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Anaphylaxis

Anaphylactic reaction; Anaphylactic shock; Shock - anaphylactic; Allergic reaction - anaphylaxis

 

Anaphylaxis is a life-threatening type of allergic reaction .

Causes

 

Anaphylaxis is a severe, whole-body allergic reaction to a chemical that has become an allergen . An allergen is a substance that can cause an allergic reaction.

After being exposed to a substance such as bee sting venom, the person's immune system becomes sensitized to it. When the person is exposed to that allergen again, an allergic reaction may occur. Anaphylaxis happens quickly after the exposure. The condition is severe and involves the whole body.

Tissues in different parts of the body release histamine and other substances. This causes the airways to tighten and leads to other symptoms.

Some drugs (morphine, x-ray dye, aspirin, and others) may cause an anaphylactic-like reaction (anaphylactoid reaction) when people are first exposed to them. These reactions are not the same as the immune system response that occurs with true anaphylaxis. But, the symptoms, risk of complications, and treatment are the same for both types of reactions.

Anaphylaxis can occur in response to any allergen. Common causes include:

  • Drug allergies
  • Food allergies
  • Insect bites/stings

Pollen and other inhaled allergens rarely cause anaphylaxis. Some people have an anaphylactic reaction with no known cause.

Anaphylaxis is life-threatening and can occur at any time. Risks include a history of any type of allergic reaction.

 

Symptoms

 

Symptoms develop quickly, often within seconds or minutes. They may include any of the following:

  • Abdominal pain
  • Feeling anxious
  • Chest discomfort or tightness
  • Diarrhea
  • Difficulty breathing, coughing, wheezing, or high-pitched breathing sounds
  • Difficulty swallowing
  • Dizziness or lightheadedness
  • Hives , itchiness, redness of the skin
  • Nasal congestion
  • Nausea or vomiting
  • Palpitations
  • Slurred speech
  • Swelling of the face, eyes, or tongue
  • Unconsciousness

 

Exams and Tests

 

The health care provider will examine the person and ask about what might have caused the condition.

Tests for the allergen that caused anaphylaxis (if the cause is not obvious) may be done after treatment.

 

Treatment

 

Anaphylaxis is an emergency condition that needs medical attention right away. Call 911 immediately.

Check the person's airway, breathing, and circulation, which are known as the ABC's of Basic Life Support. A warning sign of dangerous throat swelling is a very hoarse or whispered voice, or coarse sounds when the person is breathing in air. If necessary, begin rescue breathing and CPR .

  1. Call 911.
  2. Calm and reassure the person.
  3. If the allergic reaction is from a bee sting, scrape the stinger off the skin with something firm (such as a fingernail or plastic credit card). Do not use tweezers. Squeezing the stinger will release more venom.
  4. If the person has emergency allergy medicine on hand, help the person take or inject it. Do not give medicine through the mouth if the person is having difficulty breathing.
  5. Take steps to prevent shock . Have the person lie flat, raise the person's feet about 12 inches (30 centimeters), and cover the person with a coat or blanket. Do not place the person in this position if a head, neck, back, or leg injury is suspected, or if it causes discomfort.

DO NOT:

  • Do not assume that any allergy shots the person has already received will provide complete protection.
  • Do not place a pillow under the person's head if they are having trouble breathing. This can block the airways.
  • Do not give the person anything by mouth if they are having trouble breathing.

Paramedics or other providers may place a tube through the nose or mouth into the airways. Or emergency surgery will be done to place a tube directly into the trachea .

The person may receive medicines to further reduce symptoms.

 

Outlook (Prognosis)

 

Anaphylaxis can be life-threatening without prompt treatment. Symptoms usually do get better with the right therapy, so it is important to act right away.

 

Possible Complications

 

Without prompt treatment, anaphylaxis may result in:

  • Blocked airway
  • Cardiac arrest (no effective heartbeat)
  • Respiratory arrest (no breathing)
  • Shock

 

When to Contact a Medical Professional

 

Call 911 if you or someone you know develops severe symptoms of anaphylaxis. Or, go to the nearest emergency room.

 

Prevention

 

To prevent allergic reactions and anaphylaxis:

  • Avoid triggers such as foods and medicines that have caused an allergic reaction in the past. Ask detailed questions about ingredients when you are eating away from home. Also carefully examine ingredient labels.
  • If you have a child who is allergic to certain foods, introduce one new food at a time in small amounts so you can recognize an allergic reaction.
  • People who know that they have had serious allergic reactions should wear a medical ID tag.
  • If you have a history of serious allergic reactions, carry emergency medicines (such as a chewable antihistamine and injectable epinephrine or a bee sting kit) according to your provider's instructions.
  • Do not use your injectable epinephrine on anyone else. They may have a condition (such as a heart problem) that could be worsened by this drug.

 

 

Open References

References

Brown SGA, Kemp SF, Lieberman PL. Anaphylaxis. In: Adkinson NF Jr, Bochner BS, Burks AW, et al, eds. Middleton's Allergy: Principles and Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 77.

Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis – a practice parameter update 2015. Ann Allergy Asthma Immunol . 2015;115(5):341-384. PMID: 26505932 www.ncbi.nlm.nih.gov/pubmed/26505932 .

Schwartz LB. Systemic anaphylaxis, food allergy, and insect sting allergy. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 253.

Tran TP, Muelleman RL. Allergy, hypersensitivity, angioedema, and anaphylaxis. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 119.

 
  • Shock

    Shock - illustration

    Shock is a severe condition that occurs when not enough blood flows through the body, causing very low blood pressure, a lack of urine, and cell and tissue damage.

    Shock

    illustration

  • Allergic reactions

    Allergic reactions - illustration

    Allergic reaction can be provoked by skin contact with poison plants, chemicals and animal scratches, as well as by insect stings. Ingesting or inhaling substances like pollen, animal dander, molds and mildew, dust, nuts and shellfish, may also cause allergic reaction. Medications such as penicillin and other antibiotics are also to be taken with care, to assure an allergic reflex is not triggered.

    Allergic reactions

    illustration

  • Anaphylaxis

    Anaphylaxis - illustration

    Anaphylaxis is an acute systemic (whole body) type of allergic reaction which occurs when a person has become sensitized to a certain substance or allergen and is again exposed to the allergen. Some drugs, such as those used for pain relief or for x-rays, may cause an anaphylactoid reaction on first exposure. Histamines and other substances released into the bloodstream cause blood vessels to dilate and tissues to swell. Anaphylaxis may be life threatening if obstruction of the airway occurs, if blood pressure drops, or if heart arrhythmias occur.

    Anaphylaxis

    illustration

  • Hives

    Hives - illustration

    Hives are raised red welts of various size on the surface of the skin, often itchy, which come and go. Also called urticaria, hives is usually part of an allergic reaction to drugs or food. The term "dermatitis" describes an inflammatory response of the skin, caused by contact with allergens or irritants, exposure to sunlight, or by poor circulation, even stress. AVOID SCRATCHING. Scratching the rash may spread the inflammation, lead to infection and even leave scars.

    Hives

    illustration

  • Food allergies

    Food allergies - illustration

    The body's immune system normally reacts to the presence of toxins, bacteria or viruses by producing a chemical reaction to fight these invaders. However, sometimes the immune system reacts to ordinarily benign substances such as food or pollen, to which it has become sensitive. This overreaction can cause symptoms from the mild (hives) to the severe (anaphylactic shock) upon subsequent exposure to the substance. An actual food allergy, as opposed to simple intolerance due to the lack of digesting enzymes, is indicated by the production of antibodies to the food allergen, and by the release of histamines and other chemicals into the blood.

    Food allergies

    illustration

  • Insect stings and allergy

    Insect stings and allergy - illustration

    Allergic reaction to bee stings occurs when a person becomes sensitized to the venom from a previous sting. This reaction is different from the reaction to the poison in the bite of a black widow spider, which injects a potent toxin into the blood. Ordinarily, bee venom is not toxic and will only cause local pain and swelling. The allergic reaction comes when the immune system is oversensitized to the venom and produces antibodies to it. Histamines and other substances are released into the bloodstream, causing blood vessels to dilate and tissues to swell. Severe reactions can lead to anaphylactic shock, a life-threatening series of symptoms including swelling of the throat and difficulty breathing. Persons who develop an allergy to bee stings should carry prescription bee sting kits to counteract the reaction to bee venom.

    Insect stings and allergy

    illustration

  • Allergic reactions to medication

    Allergic reactions to medication - illustration

    A true allergy to a medication is different than a simple adverse reaction to the drug. The allergic reaction occurs when the immune system, having been exposed to the drug before, creates antibodies to it. On subsequent exposure to the drug these antibodies cause release of histamines. If severe, this reaction can result in a life-threatening situation known as anaphylactic shock.

    Allergic reactions to medication

    illustration

  • Antibodies

    Antibodies - illustration

    Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

    Antibodies

    illustration

    • Shock

      Shock - illustration

      Shock is a severe condition that occurs when not enough blood flows through the body, causing very low blood pressure, a lack of urine, and cell and tissue damage.

      Shock

      illustration

    • Allergic reactions

      Allergic reactions - illustration

      Allergic reaction can be provoked by skin contact with poison plants, chemicals and animal scratches, as well as by insect stings. Ingesting or inhaling substances like pollen, animal dander, molds and mildew, dust, nuts and shellfish, may also cause allergic reaction. Medications such as penicillin and other antibiotics are also to be taken with care, to assure an allergic reflex is not triggered.

      Allergic reactions

      illustration

    • Anaphylaxis

      Anaphylaxis - illustration

      Anaphylaxis is an acute systemic (whole body) type of allergic reaction which occurs when a person has become sensitized to a certain substance or allergen and is again exposed to the allergen. Some drugs, such as those used for pain relief or for x-rays, may cause an anaphylactoid reaction on first exposure. Histamines and other substances released into the bloodstream cause blood vessels to dilate and tissues to swell. Anaphylaxis may be life threatening if obstruction of the airway occurs, if blood pressure drops, or if heart arrhythmias occur.

      Anaphylaxis

      illustration

    • Hives

      Hives - illustration

      Hives are raised red welts of various size on the surface of the skin, often itchy, which come and go. Also called urticaria, hives is usually part of an allergic reaction to drugs or food. The term "dermatitis" describes an inflammatory response of the skin, caused by contact with allergens or irritants, exposure to sunlight, or by poor circulation, even stress. AVOID SCRATCHING. Scratching the rash may spread the inflammation, lead to infection and even leave scars.

      Hives

      illustration

    • Food allergies

      Food allergies - illustration

      The body's immune system normally reacts to the presence of toxins, bacteria or viruses by producing a chemical reaction to fight these invaders. However, sometimes the immune system reacts to ordinarily benign substances such as food or pollen, to which it has become sensitive. This overreaction can cause symptoms from the mild (hives) to the severe (anaphylactic shock) upon subsequent exposure to the substance. An actual food allergy, as opposed to simple intolerance due to the lack of digesting enzymes, is indicated by the production of antibodies to the food allergen, and by the release of histamines and other chemicals into the blood.

      Food allergies

      illustration

    • Insect stings and allergy

      Insect stings and allergy - illustration

      Allergic reaction to bee stings occurs when a person becomes sensitized to the venom from a previous sting. This reaction is different from the reaction to the poison in the bite of a black widow spider, which injects a potent toxin into the blood. Ordinarily, bee venom is not toxic and will only cause local pain and swelling. The allergic reaction comes when the immune system is oversensitized to the venom and produces antibodies to it. Histamines and other substances are released into the bloodstream, causing blood vessels to dilate and tissues to swell. Severe reactions can lead to anaphylactic shock, a life-threatening series of symptoms including swelling of the throat and difficulty breathing. Persons who develop an allergy to bee stings should carry prescription bee sting kits to counteract the reaction to bee venom.

      Insect stings and allergy

      illustration

    • Allergic reactions to medication

      Allergic reactions to medication - illustration

      A true allergy to a medication is different than a simple adverse reaction to the drug. The allergic reaction occurs when the immune system, having been exposed to the drug before, creates antibodies to it. On subsequent exposure to the drug these antibodies cause release of histamines. If severe, this reaction can result in a life-threatening situation known as anaphylactic shock.

      Allergic reactions to medication

      illustration

    • Antibodies

      Antibodies - illustration

      Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

      Antibodies

      illustration

    Tests for Anaphylaxis

     
       

      Review Date: 3/20/2016

      Reviewed By: Stuart I. Henochowicz, MD, FACP, Associate Clinical Professor of Medicine, Division of Allergy, Immunology, and Rheumatology, Georgetown University Medical School, Washington, DC. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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