How Anaphylaxis Is Treated

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Anaphylaxis is a severe form of allergy most commonly triggered by foods, medications, and insect stings. It has a sudden onset, rapid progression, and is potentially life-threatening. You will need quick administration of epinephrine (adrenaline) to stop the reaction and will require emergency care at a hospital. After an episode of anaphylaxis, your allergy will be further identified so you can avoid it and you should carry an epinephrine autoinjector in case of recurrence.

First Aid and Emergency Care

Because anaphylaxis can be life-threatening, you need to recognize the symptoms and treat it as a medical emergency. Hives, swelling, and wheezing are the most common symptoms.

Call 911 and Administer Epinephrine

Call 911 for an immediate medical response. If you have an epinephrine injector, you need to use it at the first sign of symptoms, before they become severe. Seconds can count in saving a life during anaphylaxis.

If you are assisting the person having the reaction, ask for their epinephrine autoinjector. If you do not have an injector, the emergency responders may be able to administer epinephrine. There are two common types of autoinjectors—the EpiPen and the Auvi-Q.

To use an EpiPen on a person who is incapacitated, follow these steps.

  1. Care must be taken not to hold it backward, which is a common mistake, and you will end up injecting into your own thumb instead of the person's thigh.
  2. Pull the grey safety cap off the back of the device
  3. Press the black end firmly into the person's thigh and hold it for at least 10 seconds. It's better to administer it directly to the skin, but you can inject through clothing if necessary.
  4. There will be an exposed needle sticking out of the black end after the injection. Use care not to stick yourself. Discard it safely in a sharps container afterward (the emergency responders should have one).

An Auvi-Q is a rectangular-shaped device about the size of a credit card. It uses a voice prompt system to provide step-by-step instructions on how to use it correctly and prevent accidental needle sticks.

A single injection from an autoinjector may not be enough to stop anaphylaxis. You should administer a repeat dose after five or 10 minutes if the severe symptoms continue, and you can give it sooner if needed.

Epinephrine (adrenaline) is the only effective treatment for anaphylaxis. Antihistamines mainly relieve symptoms such as hives and itching, and asthma inhalers will improve respiratory symptoms, but neither will likely treat anaphylaxis.

While waiting for the emergency responders, have the person lie down and elevate the legs. This helps maintain blood flow to the heart during anaphylactic shock. The person may want to remain sitting up if she is having trouble breathing or vomiting and you should allow her to be in a comfortable position, with legs elevated if possible. A companion should monitor the person's pulse and breathing and administer CPR if required.

Remove the Allergen

The next important first aid step in treatment is to remove allergens. An allergic reaction can continue as long as the allergen is in the body. For insect stings, the key is to remove the stinger as soon as possible. The longer the stinger is in the body, the greater the reaction will be. If the allergen is topical, such as poison ivy or poison oak, wash the skin thoroughly as soon as possible. In the case of a food or drug that is ingested, there is not much that can be done except to not continue taking the offending agent.

Go to the Hospital

After injecting epinephrine, it is important to go to a hospital emergency department for evaluation. Doctors and nurses can appropriately monitor you and provide further treatment as needed. Besides epinephrine, you may be given oxygen, IV fluids, IV antihistamines, cortisone, and a beta-agonist such as albuterol to assist in breathing and stop the allergic response. In severe cases, your breathing may be blocked which will require a breathing tube down your throat (intubation) or an emergency surgical airway (cricothyroidotomy) through your neck to get air to your lungs.

Hospital observation for several hours is important because it is possible for anaphylaxis to return. There is the possibility of cardiac complications, especially in people over age 50 and those who have a cardiovascular condition.

There are also additional problems that can mimic anaphylaxis. For example, a severe asthma attack, panic attack, or heart attack may cause symptoms very similar to an anaphylactic reaction. Depending on your history, physical exam, and clinical course, the doctor may want to rule out some of these conditions.

Prescriptions

You will be given a personalized anaphylaxis emergency action plan before you are discharged from the hospital after an episode of anaphylaxis. This will guide you in learning how to recognize the symptoms and the steps to take when you see them.

Epinephrine Autoinjector

Carry an epinephrine autoinjector (EpiPen or Auvi-Q) with you at all times. It is important to fill the prescription immediately and two autoinjectors are often recommended because up to 20 percent of people need more than one injection to stop anaphylaxis. For a child, you should work with the school on an action plan to access the autoinjector when needed. The injector must be protected from light and kept in its outer container. It should not be refrigerated. Check it regularly to ensure the solution is clear and colorless and replace it if it turns brown or become crystallized or hazy.

Further Assessment and Testing

After an episode of anaphylaxis, your doctor may schedule you for other testing or evaluations. You may be referred to an allergist who specializes in allergies and anaphylaxis. She will likely order skin testing and blood tests to determine if you have a true allergy and what the best treatment course might be to prevent future episodes of anaphylaxis. Your allergist may recommend antihistamines or corticosteroids as treatments for future episodes. If you have asthma, chronic pulmonary diseases, or heart disease your doctor will work with you for better control as these raise your risk of dying during anaphylaxis.

Immunotherapy

Your allergist may recommend immunotherapy (allergy shots) to help prevent future reactions. These are only available for insect sting allergies and not for other causes. A five-year course of immunotherapy for insect stings may significantly reduce your future risk of an episode of anaphylaxis.

Lifestyle

Some triggers, such as certain food groups, can be difficult to avoid, but staying away from allergens that cause anaphylaxis is a part of a comprehensive treatment plan.  

  • Food: Anytime a particular food leads to anaphylaxis, it needs to be eliminated from the diet and you may need to learn how to read food labels. You'll need to be hypervigilant in terms of asking about the preparation and makeup of foods away from home.
  • Insect bites/stings: Wear protective clothing to prevent this type of anaphylaxis. This includes closed shoes, long-sleeved clothes, hats, and not drinking from open containers when outdoors.
  • Medications: Understand that medications have different names and are made by many different manufacturers. As a result, it is important for you to learn not only the medication that brought on a specific reaction but also similar medications and their brand and generic names.

You should also consider wearing a medical identification bracelet. If you are found unresponsive, emergency responders can identify that you have suffered a potential anaphylactic reaction and provide you with appropriate and swift care.

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