Anaphylaxis

Anaphylaxis is a severe, life-threatening type I hypersensitivity reaction, triggered by exposure to various antigens, affecting multiple organ systems. Several factors can increase the risk of anaphylaxis, including:

Cardiovascular Diseases

• Individuals with preexisting heart conditions are at greater risk for fatal anaphylaxis or long-term complications, such as heart attacks or strokes triggered by the reaction.

Asthma

• Poorly controlled asthma, particularly in children, is a significant risk factor for experiencing severe anaphylaxis.

Mastocytosis

• Mastocytosis is a rare condition where there is an abnormal increase in mast cells (immune cells) within the body’s tissues. Both adults and children with widespread skin involvement from mastocytosis face a heightened risk of severe anaphylaxis.

Age

• The first anaphylactic reaction commonly occurs in children between the ages of 0–2 years. Additionally, older age is consistently linked to a higher incidence of fatal drug-related anaphylaxis.

Previous Anaphylactic Reaction

• If an individual has previously experienced anaphylaxis, the risk of subsequent, more severe reactions increases.

Gender

• Adult women are more likely to experience anaphylaxis caused by food, medications, radiocontrast agents, and idiopathic causes compared to men.

Alcohol

• Alcohol allergies can cause symptoms that range from mild itching in the mouth or eyes to severe reactions, including vomiting and anaphylaxis.

Exercise

• Exercise-induced anaphylaxis is a rare but potentially life-threatening condition. It can occur with physical activities as mild as walking, highlighting the critical link between exercise and the reaction.

To assess your risk of anaphylaxis or determine if previous symptoms were linked to an anaphylactic reaction, your allergist or immunologist will conduct a comprehensive evaluation, considering all potential triggers. This typically includes:

Medical History

Your allergist will gather detailed information about any past allergic reactions. A combination of clinical history and allergy testing helps identify specific allergens that may have caused the reactions.

Laboratory Tests

Medically supervised allergen challenges may be used to confirm the diagnosis or assess whether you’ve outgrown an allergy. Tests to detect sensitization to specific allergens include:

1. Skin Prick Test (Puncture or Scratch Test): This test checks for immediate allergic reactions to multiple allergens at once. It is usually performed on the forearm in adults and on the upper back in children.
2. Serum-Specific IgE Test: Previously known as RAST (Radioallergosorbent Testing), this test measures the amount of IgE your body produces in response to a single allergen. It’s commonly used when a skin prick test is not feasible or available.
3. Serum Enzyme Tryptase Test: Tryptase is released by mast cells during an anaphylactic reaction. Its levels can remain elevated for up to three hours post-reaction. Levels above 11.5 ng/mL are considered high.
4. SC5b-9 (Soluble Membrane Attack Complex or Terminal Complement Complex): This test measures the activation of the complement system, which can increase shortly after a severe allergic reaction.

Note: Allergen-specific IgE food mixes are not recommended, as they do not pinpoint which specific foods in the mix may be triggering the allergy, potentially leading to unnecessary food avoidance.

If you have a severe allergy or have previously experienced anaphylaxis, taking steps to prevent future reactions is essential. Here are key strategies to help you avoid anaphylactic episodes:

Identify Triggers

Knowing what you are allergic to is the first step in preventing future anaphylaxis episodes.

Avoid Identified Triggers

Once you've pinpointed your triggers, it’s crucial to take steps to avoid them. Here are some common triggers and tips on how to avoid them:

Food

1. Always check food labels for allergens.
2. Inform restaurant staff about your allergies to ensure your food is prepared safely.
3. Be aware that certain foods may contain trace amounts of allergens, even in small quantities.

Insect Stings

1. If you encounter wasps, hornets, or bees, move away calmly and avoid panicking.
2. Use insect repellent when outdoors, especially in warmer months.
3. Avoid drinking from open cans when insects are nearby.
4. Don’t walk barefoot outside, as stings are more likely to occur when you're unprotected.

Medications

1. If you are allergic to specific medications, consult your doctor about suitable alternatives that won’t trigger an allergic reaction.

Always Carry Adrenaline Auto-Injectors

If you are at risk for anaphylaxis, your doctor may prescribe an adrenaline auto-injector. Important points to remember:

• Carry two auto-injectors that are within their expiry dates at all times.
• Ensure that you and your caregivers know how to use the auto-injector correctly.
• Regularly check the expiry date and replace the injectors before they expire.
• Don’t hesitate to use the auto-injector if you suspect you are experiencing anaphylaxis.

Consider Allergy Shots (Immunotherapy)

For some individuals, allergy shots can reduce the risk of anaphylaxis and lessen the severity of allergic reactions over time.

Specialists to Consult

In the event of an anaphylactic reaction, contact the nearest emergency department. For ongoing management, you should consult the following specialists:

• General physician
• Allergist
• Immunologist

An allergist specializes in diagnosing and treating allergies, while an immunologist focuses on immune system disorders, including those that contribute to anaphylaxis.

The approach to treating anaphylaxis varies depending on the patient's ability to describe their condition, but if the patient is unconscious or not fully aware, recognizing the symptoms becomes critical. The treatment plan for anaphylaxis includes:

Medications

The main medications used to treat an anaphylactic reaction are:

• Adrenaline (Epinephrine): This is the primary treatment for anaphylaxis. It is essential for managing life-threatening reactions by halting their progression and stabilizing the patient.
• Antihistamines: These medications, such as diphenhydramine or cetirizine, help reduce inflammation in the airways and alleviate symptoms like itching and hives.
• Beta Antagonists: These are used to protect the airways and relieve respiratory symptoms associated with anaphylaxis.
• Glucocorticoids: Steroids, such as glucocorticoids, are often administered to lessen the severity of the reaction and decrease the likelihood of a recurrence.

For Hospitalized Patients

Patients admitted to the hospital and stabilized may be treated with:

• Activated Charcoal: Commonly used for poisoning, activated charcoal can also be effective after peanut exposure. When consumed soon after accidental exposure, it prevents further absorption of the allergens and can mitigate the allergic response.
• Vasopressors: Medications like norepinephrine or vasopressin help manage persistent low blood pressure in patients with anaphylaxis.
• Glucagon: This is used to treat anaphylaxis that does not respond to epinephrine, and it can also aid in moving food boluses through the body.
• Intravenous Fluids: IV fluids are administered to maintain stable blood circulation.

In an Emergency Situation

If you are with someone experiencing an allergic reaction with signs of anaphylaxis, follow these steps:

1. Immediately call the local emergency medical number.
2. Check if the person has an epinephrine auto-injector (EpiPen, Auvi-Q, etc.) and assist them in injecting it into the thigh.
3. Help the person lie down flat and remain still.
4. Loosen tight clothing and cover the individual with a blanket.
5. If vomiting or bleeding occurs from the mouth, turn the person on their side to prevent choking.
6. Place the person in the Trendelenburg position—lying flat on their back with their legs raised—to improve blood flow to the heart.
7. If the person is not breathing, coughing, or moving, initiate CPR by performing chest compressions at a rate of 100 per minute.

Anaphylactic shock is a critical condition that can obstruct the airways and make breathing impossible, as well as potentially lead to cardiac arrest. This occurs due to a drop in blood pressure, which prevents the heart from getting enough oxygen. The complications of anaphylaxis include:

• Cerebral Hypoxia: This condition occurs when there is insufficient oxygen supply to the brain, despite adequate blood circulation.

• Acute Renal Failure: This complication is often associated with anaphylactic shock triggered by diclofenac sodium.

• Fetal Death: While anaphylaxis does not directly affect the fetus, severe maternal anaphylaxis can pose a significant risk to the fetus, potentially leading to neurological damage or death.

• Septic Shock: Severe allergic reactions like anaphylaxis can disrupt the vascular system, leading to blood poisoning from bacteria, known as septic shock.

• Acute Respiratory Distress Syndrome (ARDS): ARDS involves fluid accumulation in the lungs' air sacs, which prevents oxygen from reaching vital organs.

• Abnormal Coagulation Profile: Anaphylaxis involves complex immune responses that can lead to disturbances in the body’s blood clotting mechanisms, especially in severe cases.

• Pulmonary Edema: During an allergic reaction, histamines cause blood vessels to dilate, leading to a dangerous drop in blood pressure and fluid leakage into the lungs, causing swelling (pulmonary edema).

• Arrhythmia: Anaphylaxis can disrupt the heart’s normal rhythm, leading to arrhythmia.

• Abnormal Liver Function: Although rare, there are instances where repeated anaphylactic episodes are associated with acute liver damage.

Homeopathy

Homeopathy aims to adjust the immune response of individuals instead of suppressing or altering the immune system. While some individuals turn to homeopathic remedies for allergies, there is no scientific evidence to support the effectiveness of homeopathy in preventing or treating anaphylaxis. Emergency medical treatment is essential for managing anaphylaxis.

Acupuncture

Acupuncture has been used as a method to support immune function and alleviate symptoms of seasonal allergies. However, it should not be used as a treatment for anaphylaxis, which requires immediate medical intervention.

Traditional Chinese Medicine (TCM)

TCM has been practiced for thousands of years in China and other Asian countries, either alone or alongside conventional Western medicine. Some studies suggest that herb-based formulas, such as FAHF-2, may offer an effective treatment for food allergies, potentially helping with multiple food allergens rather than just one.

There are several strategies and recommendations that can help you or your child avoid anaphylaxis and manage reactions more effectively:

Education on Anaphylaxis

• Educating those around you, including family members and caregivers, about anaphylaxis can help reduce anxiety and increase confidence in handling allergic reactions. This knowledge is crucial for identifying symptoms and providing timely treatment.

Be Vigilant About Food Ingredients

• If you have a severe food allergy, always read food labels thoroughly to check for harmful ingredients. Don’t hesitate to ask questions about food contents and preparation methods when dining out.

Introduce New Foods Slowly

• If you or your child have experienced a severe allergic reaction to a food, it’s more likely that other new foods could cause problems. To reduce the risk, introduce new foods gradually, offering small portions and spacing out each serving.

Wear a Medical ID Tag

• Wearing a medical bracelet or necklace that indicates your risk of anaphylaxis can help alert bystanders and emergency responders about your condition in the event of an allergic reaction.

Keep Treatment Options Accessible

• Ensure that you have your epinephrine auto-injector, a chewable antihistamine, and other necessary treatments readily available. A stiff card to remove a bee sting may also be useful.

Do Not Share Your Epinephrine

• Avoid using your epinephrine auto-injector on anyone other than yourself unless you are certain they are experiencing an anaphylactic reaction. Sharing it could put you at risk of not having the medication available when you need it, and it could cause harm to someone who is not having an anaphylactic event.