Anaphylaxis

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Anaphylaxis is a serious life-threatening allergic reaction that responds to an allergen such as drug allergy, food allergy, insect bites/stings, venom allergy, latex, etc. Allergic reactions usually occur within a few seconds/minutes after exposure to a certain allergen. Read More

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Anaphylaxis

Anaphylaxis is a serious life-threatening allergic reaction that responds to an allergen such as drug allergy, food allergy, insect bites/stings, venom allergy, latex, etc. Allergic reactions usually occur within a few seconds/minutes after exposure to a certain allergen. It causes the immune system to release certain chemical mediators from mast cells and basophils, which can cause the patient to go into shock (sudden drop in blood pressure associated with breathing difficulty) [1].
anaphylaxis
Picture Courtesy: researchgate

Diagnosis of Anaphylaxis

Anaphylaxis is a serious life-threatening condition that needs to be diagnosed early. Diagnosing anaphylaxis is difficult since we don’t know what the cause is. A doctor will take a complete medical history and family history to identify the cause. A few diagnostic methods are as follows.
  • Medical and family history of the patient.
  • Physical examinations: The doctor should access the patient’s airway, breathing, heart rate, orientation, pulse rate.
  • Blood test
  • Urine analysis
  • Skin test

Treatment of Anaphylaxis

Since anaphylaxis is a serious life-threatening condition, start the treatment as early as possible. If left untreated, it can result in anaphylaxis shock n death.
  • Avoid the allergens that trigger allergic reactions.
  • Role of Epinephrine/adrenaline: It is considered the first-line treatment in the anaphylaxis condition [2]. It helps constrict the blood vessels, decreases the swelling, and helps in increasing the blood pressure. It also helps in reducing allergic reactions.
  • Anti-histamines & corticosteroids are often considered adjunctive therapy for cutaneous signs and symptoms of anaphylaxis.
  • Other supportive care such as iv fluids, oxygen inhalers in case of breathing difficulties,
  • Beta-agonists
  • Bronchodilators
  • Long term therapy such as immunotherapy includes venom immunotherapy for insect bites oral immunotherapy for food allergies.
  • Drug desensitizations[3]

Complications

A few of the complications are as follows:
  • Myocardial ischemia or cardiac arrest
  • Brain injury
  • Respiratory arrest
  • shock 
symptoms of anaphylaxis Picture Courtesy: Jacionline

Symptoms

Symptoms of anaphylaxis generally include two or more of these body systems.

  • Respiratory (breathing): coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny itchy nose and watery eyes, sneezing), trouble swallowing
  • Skin: hives, swelling (face, lips, tongue), itching, warmth, redness
  • Cardiovascular (heart): paler than normal skin colour/blue colour, weak pulse, passing out, dizziness or lightheadedness, shock
  • Gastrointestinal (stomach): nausea, pain/cramps, vomiting, diarrhea
  • Other: anxiety, sense of doom (the feeling that something bad is about to happen), headache, uterine cramps, metallic taste

Sometimes a drop in blood pressure without other symptoms may also indicate anaphylaxis. Anaphylaxis can occur without hives.

Causes

It happens due to intake of nuts, soy, milk, and dairy, seafood, eggs, meat, insect stings. Some drugs such as non-beta antibiotics and hypnotics are also responsible for allergic reactions.

The risk factors for food allergy include:

  • Age: Food allergy is more common in young children than in older children or adults.
  • Family history: You’re more likely to have a food allergy if your parent or sibling has one.
  • Another food allergy: If you have a food allergy, you’re at greater risk for developing another.
  • Related medical conditions: Your risk is increased if you have an allergic disease such as asthma, eczema, or hay fever.

FAQ

  • How fast can a reaction to food occur?

Most allergic reactions usually occur within minutes, although some may occur a few hours post-exposure

  • What quantity of a food allergen will it take to cause a reaction?

Even a very small amount ‘hidden’ in a food or a trace amount of an allergen transferred to a serving utensil can cause severe allergic reactions. 

  •  Can someone react without ingesting their allergen?

Accident eating food containing their allergen poses the greatest risk for most people. This is because specific food proteins cause allergic reactions to foods. Food odors have no protein, and they cannot, therefore, cause reactions. However, people can have reactions when they inhale food proteins to which they are allergic, such as in the steam produced while cooking certain foods, like fish.

  • Can someone allergic to food have an allergic reaction after kissing someone who has eaten that food?

If you are at risk, you should inform your friends and partners about your food allergies to avoid the risk of accidental exposure. Small amounts of food can be transferred from one person to another through kissing.

  • How are allergic reactions avoided?

Reading ingredient labels on foods, taking special precautions in food preparation, and ensuring proper handwashing and cleaning go a long way toward reducing the risk of accidental exposure.

  • Does anaphylaxis get worse each time?

Yes, in most cases, it does, and it also depends on how much you come in contact with your allergic things and how often you touch it, smell it or eat it decides its reaction level.

  • Will Benadryl stop Anaphylaxis?

If the allergy is severe, it will not help, but it works well with mild or moderate allergies.

  • Can stress cause anaphylaxis?

Mostly it doesn’t, but it is responsible for making it worse because of histamine, which is released due to high-stress levels in the body.

  • Can anaphylaxis go away on its own?

Personal dedicated care and regular visits to a doctor for regular check-ups create a high possibility of anaphylaxis going away. But, left untreated, it can at times even prove lethal. It has been estimated to be fatal in 0.7 to 2 % of the cases.

 

References

1. Kemp SF, Lockey RF. Anaphylaxis: a review of causes and mechanisms. J Allergy Clin Immunol. 2002 Sep. 110(3):341-8. Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2008 Feb. 121(2 Suppl): S402-7; quiz S420.

2. https://www.jacionline.org/article/S0091-6749(20)30105-6/fulltext.

3. https://my.clevelandclinic.org/health/diseases/8619-anaphylaxis