Anaphylaxis

Anaphylaxis (pronounced ana-fil-ax-is) is a life threatening severe allergic reaction. It can occur when someone with allergies is exposed to something they are allergic to (known as an allergen). Reactions usually begin within minutes and rapidly progress but can occur up to 2-3 hours later.

It is a medical emergency, and requires immediate treatment.

What causes an anaphylactic reaction?

In most allergic reactions the resulting chemicals are released locally into the tissues in a particular part of the body (skin, eyes etc.). This means the symptoms of the allergic reaction usually only occur in this area.

In anaphylaxis, the chemicals that cause the allergic symptoms (e.g. histamine) are released into the bloodstream. The symptoms of anaphylaxis usually occur within minutes of exposure to the trigger substance (allergen) but sometimes an hour or so late

The most common causes of anaphylactic reactions include:

Foods – including nuts, milk, fish, shellfish, eggs and some fruits
Medicines and drugs – including some antibiotics
Insect stings – particularly wasp and bee stings
General anaesthetic
Contrast agents – dyes used in some medical tests to help certain areas of your body show up better on scans
Latex – a type of rubber found in some rubber gloves

In some cases, there’s no obvious trigger. This is known as idiopathic anaphylaxis.

What are the symptoms of anaphylaxis?

A reaction is usually classed as anaphylaxis if there are changes in a person’s breathing, heart rate or blood pressure.

Any one or more of the following symptoms may be present. These are often referred to as the ABC symptoms.

Airway

Swelling in the throat, tongue or upper airways (tightening of the throat, hoarse voice, difficulty swallowing)

Breathing

Sudden onset wheezing, breathing difficulty, noisy breathing

Circulation

Dizziness, feeling faint, sudden sleepiness, tiredness, confusion, pale clammy skin, loss of consciousness

Treatment for anaphylaxis

Dial 999 and inform the controller that the patient is suffering from anaphylaxis.

Here are the steps you need to follow if someone is having an anaphylactic shock:

The first line treatment for severe symptoms is adrenaline (epinephrine) given by an injection into the upper outer muscle of the thigh. Adrenaline given in this way is a safe treatment and you should not hesitate to use it if required. It starts to work within minutes, reducing swelling, relieving wheeze and improving blood pressure.
Do not wait to see if the symptoms clear up – call an ambulance immediately. All patients receiving emergency adrenaline should be transported to hospital for further care.
Adrenaline is a short-acting drug and the effects will wear off quite quickly. If there is no response to the initial injection, current recommendations are to give a further adrenaline dose after 5 minutes.
If your child has asthma or has been prescribed a salbutamol inhaler and your child is wheezy, please consider giving up to 10 puffs of salbutamol using spacer device after the adrenaline pen. Remember - in suspected anaphylaxis, always give adrenaline pen first followed by other treatments.

If you are suffering from an anaphylactic shock, you should use your adrenaline pen immediately. While waiting for the ambulance, it is better if you lie down as this helps to maintain your blood pressure and avoids injury if you faint. You may be more comfortable with your shoulders raised a bit if you feel wheezy or short of breath.

Preventing anaphylaxis

If you have a serious allergy or have experienced anaphylaxis before, it’s important to try to prevent future episodes.

The following can help reduce your risk:

Identify triggers

Finding out if you’re allergic to anything that could trigger anaphylaxis can help you avoid these triggers in the future.

If you’ve had anaphylaxis and have not already been diagnosed with an allergy, you should be referred to an allergy clinic for tests to identify any triggers.

The most commonly used tests are:

Skin prick test – your skin is pricked with a tiny amount of a suspected allergen to see if it reacts
Blood test – a sample of your blood is taken to test its reaction to a suspected allergen

Avoid triggers

If a trigger has been identified, you’ll need to take steps to avoid it in the future whenever possible.

Food

You can reduce the chances of being exposed to a food allergen by:

Checking food labels and ingredients
Letting staff at a restaurant know what you’re allergic to so it’s not included in your meal. Allergy UK’s translation cards for eating out when travelling abroad are available via our Helpline.
Remembering some types of food may contain small traces of potential allergens – for example, some sauces contain wheat and peanuts
Identify any triggers – you may be referred to an allergy clinic for allergy tests to check for anything that could trigger anaphylaxis
Avoid triggers whenever possible – for example, be careful when food shopping or eating out if you have a food allergy
Carry two in-date adrenaline auto-injectors at all times – give yourself an injection whenever you think you may be experiencing anaphylaxis, even if you’re not completely sure

Insect stings

You can reduce your risk of being stung by an insect by taking basic precautions, such as:

Moving away from wasps, hornets or bees slowly without panicking – do not wave your arms around or swat at them
Using an insect repellent if you spend time outdoors, particularly in the summer
Being careful drinking out of cans when there are insects around – insects may fly or crawl inside the can and sting you in the mouth when you take a drink
Not walking around outside with bare feet

Some specialist allergy centres can also offer special treatment to help desensitise you to insect stings (immunotherapy).

Medicines

If you’re allergic to certain types of medicines, there are normally alternatives that can be safely used.

For example, if you’re allergic to:

Penicillin – you can normally safely take a different group of antibiotics known as macrolides.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin – you can normally safely take paracetamol; read the ingredients of things like colds medicines carefully to make sure they do not contain NSAIDs
One type of general anaesthetic – others are available, or it may be possible to perform surgery using a local anaesthetic or an epidural injection.

Always tell any healthcare professional about medicine allergies you have, as they may not be aware of them.

Carry adrenaline auto-injectors

You may be prescribed an adrenaline auto-injector if there’s an ongoing risk you could develop anaphylaxis.

There are three types of auto-injectors – EpiPen, Jext and Emerade – that are each slightly different. Instructions are also included on the side of each injector if you forget how to use it or someone else needs to give you the injection.

It’s important to remember the following:

Carry 2 in-date auto-injectors at all times. There should be no exceptions; you may also be advised to get an emergency card or bracelet with full details of your allergy and doctor’s contact details to alert others
Make sure you and any carers know when and how to use your auto-injector – read the leaflet that comes with it and practise with a training device, which you can get from the manufacturer
Extremes of heat can make adrenaline less effective, so do not leave your auto-injector in the fridge or your car’s glove compartment, for example
Check the expiry date regularly and replace it before it expires. An out-of-date injector will offer limited protection
Manufacturers offer a reminder service, where you can be contacted near the expiry date – check the information leaflet that comes with your medicine for more information
Do not delay injecting yourself if you think you may be experiencing anaphylaxis, even if your initial symptoms are mild – it’s better to use adrenaline early and then find out it was a false alarm than delay treatment until you’re sure you’re experiencing severe anaphylaxis.