a hospital. (Epinephrine is a hormone that increases heart rate, constricts the blood vessels, and opens the airways.) If you are in a hospital, summon a resuscitation team.

If epinephrine is not given promptly, rapid decline and death could occur within 30 to 60 minutes. Epinephrine acts immediately but does not last long in the body, so it may be necessary to give repeat doses.

After epinephrine has been given, the patient can be placed in a reclining position with feet elevated to help restore normal blood flow.

A healthcare professional also may give the patient any of the following secondary treatments:

  • Medicines to open the airways

  • Antihistamines to relieve itching and hives

  • Corticosteroids (a class of drugs used to treat inflammatory diseases) to prevent prolonged inflammation and long-lasting reactions

  • Additional medicines to constrict blood vessels and increase heart rate

  • Supplemental oxygen therapy

  • Intravenous fluids

Conditions such as asthma, chronic lung disease, and cardiovascular disease may increase the risk of death from anaphylaxis. Medicines such as those that treat high blood pressure also may worsen symptom severity and limit response to treatment.

Antihistamines should be used only as a secondary treatment. Giving antihistamines instead of epinephrine may increase the risk of a life-threatening allergic reaction.

Management

Before leaving emergency medical care, your healthcare professional should provide the following:

  • An epinephrine auto-injector or a prescription for two doses and training on how to use the auto-injector

  • A follow-up appointment or an appointment with a clinical specialist such as an allergist or immunologist

  • Information on where to get medical identification jewelry or an anaphylaxis wallet card that alerts others of the allergy

  • Education about allergen avoidance, recognizing the symptoms of anaphylaxis, and giving epinephrine

  • An anaphylaxis emergency action plan

If you or someone you know has a history of severe allergic reactions or anaphylaxis, your healthcare professional should remember to keep you S.A.F.E.

  • Seek support: Your healthcare professional should tell you the following:

    • Anaphylaxis is a life-threatening condition.

    • The symptoms of the current episode may occur again (sometimes up to three days later).

    • You are at risk for anaphylaxis in the future.

    • At the first sign of symptoms, give yourself epinephrine and then immediately call an ambulance or have someone else take you to the nearest emergency facility.

  • Allergen identification and avoidance: Before you leave the hospital, your healthcare professional should have done the following:

    • Made efforts to identify the allergen by taking your medical history

    • Explained the importance of getting additional testing to confirm what triggered the reaction, so you can successfully avoid it in the future

  • Follow-up with specialty care: Your healthcare professional should encourage you to consult a specialist for an allergy evaluation.

  • Epinephrine for emergencies: Your healthcare professional should give you the following:

    • An epinephrine auto-injector or a prescription and training on how to use an auto-injector

    • Advice to routinely check the expiration date of the auto-injector

Section 13.2 Medical Identification Critical for People with Life-Threatening Allergies

“Medical Identification Critical for People with Life-Threatening Allergies,” 2016 © Omnigraphics, Inc. Reviewed November 2015.

In an emergency, making quick decisions with regard to medical treatment may mean the difference between life and death. It is critical for medical response personnel to be aware of any allergies or medical conditions that the patient they are treating might have. But if the patient is unconscious or unable to answer questions, they cannot provide this vital information. As a result, medical care may be delayed, or the treatment provided may be inappropriate for the patient's condition or even dangerous to their health. Wearable medical identification (ID) can play a life-saving role in such emergencies.

An individual with a serious medical condition or a life-threatening allergy can carry the information on a bracelet or necklace that is immediately identifiable. Wearable medical IDs can warn medical responders about the presence of such conditions as Alzheimer's disease, asthma, autism, diabetes, epilepsy, heart disease, high blood pressure, or organ transplant. They can also carry information about allergies to pharmaceutical drugs, foods, insects, or substances such as latex. They also typically display the individual's blood type, along with specific medical treatment requests such as DNR (do not resuscitate), DNI (do not intubate), or organ donation.

Most medical IDs also list any medications the individual takes regularly as well as the names and phone numbers of people to contact in case of emergency. It has become common practice for emergency medical technicians (EMTs) and other first responders to look for medical IDs before proceeding with treatment.

Obtaining a Medical ID

Wearable medical IDs are available from many sources online. They come in a wide variety of attractive styles and are fully customizable for individual needs. Some wearable IDs are designed to inform emergency medical responders of the presence of a more detailed medical alert card. These cards are typically carried in a wallet, purse, or backpack and provide further information about the patient's allergies or other health issues. Patients can consult with their primary-care physicians to obtain guidance in deciding what information to include on their ID.

In addition to people with life-threatening allergies and other health conditions, parents of small children and people who serve as sole caregivers for elderly or disabled individuals should also consider wearing a medical ID bracelet or necklace. If the parent or caregiver is involved in an accident or has another type of medical emergency, the medical ID can provide contact information for alternate care providers to ensure that dependent family members will receive needed assistance and remain safe. Experts also recommend wearable medical IDs for solo travelers, athletes who run or bike alone outdoors over long distances, and people who have undergone recent surgery. At a minimum, these IDs should include contact information in case of emergency.

Reference:
  • White, Jenna. “Top Ten Reasons People Wear Medical ID Jewelry.” Lauren's Hope, February 27, 2013.
  • © 2015 Omnigraphics, Inc.

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