Focus on Anaphylaxis


YOUR ALLERGY PARTNERS

Maria Patricia S. Abes, MD; Maria Remedios D. Ignacio, MD; Nanneth T. Tiu, MD – a group of expert Filipino ALLERGISTS bond together as the H & L Allergy Team, whose aim is to give advice, to help readers understand and find relief in dealing with common allergic disorders.

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A Medical Emergency!

Most people with allergies have mild to moderate symptoms such as watery eyes, a runny nose or a rash. But sometimes, exposure to an allergen can cause an allergic emergency known as “Anaphylaxis”.

Anaphylaxis, coined in 1901 by Charles Richet and Paul Portier (ana being Greek for “against” or “opposite”; phylaxis being Greek for “protection”), is defined as a severe, potentially life-threatening generalized hypersensitivity reaction. This severe reaction happens when an over-release of chemicals puts the person into shock. It is characterized by being rapid in onset with life-threatening airway, breathing or circulatory problems, and is usually, although not always, associated with skin and mucosal changes. Prevalence is estimated at 0.3 percent. Overall, the case fatality rate for anaphylaxis is low, below 0.001 percent.

Who are at risk?

Patients who have a history of allergies and/or asthma and have previously had a severe reaction are at greater risk for anaphylaxis.

In general, adult females have a higher frequency of anaphylaxis than adult males and specifically to plant foods and non-steroidal anti-inflammatory drugs (NSAIDs).

What are the symptoms?

Anaphylaxis symptoms occur suddenly and can progress quickly. The early symptoms may be mild, such as a runny nose, a skin rash or a “strange feeling.” These symptoms can quickly lead to more serious problems, including:

• Hives, itchiness and redness on the skin, or swelling
• Wheezing and/or trouble breathing
• Tightness of the throat and Hoarse voice
• Nausea, Vomiting, Abdominal cramps, Diarrhea
• Dizziness and Fainting or loss of consciousness
• Low blood pressure, Rapid heart beat
• Feeling of doom
• Cardiac arrest

What are the causes?

Foods such as peanuts, tree nuts, fish, shellfish, cow’s milk, and eggs are the most frequent cause of anaphylaxis in children, with pollen allergy and asthma being important risk factors.

Insect sting triggered anaphylaxis from bees, wasps, hornets, yellow jackets, and fire ants are more common in adults than in children. (*No data in the Philippines)

Drugs are the most frequent cause of anaphylaxis in hospitalized patients. Most common medications implicated are Penicillin, other antibiotics, aspirin and pain relievers. For anaphylaxis during anesthesia, neuromuscular blocking agents are the most frequent triggers in adult patients in most countries, with a higher incidence in females.

How is it diagnosed?

Allergists can help with the diagnosis because they have the training and expertise to review your history of allergic reactions, conduct diagnostic tests (such as skin-prick tests, blood tests and oral food challenges) to determine your triggers, review treatment options and teach avoidance techniques.

WORLD ALLERGY ORGANIZATION 2015 Guidelines on Anaphylaxis
WORLD ALLERGY ORGANIZATION 2015 Guidelines on Anaphylaxis

How is it treated?

Checklist for managing anaphylaxis

1. Stay with patient
2. Look for signs of anaphylaxis
3. First-line treatment: Administer Epinephrine/Adrenaline (effective for all symptoms) if there is Anaphylaxis
4. Repeat Epinephrine/Adrenaline as necessary
5. Second-line interventions as indicated (eg correct positioning of the patient, oxygen, inhaled bronchodilators, fluids, antihistamine, corticosteroid)
6. Look for and remove the trigger (eg food, drug, venom)

A second anaphylactic reaction, known as a biphasic reaction, can occur as long as 12 hours after the initial reaction. Patients should be monitored after recovery to observe for possible biphasic reactions.

WORLD ALLERGY ORGANIZATION 2015 Guidelines on Anaphylaxis
WORLD ALLERGY ORGANIZATION 2015 Guidelines on Anaphylaxis

Before discharge, an assessment should be made of the risk of further reactions; where appropriate, the patient should be equipped with an epinephrine auto-injector.

For those at risk of a severe allergic reaction know the four steps to manage your condition and keep you S.A.F.E. :

* It is important to Seek immediate medical help. Get to the nearest emergency facility at the first sign of anaphylaxis, even if you have already administered epinephrine.
* Identify the Allergen. Think about what you might have eaten or come in contact with – food, insect sting, medication, latex – to trigger an allergic reaction. It is particularly important to identify the cause because the best way to prevent anaphylaxis is to avoid its trigger.
* Follow up with a specialist. It is important that you consult an allergist for testing, diagnosis and ongoing management of your allergic disease.
* Carry Epinephrine for emergencies. Make sure that you carry a self-administered epinephrine kit with you at all times, and that family and friends know of your condition, your triggers and how to use epinephrine. Consider wearing an emergency medical bracelet or necklace identifying yourself as a person at risk of anaphylaxis. Teachers and other caregivers should be informed of children who are at risk for anaphylaxis and know what to do in an allergic emergency.

References:

EAACI GUIDELINES Food Allergy and Anaphylaxis 2014; AAAAI, ACAAI GUIDELINES Anaphylaxis a Practice Parameter Update 2015; ACAAI, ACEP Anaphylaxis Prevention Tips; WAO, Anaphylaxis Guidelines 2015

March 2018 Health and Lifestyle

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