Anaphylaxis (cont.)
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 you are prone to these
reactions, you must be familiar with the use of emergency anaphylaxis treatment
kits and always have them with you. 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 for 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 epi-pen, 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.
Allergy Assist
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 healthcare provider.
After 10 to 15 minutes, if the symptoms are still significant, you can inject another dose of epinephrine if available. Even after the reaction subsides you need 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 you feel shaky and
causes a rapid, pounding pulse. These are normal side
effects and are not dangerous except for those with severe
heart problems.
Two situations deserve special attention at this point since they
are not covered elsewhere but are particularly interesting.
- In the 1970's, it was
noted that exercise could cause anaphylaxis. Exercise-induced anaphylaxis (EIA) usually
occurs with prolonged, strenuous exercise. Conditioned
athletes such as marathon runners are frequently affected.
The reaction may occur while exercising shortly after
eating a meal, after eating specific foods (for example, lettuce,
shellfish, or celery) or after taking aspirin. It appears
as though food or aspirin loads the gun and exercise pulls
the trigger. Early symptoms are usually flushing and
itching, which may progress to other typical symptoms of
anaphylaxis if the exercise continues. Pre-medication with
antihistamines or other drugs does not consistently prevent
EIA. Exercise avoidance is the most effective treatment.
If this is not feasible, exercising with a "buddy" and
carrying emergency kits is mandatory.
- When no cause can be found for
anaphylaxis, it is termed
idiopathic. Recent reports suggest that 25% of all
episodes of anaphylaxis are idiopathic. Many of those
affected have underlying allergy or asthma conditions.
Extensive allergy testing for foods may uncover an unusual food allergy that is responsible for these reactions. For
frequent episodes of anaphylaxis, your physician may
recommend a combination of antihistamine, cortisone, and a
medication to widen the airways of the lungs (bronchial
dilator) to help reduce the severity of attacks.
Next: Can anaphylaxis be prevented? »
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