Category: Anaphylaxis Emergency

Some triggers, such as certain food groups, can be difficult to avoid. But staying away from allergens that cause anaphylaxis is a part of a comprehensive treatment plan.  

• Food: Anytime a particular food leads to anaphylaxis, it needs to be eliminated from the diet. This may require you to learn how to search food labels for the ingredient(s) you are allergic to. You’ll need to be hypervigilant in terms of asking about the preparation and makeup of foods when you are away from home.
• Insect bites/stings: Wear protective clothing to prevent this type of anaphylaxis. This includes closed shoes, long-sleeved clothes, hats, and not drinking from open containers when outdoors.
• Medications: Understand that medications have different names and are made by many different manufacturers. As a result, it is important for you to learn not only the medication that brought on a specific reaction but also the brands and generic names of any similar medications.

You should also consider wearing a medical identification bracelet. If you are found unresponsive, emergency responders can identify that you have suffered a potential anaphylactic reaction and provide you with appropriate and swift care.

You will be given a personalized anaphylaxis emergency action plan before you are discharged from the hospital after an episode of anaphylaxis. This will guide you in learning how to recognize the symptoms early and the steps to take when you see them.

Epinephrine Autoinjector

Carry an epinephrine autoinjector (EpiPen or Auvi-Q) with you at all times. It is important to fill the prescription immediately. Two autoinjectors are often recommended because up to 36% of people need more than one injection to stop anaphylaxis.⁵

For a child, you should work with the school on an action plan to access the autoinjector when needed. The injector must be protected from light and kept in its outer container. It should not be refrigerated. Check it regularly to ensure the solution is clear and colorless. Replace it if it turns brown or becomes crystallized or hazy.

Further Assessment and Testing

After an episode of anaphylaxis, your healthcare provider may schedule you for other testing or evaluations. You may be referred to an allergist who specializes in allergies and anaphylaxis.

Your allergist will likely order skin testing and blood tests to determine if you have a true allergy. This can help determine what the best treatment course might be to prevent future episodes of anaphylaxis.

If you have asthma, chronic pulmonary diseases, or heart disease, your healthcare provider will work with you for better control as these raise your risk of dying during anaphylaxis.

Immunotherapy

Your allergist may recommend immunotherapy (allergy shots) to help prevent future reactions. These are only available for insect sting allergies and not for other causes. A course of immunotherapy for insect stings may significantly reduce your future risk of an episode of anaphylaxis.

After injecting epinephrine, it is important to go to a hospital emergency department for evaluation. Healthcare providers and nurses can appropriately monitor you and provide further treatment as needed.

Besides epinephrine, you may be given oxygen, IV fluids, IV antihistamines, cortisone, and a beta-agonist such as albuterol to assist in breathing and stop the allergic response.

In severe cases, your breathing may be blocked, which will require a breathing tube down your throat (intubation) or an emergency surgical airway (cricothyroidotomy) through your neck to get air to your lungs.

Hospital observation for several hours is important because it is possible for anaphylaxis to return. There is the possibility of cardiac complications, especially in people over age 50 and those who have a cardiovascular condition.

Depending on your history, physical exam, and clinical course, the healthcare provider may want to rule out some of these conditions.

There are also additional problems that can mimic anaphylaxis. For example, a severe asthma attack, panic attack, or heart attack may cause symptoms very similar to an anaphylactic reaction.

The next important first aid step in treatment is to remove allergens. An allergic reaction can continue as long as the allergen is in the body.

For insect stings, the key is to remove the stinger as soon as possible. The longer the stinger is in the body, the greater the reaction will be. Use a blunt-edged object, such as a credit card, to gently scrape across the sting site. If you only have your fingers to remove it, be very careful not to squeeze the stinger and release more venom.²

If the allergen is topical, such as poison ivy or poison oak, wash the skin thoroughly as soon as possible. With food or a drug that’s ingested, stop eating or taking the offending substance.

Because anaphylaxis can be life-threatening, you need to recognize the symptoms and treat it as a medical emergency. Hives, swelling, itching, wheezing, shortness of breath, and pale skin color are common symptoms.

If you are assisting the person having the reaction, ask for their epinephrine autoinjector. There are two common types of autoinjectors—the EpiPen and the Auvi-Q. If you do not have an injector, the emergency responders may be able to administer epinephrine.

An Auvi-Q is a rectangular-shaped device about the size of a credit card. It uses a voice prompt system to provide step-by-step instructions on how to use it correctly and prevent accidental needle sticks.

A single injection from an autoinjector may not be enough to stop anaphylaxis. You should administer a repeat dose after five or 10 minutes if the severe symptoms continue. You can give it sooner if needed.

You should never use the same autoinjector twice. If you need a repeat dose, you will need to use a second, unused autoinjector.

Epinephrine (adrenaline) is the only effective treatment for anaphylaxis. Antihistamines mainly relieve mild allergy symptoms, such as hives and itching, and asthma inhalers will improve respiratory symptoms, but neither will treat anaphylaxis.

Anaphylaxis is the most severe form of an allergic reaction. It is most commonly triggered by foods, medications, and insect stings.¹ It has a sudden onset, rapid progression, and is potentially life-threatening.

To stop anaphylaxis, you will need to use an epinephrine autoinjector, such as an EpiPen, as soon as possible. You will then need to be monitored at the hospital to ensure your symptoms do not return.

You cannot treat anaphylaxis with home remedies or over-the-counter medications. Once you are prescribed an epinephrine autoinjector, you should keep it with you at all times, just in case anaphylaxis reoccurs.

This article explains the immediate steps to take if you or another person develops anaphylaxis. It covers how to use an EpiPen and why you should go to the hospital after using one. It also provides several tips for preventing anaphylaxis.