Anaphylaxis (Severe Allergic Reaction)

  • Medical Author:
    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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How do we manage anaphylaxis?

The optimal management of anaphylaxis saves lives. An affected or at-risk person must be aware of possible triggers and early warning signs. If someone is prone to these reactions, he or she must be familiar with the use of emergency anaphylaxis treatment kits and always carry them.

If one is aware of what triggers severe reactions and potentially anaphylaxis, a wrist bracelet indicating this can be helpful in case of unresponsiveness. Emergency measures and prevention are central to management. As always, allergic diseases are best treated by avoidance measures, which will be reviewed in detail below.

What are emergency measures used in the treatment of anaphylaxis?

If you suspect that you or someone you are with is having an anaphylactic reaction, the following are important first aid measures. In general, try to perform these in the order that they are presented.

  • Call emergency services or 911 IMMEDIATELY.
  • If the patient has an EpiPen, inject epinephrine immediately. The shot is given into the outer thigh and can be administered through light fabric. Rub the site to improve absorption of the drug.
  • Place a conscious person lying down and elevate the feet if possible.
  • Stay with the person until help arrives.
  • If trained, begin CPR if the person stops breathing or doesn't have a pulse.

Shots of epinephrine can be given through light clothing such as trousers, skirts, or stockings. Heavy garments may have to be removed prior to injecting. Only inject epinephrine if the patient has a history of anaphylactic reactions or under guidance of a health-care provider.

After 10-15 minutes, if the symptoms are still significant, one can inject another dose of epinephrine if available. Even after the reaction subsides, the individual needs to go to an emergency department immediately. Other treatments may be given, such as oxygen, intravenous fluids, breathing medications, and possibly more epinephrine. Steroids and antihistamines may be given, but these are often not helpful initially and do not take the place of epinephrine. However, they may be more useful in preventing a recurrent delayed reaction.

Do not be surprised if epinephrine makes the individual feel shaky and causes a rapid, pounding pulse. These are normal side effects and are not dangerous except for those with severe heart problems.

Medically Reviewed by a Doctor on 6/24/2015

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