Anaphylaxis: What It Is, Treatment Options, & Setting an Action Plan

What is anaphylaxis?

Summary

Anaphylaxis is a life-threatening condition most commonly caused by an allergic reaction. In anaphylaxis, two types of immune cells — mast cells and basophils — are suddenly activated and release numerous inflammatory substances that cause blood vessels to dilate and become leaky, which can lead to low blood pressure, swelling, and damage to organs.

Symptoms of anaphylaxis include itching, redness, and warmth in the form of hives, as well as itching or swelling of the lips, tongue, mouth, or around the eyes, as well as difficulty breathing and nasal congestion. Several other symptoms are also likely.

Anaphylaxis is a medical emergency. Treatment options will likely involve an epinephrine injection (same contents as in an EpiPen), followed by oxygen and IV fluids, other medications, and an action plan for possible future incidents.

Recommended care

Call 911 immediately for an ambulance. If you have been prescribed an epinephrine pen, use it. Don't do this if you have never been prescribed one!

Hallmarks of anaphylaxis

Symptoms of anaphylaxis usually develop within seconds to minutes after exposure to a trigger, although in some cases symptoms develop hours later. Symptoms may be mild and resolve on their own, but in many cases, the symptoms can worsen rapidly and even lead to death if not treated as an emergency. In some cases, the symptoms may recur within 12 hours of the initial episode, known as a biphasic reaction.

Main symptoms

The main symptoms experienced by most people with anaphylaxis include:

• Itching, redness, warmth, and/or hives: Hives, which are raised itchy red bumps on the skin, usually occur all over the body shortly after exposure to the trigger.
• Itching, tingling, and/or swelling of the lips, tongue, or mouth: In severe cases, the swelling may make it difficult to swallow or breathe.
• Itching or swelling around the eyes and/or red eyes: The eyes may also tear from the irritation.
• Difficulty breathing or noisy breathing: There may be a sensation of choking or the throat closing. The noisy breathing can be heard either when breathing in or breathing out.
• Nasal congestion or discharge: This may occur rapidly in some people with anaphylaxis.

Other symptoms

Other symptoms that may occur in some people with anaphylaxis include:

• Abdominal pain, cramps, nausea, vomiting, and/or diarrhea: This occurs in about half of people with anaphylaxis. These symptoms are caused by swelling of the gastrointestinal tract.
• Dizziness, lightheadedness, confusion, or passing out: During anaphylaxis, the blood vessels throughout the body dilate, causing a fall in blood pressure and the prevention of enough blood from reaching the brain, which leads to these symptoms.
• Chest pain or feeling the heart racing: These symptoms may occur because, during anaphylaxis, the heart beats faster to try to compensate for the low blood pressure.
• Anxiety and/or a sense of impending doom

Anaphylaxis causes

Most cases of anaphylaxis are caused by a reaction to an allergen, such as foods, insect stings, and bites, or certain medications. Some cases of anaphylaxis are caused by a non-allergic type reaction, in which mast cells and basophils are directly activated. Other common causes of anaphylaxis can also be related to exposures listed below.

1. Foods

Foods are the most common cause of anaphylaxis in children, teenagers, and young adults. Common foods that can trigger anaphylaxis include:

• Peanuts
• Tree nuts
• Crustacean shellfish
• Milk
• Eggs

2. Insect stings and bites

Insect stings and bites are a common cause of anaphylaxis, especially among older adults. Common insects that can trigger anaphylaxis include:

• Bees
• Wasps
• Yellowjackets
• Hornets
• Fire ants

3. Medications

Medications are another common cause of anaphylaxis, especially among older adults. Common medications that can trigger anaphylaxis include:

• Antibiotics
• Aspirin
• Some over-the-counter pain medications
• Intravenous contrast used in some imaging studies

In addition, some medications can exacerbate anaphylactic reactions or prevent the body from responding to anaphylaxis. These include:

• Alcohol
• Opioids
• Certain medications used for heart disease and high blood pressure

Other exposures

Being exposed to the following can also cause anaphylaxis or an allergic reaction in some people:

• Latex: Many medical centers now use latex-free gloves to reduce the risk of triggering an allergic reaction.
• Exercise: This is a special type of anaphylaxis known as exercise-induced anaphylaxis.
• Exposure to cold or heat

Treatment options and prevention for anaphylaxis

The most important initial treatment for anaphylaxis involves administering epinephrine. Other specific components of treatment include oxygen and IV fluids, other medications, as well as education to better handle any future incidents.

Epinephrine injection

Epinephrine is injected into a vein (IV) or a muscle by a clinician to restore blood pressure and heart function during anaphylaxis.

• Details: The best way to give epinephrine is to inject it into a muscle, usually the side of the thigh.
• Types: People who have had episodes of anaphylaxis may be prescribed an epinephrine autoinjector, such as EpiPen, Adrenaclick, or Auvi-Q, and they will be instructed how to use it. In some cases, additional epinephrine may be given intravenously after it has been injected into the muscle.

When to seek further consultation for anaphylaxis

If you experience any symptoms of anaphylaxis, such as hives, swelling, or trouble breathing, you should go to the emergency room or call an ambulance immediately.

If you believe you are having another episode and you have an autoinjector

You should use your autoinjector if you feel confident doing so and you feel symptoms of another episode of anaphylaxis coming on. You should go to the emergency room immediately after.