First Aid Anaphylaxis Anaphylaxis Guide Anaphylaxis Guide Symptoms Causes Treatment Prevention Symptoms of Anaphylaxis By Rod Brouhard, EMT-P facebook twitter linkedin Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients. Learn about our editorial process Rod Brouhard, EMT-P Medically reviewed by Medically reviewed by Michael Menna, DO on November 06, 2019 Michael Menna, DO, is a board-certified, active attending emergency medicine physician at White Plains Hospital in White Plains, New York. Learn about our Medical Review Board Michael Menna, DO on November 06, 2019 Print Table of Contents View All Table of Contents Frequent Symptoms Rare Symptoms Complications When to See a Doctor Frequently Asked Questions Next in Anaphylaxis Guide What Allergies Can Trigger Anaphylaxis? Anaphylaxis is a sudden and severe allergic reaction that involves more than one body system. It is a life-threatening medical emergency. You will often have skin reactions and shortness of breath, which can develop into anaphylactic shock with a drop in blood pressure. Learn how to identify an anaphylactic reaction so you can seek immediate medical care. Illustration by Verywell Frequent Symptoms Anaphylaxis is primarily an allergic reaction. Allergic reactions become anaphylaxis once an allergy begins to affect more than one body system, such as the skin and respiratory system. Anaphylaxis comes on suddenly and the symptoms progress quickly. It will develop most commonly after eating, getting stung by an insect, or taking medications. What to Watch For To identify anaphylactic shock, first look for symptoms of allergy which include: Itching Red, raised, blotchy skin, seen in 90 percent of cases Wheezing or shortness of breath, seen in 70 percent of cases Symptoms can be seen in many parts of the body: Skin: You may have flushing and itching. Hives can develop, which are raised itchy bumps that blanch (turn white) when you press on them. Angioedema can develop, which is swelling under the skin. Eyes: You may have signs of irritation including itching, redness, production of tears, and the skin may swell around the eyes. Upper respiratory: Congestion, a runny nose, and sneezing can develop. You can feel throat swelling, choking, or hoarseness. Oral: You may experience a swollen tongue, lips, or throat, or abnormal taste sensations. Lower respiratory: You can have difficulty breathing, wheezing, and chest tightness Circulatory: You may have a rapid or slow heartbeat and low blood pressure. You may feel dizzy, faint, or you may pass out. Nervous system: You can become anxious or confused, have slurred speech, and may even feel a sense of impending doom. Digestive system: Nausea, vomiting, diarrhea, or abdominal pain may be experienced. Anaphylactic Shock Anaphylaxis becomes anaphylactic shock when a person shows signs of low blood pressure: Confusion Weakness Pale color Unconsciousness Anaphylactic shock often includes shortness of breath. A person doesn't always have trouble breathing, but if the symptom is present, it's a good indicator that the allergic reaction is turning into anaphylaxis. Signs of Anaphylactic Shock Some of the telltale signs include: Unable to speak more than one or two words Sitting straight up or with hands on knees Gasping for breath Pursing lips to breathe Using neck muscles to take breaths Allergen Exposure as a Sign It's easier to identify the signs and symptoms of anaphylactic shock if there is a known allergen exposure. For instance, those with allergies to bee stings will usually know they've been stung. Anyone who's had allergic reactions in the past should be aware of any symptoms, even if no allergen exposure has been identified. For example, people with food allergies are more likely to have anaphylaxis while eating even when they don't think they're eating the food they are allergic to. If someone is wearing medical alert jewelry that indicates an allergy, that can help identify the cause of the symptoms. Rare Symptoms An episode of anaphylaxis typically begins within 5 to 30 minutes of coming into contact with the allergen to which you are allergic, though it can take more than an hour. However, there are atypical patterns. Biphasic anaphylaxis is seen in up to 20 percent of patients, occurring in both children and adults, though it was once thought to be rarer. In this presentation, the initial anaphylactic reaction would manifest and it would resolve, only to have the reaction return hours to days later. This is why someone may be admitted to the hospital for observation after an anaphylactic reaction. In some cases, people won't experience the most severe symptoms of anaphylaxis, such as difficulty breathing, and thus decide not to seek medical care. However, this puts them at risk for a biphasic reaction, which can lead to severe consequences. A study of pediatric cases published in 2015 found a higher incidence in children of age 6 to 9. They were more likely to have been treated with more than one dose of epinephrine, indicating they had a more severe reaction. They were also more likely to have had a delay in getting treatment with epinephrine or arriving at an emergency department. Protracted anaphylaxis is seen rarely. In this case, the symptoms can last from several days to over a week without clearly resolving completely. Complications Anaphylaxis can result in death if not treated. A myocardial infarction or atrial fibrillation can develop during anaphylaxis, and these cardiac risks are greater in patients over the age of 50. Epinephrine is the drug of choice to treat anaphylaxis, but it carries a risk of overdose and of triggering cardiovascular complications. In older patients, some research suggests it is safer to administer intramuscular injections rather than intravenous epinephrine. When to See a Doctor If you have any symptoms of anaphylaxis, get to medical care immediately. It is appropriate to call 911 for emergency treatment. Don't wait to summon emergency care. The reaction can progress rapidly. Hives can turn into anaphylactic shock in minutes. If you are alone, you risk becoming unconscious before you can call for care. If you know you are at risk of anaphylaxis from an allergy, call for emergency medical care as soon as you know you have been exposed. Even if you use an epinephrine self-injector, you will need emergency treatment. Frequently Asked Questions What is anaphylaxis? Anaphylaxis is a severe, potentially life-threatening allergy affecting the whole body. It is caused by an extreme overreaction of the immune system to an allergy-causing substance (allergen), When anaphylaxis occurs, the immune system will flood the body with inflammatory compounds that can cause you to go into shock. What causes anaphylaxis? Anaphylaxis is triggered by an allergen. Foods like nuts, fish, shellfish, and milk are allergens commonly linked to anaphylaxis in children. In adults, insect bites, latex, and certain medications are common causes of anaphylaxis in addition to foods. Causes and Risk Factors of Anaphylaxis What are the signs and symptoms of anaphylaxis? Anaphylaxis can be recognized by the following signs and symptoms: Severe rash or hives Shortness of breath Wheezing Weak and rapid heartbeat Lightheadedness, dizziness, or fainting Nausea or vomiting Swelling of the face, tongue, or throat A feeling of impending doom How long does it take for anaphylaxis to occur? Anaphylaxis mostly occurs within 20 minutes to two hours of exposure to an allergen. With that said, some people have a delayed reaction and only experience symptoms several days later. Others have biphasic anaphylaxis, in which initial mild symptoms appear to resolve, only to return more severely within hours or days. When is anaphylaxis life-threatening? Anaphylaxis can cause shock. This is a critical condition brought on by a sudden drop of blood flow throughout the body. Anaphylactic shock can cause death by restricting the amount of blood and oxygen that reaches organs, causing unconsciousness, coma, cardiac arrest, and even death. Anaphylaxis can also cause suffocation due to severe swelling of the throat. If left untreated, anaphylaxis can cause death within minutes to hours. How is anaphylaxis treated? The first line of treatment for anaphylaxis is an injection of epinephrine, which relaxes smooth muscles and increases blood circulation. Cardiopulmonary resuscitation (CPR) may be needed if the affected person stops breathing. Other treatments may include: High-flow oxygen therapy Intravenous antihistamines to temper the allergic response Intravenous corticosteroids to temper the overall immune response A beta-agonist like albuterol to ease breathing What to Do in an Anaphylaxis Emergency What can you expect after receiving treatment for anaphylaxis? If treated early and appropriately, anaphylaxis can usually improve within a few hours (although you may be admitted to the hospital for overnight observation). In severe cases, recovery may take several days. If not treated appropriately, anaphylaxis can cause permanent heart, brain, lung, and kidney injury. Who should carry an anaphylaxis kit? Anyone with a history of anaphylaxis should carry an anaphylaxis kit, which includes an epinephrine auto-injector (called an EpiPen) and sometimes a strong oral antihistamine like diphenhydramine. You may also be advised to carry an anaphylaxis kit as well as a medical ID bracelet if you have a history of severe allergies. An allergist can advise you if you need one. How to Prevent Anaphylaxis Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Academy of Allergy, Asthma & Immunology. Anaphylaxis Campbell RL, Bellolio MF, Knutson BD, et al. Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. J Allergy Clin Immunol Pract. 2015;3(1):76-80. doi:10.1016/j.jaip.2014.06.007. McLendon K, Sternard BT. Anaphylaxis. In: StatPearls [Internet]. Updated June 7, 2020. Fischer D, Vander Leek TK, Ellis AK, Kim H. Anaphylaxis. Allergy Asthma Clin Immunol. 2018;14(S2):54. doi:10.1186/s13223-018-0283-4 Kim SY, Kim MH, Cho YJ. Different clinical features of anaphylaxis according to cause and risk factors for severe reactions. Allergol Int. 2018;67(1):96-102. doi:10.1016/j.alit.2017.05.005 American Academy of Allergy, Asthma & Immunology. Anaphylaxis. Updated 2021. Additional Reading Anaphylaxis. American Academy of Allergy Asthma and Immunology. http://www.aaaai.org/conditions-and-treatments/library/allergy-library/anaphylaxis. Alqurashi W, Stiell I, Chan K, Neto G, Alsadoon A, Wells G. Epidemiology and Clinical Predictors of Biphasic Reactions in Children with Anaphylaxis. Annals of Allergy, Asthma & Immunology. 2015;115(3). doi:10.1016/j.anai.2015.05.013. Campbell RL, Bellolio MF, Knutson BD, et al. Epinephrine in Anaphylaxis: Higher Risk of Cardiovascular Complications and Overdose After Administration of Intravenous Bolus Epinephrine Compared with Intramuscular Epinephrine. The Journal of Allergy and Clinical Immunology: In Practice. 2015;3(1):76-80. doi:10.1016/j.jaip.2014.06.007. Campbell RL, Hagan JB, Li JT, et al. Anaphylaxis in Emergency Department Patients 50 or 65 Years or Older. Annals of Allergy, Asthma & Immunology. 2011;106(5):401-406. doi:10.1016/j.anai.2011.01.011. Oya S, Nakamori T, Kinoshita H. Incidence and Characteristics of Biphasic and Protracted Anaphylaxis: Evaluation of 114 Inpatients. Acute Medicine & Surgery. 2014;1(4):228-233. doi:10.1002/ams2.48.