Are You Prepared for Anaphylaxis?

Your chest and arms begin to itch, your throat tightens, hives break out all over your skin, and your lungs refuse to work. This is anaphylactic shock—a rapid, life-threatening, multi-system allergic reaction that causes about 1,500 deaths a year. Food allergens, insect stings, medications, and latex products represent just a few instigators of this deadly allergic reaction. Upon contact with an allergen, the body releases chemicals into the tissues of the heart, lungs, digestive system, and skin. Blood vessels widen and blood pressure plummets. Anaphylactic reactions can affect virtually any organ in the body. Even miniscule amounts of an allergen may cause an anaphylactic reaction that can lead to death within minutes if left untreated. The concern over anaphylaxis has grown so much in the past few years that experts from the American College of Emergency Physicians and the American College of Allergy, Asthma and Immunology recently joined together to launch a public education campaign to raise awareness about anaphylaxis, which begs the question: Are you prepared for anaphylactic shock?

You never know when you may be exposed to an allergen that will bring on anaphylaxis, but if you’re armed with the proper knowledge, then you’ll have a much greater chance of surviving. With more than 15 years experience working as paramedic in Georgia, Donald Malborough has treated many patients suffering from anaphylaxis.

"I have seen a lot of anaphylaxis with shellfish, iodine, and peanuts. Some people are so allergic to peanuts that just the oil from the peanut getting on their skin will cause anaphylaxis," observes Malborough.

Peanut allergy is one of the most common food allergies; peanut proteins act as powerful allergens, even in small amounts. In fact, one in every 200 Americans is allergic to peanuts or other nuts, and people can have severe reactions from just inhaling the fragrance of peanuts. Peanut allergy is the leading cause of death in food-related anaphylaxis.

Signs and Symptoms of Anaphylaxis

You can’t always prevent an allergic reaction, but you can always be ready for it. The first step is to realize that you’re having an allergic reaction. Malborough points out several warning signs of an anaphylactic reaction: "First, most people will start with itching around the chest and arms. The second stage is an itchy throat, which is an indication that it will be a bad reaction. Another sign is hives; that’s a rash that is red and comes out in little circles. With the difficulty in breathing—they are the most common signs."

The symptoms of anaphylaxis can vary. For some people, the reaction begins slowly, but most experience symptoms rapidly. As Malborough points out, the most severe sign is the difficulty in breathing, along with loss of consciousness. Swelling and/or spasm in the airways can cause breathing to become labored. Dangerously low blood pressure can cause a loss of consciousness. In some cases, the heart stops pumping completely, which can lead to death.

Although anaphylactic shock can be life threatening, many victims of anaphylaxis experience only mild or common reactions. For a reaction to be considered "anaphylactic," it must involve at least two different body systems, such as the integumentary (skin) and circulatory (heart and lungs). Skin reactions include hives, welts, erythema (redness), and swelling in the face, eyelids, lips, tongue, hands, and feet. Other symptoms of an allergic reaction may include nausea, coughing, vomiting, weakness, diarrhea, difficulty swallowing, dizziness, wheezing, chest tightness, and rapid or irregular heart beat.

While some people may have very mild reactions to allergens, if you ever experience anaphylaxis, you will need to seek medical attention within four to six minutes from the onset of symptoms. Don’t hesitate to call for an ambulance if you are experiencing any swelling, particularly if it involves the mouth or throat, or if you are having trouble breathing, or feeling dizzy, light-headed, or faint. Never hesitate to call 911 if you believe that you are experiencing anaphylaxis. That phone call could save your life.

Responding to an Allergy Emergency

Act quickly, Malborough advises: "If [anaphylaxis victims] don’t have anything to stop the reaction, they need to call 911, because it is a life and death situation. Paramedics will be able to treat them."

An anaphylactic reaction is a medical emergency and needs to be treated immediately. If you find yourself a victim of anaphylaxis, use antihistamines or your prescribed epinephrine kit (EpiPen or Ana-Kit) to control the symptoms until paramedics arrive. Antihistamines are chemicals that block histamine receptors; histamine is the chemical that causes allergic reactions. Epinephrine (adrenaline) works by constricting the small blood vessels and relaxing muscles, which is especially helpful to reduce swelling and improve breathing. Severe reactions usually require epinephrine if the antihistamine provides no improvement.

While you wait for the paramedics, try to stay calm. If you are feeling light-headed or faint, lie down and raise your legs to increase the blood flow to your brain. Once the ambulance is on-site, advise the paramedics of what drugs you used to relieve your symptoms and when you took them. The paramedics will be prepared to treat your reaction.

"The general dosing that we give them is Benadryl, which is a histamine blocker. Even though we can control the symptoms, they have to be treated long-term until the allergen is out of their system," says Malborough.

After you have been treated by a paramedic, you will need to continue treatment in the emergency room. Although you may feel fine after the use of antihistamines and/or an EpiPen or Ana-Kit, you should always go directly to the nearest hospital or call an ambulance. Don’t attempt to drive, as taking any over-the-counter antihistamines may cause drowsiness, and your reaction may not be over. After you have been admitted and seen by a physician, you shouldn't leave the hospital less than six hours after the reaction begins. Occasionally, a reaction will seem to get better but then recur much worse after a few hours. Ensure your safety by staying until you are sure that the reaction has passed. Also, be sure to ask about an EpiPen or Ana-Kit and antihistamines, if you don’t already have them. These medications should be carried with you at all times in case of a severe allergic reaction.

Preventing Anaphylactic Shock

The only way to prevent anaphylactic shock is to avoid the allergen to which you're allergic; make sure to remove all sources of the allergen from your home and workplace. If you have a food allergy, read all food labels. Watch for allergy alerts, which may not always refer to food ingredients; allergy alerts may also refer to contamination that occurred during storage, processing, or packaging. If you're allergic to latex, allergy alerts are especially important to read, as latex products are often used in the preparation and packaging of food. If you're allergic to stinging insects, keep your EpiPen handy at all times.

"The most common way to avoid an anaphylactic reaction is to carry an EpiPen with you at all times, which helps to keep the airways open," Malborough advises.

Inform restaurant staffs of your allergy and never be afraid to ask how they prepare their dishes. Always carry food allergy restaurant cards, which convey vital food allergy information to servers and kitchen managers. If you have a small child with a food allergy, consider Table Topper disposable place mats for restaurant situations and food allergy t-shirts for all those situations when you must leave your child in the care of others.

Living with allergies is hard enough—don’t let the threat of anaphylaxis tighten its grip around your life. Arm yourself with antihistamines, an EpiPen or Ana-Kit, and knowledge. Knowing what to do during anaphylaxis will prepare you take to take control of your allergies and your life.