Anaphylaxis is defined as a severe allergic reaction. When low blood pressure occurs then it is termed anaphylactic shock. The symptoms can occur rapidly and may be life-threatening. Usual symptoms are hives (urticaria), swelling (lips, tongue, around eyes), itching, respiratory symptoms (cough, wheezing, difficulty breathing, chest tightness, or shortness of breath), GI symptoms (nausea, vomiting, or diarrhea), nasal symptoms (sneezing, itchy/runny nose, congestion, itchy or tight throat) and sometimes light-headedness with loss of consciousness. Itching of the palms of the hands and soles of the feet is an early sign of an allergic reaction and some people feel a sense of impending doom, such as “I’m going to die!” If you feel this…seek medical care immediately.
There are multiple potential allergic triggers of anaphylaxis. These include: foods, medications, insect stings (bees, yellow jackets, wasps, or hornets), CT scan dye, blood transfusions, allergy injections, and latex, to name the most common.
To assess for anaphylaxis, a blood test called tryptase can be obtained in the ER. This is a chemical substance produced by mast cells that is released into the system which lingers for several hours. This test can help differentiate an allergic reaction from other causes of shock, such as infection (sepsis), heart attack, etc. However, to identify the specific trigger, your allergist could place skin tests or obtain a blood IgE test. On occasion, anaphylaxis occurs without a known trigger. This is called idiopathic anaphylaxis.
It is important to identify and treat anaphylaxis as quickly as possible, as delay in treatment increases the risk of poor outcomes, like death. Treatment for anaphylaxis includes: 1) Epinephrine; 2) Epinephrine; 3) Epinephrine. I think this gets the point across that Epinephrine is the best treatment for anaphylaxis. Other treatments that are used in the allergist’s office or ER may include the following: oxygen, antihistamines, steroids, intra-venous fluids, asthma treatments like albuterol through the nebulizer and, rarely, other medications.
The best treatment, however, is PREVENTION and READINESS in the event of another reaction. This means knowing what you are allergic to, having a written action plan with emergency contacts listed and actions to be taken, carrying self-injectable Epinephrine (Epi-Pen® https://www.myepipen.com/), and wearing a medical alert bracelet http://www.laurenshope.com/ . Patients and parents of patients need to be proactive and assertive. The written action plan should be available at home (for the baby sitter), and work, school or daycare as appropriate. For insect sting anaphylaxis, allergy shots are very effective in decreasing the chance of having another anaphylactic reaction.
As an Anaphylaxis Community Expert (ACE), I will give FREE presentations to schools and community groups. Visit www.aanma.org/AnaphylaxisCommunityExperts to find out about this award-winning program, a joint project of AANMA and the American College of Allergy, Asthma & Immunology http://www.acaai.org/allergist/allergies/Anaphylaxis/Pages/default.aspx.
Call me at 704-817-2022 if your community organization or school is interested in this program.