Preventing Anaphylaxis

Anaphylaxis is a life-threatening condition and experiencing it can be terrifying. If you've had this experience, you likely want to prevent it from happening again in the future.

Knowing what triggered your anaphylaxis is helpful for prevention. If you don't know, identifying the cause is going to be crucial in helping you to avoid future episodes.

Skin prick allergy test
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Identifying Triggers

According to research, food-based allergies are the most common cause of anaphylaxis. This includes peanuts, fish and shellfish, tree nuts, and cow's milk. However, sensitivity to any substance could trigger an anaphylactic response. Other common triggers include medications such as penicillin and insect stings.

Allergy Testing

If you do not know what triggered your anaphylaxis you will likely be referred to a doctor who specializes in allergies and immunology. This doctor can use skin scratch tests or blood testing to determine substances you are sensitive to. If you take antihistamine medications they will need to be stopped for a period of time before these tests are performed.

Skin testing needs to occur at least four weeks after an anaphylactic episode to avoid false negative results. 

If allergy testing comes back negative you may have experienced what medical professionals call idiopathic anaphylaxis. In this case, your doctor may choose to perform more testing and should discuss ways of preventing future episodes with you.

There is also a poorly understood condition called exercise-induced anaphylaxis. However, this condition often involves a co-trigger so allergy testing is an important part of diagnosing and managing this type of anaphylaxis.

Avoiding Triggers

Once you know what triggered your anaphylaxis you will want to avoid this substance as much as possible. While it may be easy enough to avoid an allergy to shellfish, it may be more difficult to avoid a peanut allergy. You will need to read the labels of your food and practice caution before eating anything, especially when you are dining out.

If an insect sting triggered your anaphylaxis you will want to wear protective clothing when you are outdoors—long sleeve shirts, long pants, and adequate footwear. Do not drink sugary drinks outside since they attract insects. Use a lid when drinking beverages.

If a medication triggered your anaphylaxis it will be crucial that you inform medical professionals and family members about this allergy so that medication can be avoided in the future.

Medical Alert Bracelets 

It is important—especially in the case of children—that school teachers, friends, and anyone who cares for your child are aware of their allergy.

Medical alert bracelets are a useful tool for both children and adults. For example, if you were involved in an accident and rendered unconscious a medical alert bracelet could notify medical professionals of a medication allergy. If you were unable to talk because of tongue swelling or wheezing during an anaphylactic episode a medical alert bracelet can cue medical professionals and bystanders of your need for epinephrine.

Medical alert bracelets can also contain valuable information about the emergency contact numbers of your loved ones.

Manage Underlying Conditions

If you have underlying medical conditions such as heart disease or asthma, you will want to work with your physician to manage these diseases as best you can since they could increase your risk of complications or death in the event of anaphylaxis.

It should also be noted that some medications can interfere with the effectiveness of epinephrine so you will want to talk to any physician you are working with and your pharmacist about any medications you currently use and before starting any new medications.

Immunotherapy

You may not be familiar with the term immunotherapy but you've almost certainly heard of allergy shots. Referring to this treatment as an allergy shot is no longer entirely accurate since you can now be administered this treatment sublingually as a medication or drops under the tongue.

Immunotherapy involves giving you small amounts of the substance that you are allergic to over a significant period of time in order to decrease your immune systems sensitivity to this substance. 

Since your exposure to the substance increases your risk of another anaphylactic reaction, it is usually given in the doctor's office so that you can be monitored and treated if necessary. However, the substance is administered in very small amounts and reactions rarely occur.

Immunotherapy is used with both adults and children to treat allergies. Sublingual versions are becoming more common for small children who can not tolerate injections. It can be a time-consuming process but effective for long-term management, the reduction of symptoms, and sometimes even curing many allergies.

Immunotherapy is not available for all types of allergies but is becoming an option for more and more people. When it is an option it is almost always recommended to prevent anaphylaxis. You should discuss this option with your doctor to find out if it is right for you.

Planning

If you have experienced an episode of anaphylaxis you will probably be prescribed an epinephrine auto-injector.

It is important to carry the auto-injector with you at all times and that both you and your loved ones are trained in its use.

You may need to keep multiple auto-injectors around the house, in your car, or in your purse if possible. Since currently in the United States epinephrine auto-injectors can be expensive, you may not have this option. Whatever your situation is, it is important that you have access to at least one of this life saving medication in the event of an episode.

You will want to develop a plan with your doctor and family about what to do if you go into anaphylaxis. This may include teaching your friends and family to recognize symptoms such as wheezing, swelling of the hands and face, or a rash. Your family also needs to know where to find and how to use your epinephrine injection if needed.

In the case of children these instructions will need to be given to babysitters and school teachers as well as anyone who will be caring for your child while you are away.

Always call 911 or go to your nearest emergency room if you experience symptoms of anaphylaxis, even if you have epinephrine. Even if you feel that your symptoms have subsided they may suddenly get worse. While unlikely, you should be monitored in an emergency room setting for a period of time in case this occurs.

Frequently Asked Questions

How can you prevent anaphylaxis?

The best way to prevent anaphylaxis is to avoid substances that trigger a severe allergic reaction. If you are unsure what substances you are allergic to, ask for a referral to an allergist for further investigation. In some cases, immunotherapy can be used to reduce your sensitivity to known allergens.

Can immunotherapy prevent anaphylaxis?

Immunotherapy in the form of allergy shots or sublingual drops may help desensitize people to allergens they are reactive to. Exposure to tiny amounts of a known allergen may make the body become less reactive over time. Despite the benefits, immunotherapy is used with caution in people with a history of anaphylaxis. Newer immunotherapies are being explored using IgG blocking antibodies that inhibit the allergic response.

How do you prevent anaphylactic shock?

Anaphylactic shock is a potentially life-threatening complication in which an extreme drop in blood circulation can cause organ damage. If you develop symptoms of anaphylaxis, you will need an emergency injection of epinephrine (adrenaline). People with a history of severe allergies should carry an epinephrine self-injector (EpiPen) and wear a medical ID bracelet.

Can antihistamines prevent anaphylaxis?

No. Antihistamines can block histamine that causes allergies, but they work too slowly to prevent the onset of anaphylaxis. Moreover, taking too many antihistamines can lead to severe side effects, including tachycardia (rapid heart rate) and hypotension (low blood pressure). (The only exception may be in people with a history of exercise-induced anaphylaxis, although the preventive benefit may be minimal.)

Can you prevent exercise-induced anaphylaxis?

There are steps you can take to avoid it:

  • Wait four to six hours after eating before exercising.
  • Avoid known allergens (like food or NSAIDs) before exercise.
  • Take an antihistamine before exercise when pollen counts are high.
  • Avoid exercising in extreme temperatures (hot or cold).
  • Avoid exercising with premenstrual symptoms.
  • Stop exercising if there is a sudden, rapid onset of allergy.

Can you prevent biphasic anaphylaxis?

Biphasic anaphylaxis is characterized by an initial, milder attack followed by a more severe attack, usually within 10 hours. Because there is no way to know who might develop biphasic anaphylaxis, people treated for anaphylaxis are often hospitalized and observed overnight. Corticosteroids have been proposed as a preventive measure but most studies have shown this to be ineffective.

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