Anaphylaxis (Severe Allergic Reaction)

  • Medical Author:
    Allison Ramsey, MD

    Dr. Allison Ramsey earned her undergraduate degree at Colgate University and her medical degree at the University of Rochester School of Medicine and Dentistry. She completed her internal medicine training at the University of Rochester School of Medicine and Dentistry and remained at the university to complete her fellowship training in allergy and clinical immunology. Dr. Ramsey is board certified in internal medicine and allergy and immunology. Her professional interests include the treatment of drug allergy and eosinophilic disorders. She also enjoys teaching medical trainees. She is a member of the American Academy of Allergy, Asthma, and Immunology, the American College of Allergy, Asthma, and Immunology, the New York State Allergy Society, and the Finger Lakes Allergy Society. In her personal life, her interests include exercise, especially running and horseback riding; and spending time with her husband and two children.

  • Medical Author: Syed Shahzad Mustafa, MD
    Syed Shahzad Mustafa, MD

    After growing up in the Rochester area, Dr. Mustafa pursued his undergraduate studies at the Johns Hopkins University in Baltimore and attended medical school at SUNY Buffalo. He then completed his internal medicine training at the University of Colorado and stayed in Denver to complete his fellowship training in allergy and clinical immunology at the University of Colorado, National Jewish Health, and Children's Hospital of Denver.

  • 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.

View 10 Common Allergy Triggers

Quick Guide10 Common Allergy Causes

10 Common Allergy Causes

Is it possible to prevent anaphylaxis?

Preventing anaphylaxis is the ideal form of treatment. However, that may not always be easy since insect stings are frequently unanticipated, and allergens in foods may be ingested by mistake. A consultation with an allergist is vital in helping one identify the trigger(s) and providing information and instruction on how to best avoid them. The affected individual will learn how to use emergency kits and how to become prepared for any reaction in the future.

These are situations in which preventive treatment might be offered by the allergist.

  1. Allergy shots may be suggested to some people with wasp, yellow jacket, hornet, honey bee, or fire ant reactions. This form of treatment gives 98% protection against the first four insect reactions and also reduces the severity of any reactions that may occur.
  2. Premedication is most helpful in preventing anaphylaxis from IVIV contrast. Alternative dyes that are less likely to cause reactions may be available.
  3. Temporary induction of tolerance (also called desensitization) to problematic medications is often effective. This process is accomplished by gradually increasing the amount of the medication given under controlled conditions. Sensitivities to penicillin, sulfa drugs, and insulin have been successfully treated in this way.
  4. Food immunotherapy in which individuals are given small daily doses of a food to which they are allergic is an area of current research for milk, eggs, and peanuts but is not used in routine clinical practice at this point.
Table 2: Basic Avoidance Measures for Anaphylaxis
TriggerAvoidance Principle
Drugs/medications
  • Advise all health-care personnel of any allergies. Remember and describe symptoms involved in a reaction to previous drugs.
    • Ask a doctor whether the prescribed medication contains the drug(s) one is allergic to.
Insect stings
  • Avoid areas where stinging insects are attracted and avoid insect nests.
  • Avoid bright clothing, perfume, hair spray, or lotion that might attract insects.
  • Wear long-sleeved clothing, long trousers, and shoes while outdoors.
Food
  • Carefully read all labels. Foods containing milk, egg, peanut, tree nuts, soy, fish, and shellfish must be labeled by law.
  • Ask specifically about ingredients when eating at restaurants.
  • Do not eat foods with unknown ingredients.
  • It is typically best to avoid foods with precautionary labeling ("may contain," "made in a factory with," etc.).
Latex
  • Avoid all latex products.
  • Inform health-care professionals of latex allergy.
  • Make sure the hospital or doctor's office has latex-free supplies.

Since avoidance is not fail-safe, a person at risk for an anaphylactic reaction must be adequately prepared in an emergency to handle a reaction. It is recommended that everyone at risk carry self-injectable epinephrine (EpiPen or Adrenaclick).

Here are some important points to remember regarding self- injectable epinephrine:

  • Ask a doctor to explain the use of the device carefully and practice with the demonstrator kit.
  • Check expiration dates and replace outdated devices. The expiration date must be followed for epinephrine.
  • Keep devices out of extremes of temperature since this influences drug stability.
  • Additional devices should be brought to other homes, school, or work.
  • Always have two devices readily available.
  • Make sure that friends, relatives, exercise partners, and coworkers are aware of one's condition and know what to do in case of a reaction.

What is the prognosis of anaphylaxis?

Risk factors for poor outcomes from anaphylaxis include delayed treatment with epinephrine and a history of asthma, particularly uncontrolled asthma. The vast majority of deaths from anaphylaxis occur from in-hospital administration of medications. In the community, the most common causes of poor outcomes are stinging-insect allergy in adults and a history of peanut and tree nut allergy. Death from anaphylaxis from these causes is usually associated with delayed treatment with epinephrine. If recognized and treated promptly with epinephrine, the prognosis for anaphylaxis is generally good and the vast majority of patients experience a full recovery.

REFERENCE:

Tintinalli, Judith E., ed. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011.

Medically Reviewed by a Doctor on 7/21/2016

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