Key takeaways:
Anaphylaxis is a severe allergic reaction that can lead to anaphylactic shock.
Anaphylactic shock is life-threatening because blood pressure drops and the heart can stop beating.
Common symptoms of anaphylaxis include hives, itching, trouble breathing, vomiting, diarrhea, and dizziness.
Epinephrine is the primary treatment, which is why people with certain allergies should carry an auto-injector with them at all times.
These days, almost everyone is familiar with allergies in some way. Peanuts aren’t allowed in schools and some people are terrified of bee stings. And everywhere you look you see labels that say, “may contain eggs” or “manufactured in a facility that processes tree nuts.” But what do these things actually mean?
Is a serious allergic reaction — anaphylaxis — as bad as it sounds? And what should you do if you have one or see someone else having one?
Anaphylaxis is a severe allergic reaction that has an unpredictable nature. It’s important to know about because it can happen quickly and progress into a dangerous and even fatal condition — anaphylactic shock.
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It starts when your immune system responds to an allergen, like a food, as if it’s a foreign or harmful object. The body produces an extra amount of immune cells — mast cells and basophils — which then release inflammatory chemicals like histamine. Within minutes, you can start to see symptoms.
Anaphylaxis can happen even if you’ve never reacted to something before. And someone who has had mild reactions to an allergen can go on to have a more severe reaction the next time.
According to the American College of Allergy, Asthma and Immunology, the most common causes of anaphylaxis are foods, insect stings, medications, and latex. Here are some examples:
Food: peanuts, tree nuts (walnuts, almonds, and pecans), fish, shellfish, cow’s milk, and eggs
Latex: in disposable gloves, intravenous tubes, syringes, adhesive tapes, or catheters
Medications: penicillin, aspirin, muscle relaxants, and anesthesia
Insect stings: from bees, wasps, hornets, yellow jackets, or fire ants
Contrast: for medical imaging purposes
Exercise: triggered by physical activity
Idiopathic: meaning the cause is never identified
When someone has an anaphylactic reaction, it can start out with a rash or a feeling that something “just isn’t right.” But it can progress quickly into:
Trouble breathing
Hives
Itching
Runny nose
Tightness of the throat
Nausea or abdominal pain
Diarrhea
Dizziness
A feeling of doom
Skin symptoms (such as hives, itching, and swelling) are usually the first to show up, and they’re the most common sign of anaphylaxis. Other symptoms, such as runny nose or vomiting, may follow as the reaction gets worse.
The most severe cases affect the respiratory and cardiovascular systems. The airways start to close, blood pressure starts to drop, and the heart must then work harder. This is anaphylactic shock — a dangerous and life-threatening situation.
Symptoms of anaphylaxis can be mild, and they may go away on their own. But most anaphylactic reactions will require treatment. It’s difficult to predict if or how quickly they will get worse. Symptoms might be delayed for several hours. It’s also possible to have another reaction hours after the first one ends.
Shock happens when the circulatory system no longer functions properly. So organs and tissues don’t get the blood they need, and the body tries to correct that. At first, there may be no signs at all. But, over time, shock causes:
A fast heart rate
A change in blood pressure
Wheezing or gasping for air
Fainting
Clammy skin
Epinephrine (also known as adrenaline) is the primary treatment for anaphylaxis. It can be self-injected. If you have known anaphylaxis, you should carry epinephrine with you at all times.
Epinephrine works in a few different ways:
It constricts blood vessels, which may help with low blood pressure.
It decreases swelling in soft tissues and helps open the airways.
It decreases the release of inflammatory chemicals from mast cells and basophils.
People often need more than one dose of epinephrine, so it’s important to get help immediately.
Here are some tips for what to do:
Call 911. If you think you or someone around you is having an anaphylactic reaction, you should get help immediately by calling 911 and/or going to the nearest emergency room.
Administer epinephrine. Give an Epipen or an equivalent auto-injector (like AuviQ) as soon as possible. Many people will need more epinephrine minutes or hours after the first treatment. So, even if symptoms improve or go away, still seek help. If you don’t have an EpiPen, it’s even more important to get medical attention right away to prevent anaphylactic shock.
Monitor breathing. Watch for changes in breathing. You may give CPR, but remember that the airway can swell shut, so you should get emergency help.
Get a medical evaluation. There’s a risk of symptoms getting worse or another reaction happening minutes to hours later. So it’s important to be evaluated and monitored in the emergency department.
Unfortunately, if you’ve had an anaphylactic reaction, you’re likely to have another, and it could be more severe next time.
The best way to prevent another anaphylactic reaction is to avoid the trigger. If you have a food allergy, always read the labels. It’s important to know your trigger(s) and to be able to recognize the signs and symptoms of anaphylaxis. This way you can feel it coming on and know what to do.
If you start to notice symptoms in yourself or someone else, don’t hesitate to use an auto-injector. When used early in anaphylaxis, epinephrine can prevent progression to anaphylactic shock.
If you have an auto-injector:
Be sure you know how to use it.
Keep it up to date (replace it if it expires).
Keep it with you at all times.
Make sure your friends and family know about your allergy.
Make sure your friends and family know about your auto-injector, where you keep it, and how to use it (in case they need to give you the medication).
Consider wearing a bracelet that clearly states what your allergy is. It lets a bystander or healthcare worker know about your allergy if you’re not able to speak for yourself.
Finally, when it comes to allergic reactions, an allergist can help. Allergists are doctors who specialize in allergies, asthma, and other immune system problems. They can help you identify your trigger(s), run some more tests, and talk with you about treatment options.
Anaphylaxis and anaphylactic shock are life-threatening. Emergent medical help is necessary. If you know you have an allergy, be sure to keep your epinephrine auto-injector up to date and with you at all times.
American College of Allergy, Asthma & Immunology. (2018). Anaphylaxis.
Barg, W., et al. (2011). Exercise-induced anaphylaxis: An update on diagnosis and treatment. Current Allergy and Asthma Reports.