How Anaphylaxis Is Treated

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Anaphylaxis is the most severe form of an allergic reaction. It is most commonly triggered by foods, medications, and insect stings. It has a sudden onset, rapid progression, and is potentially life-threatening.

To stop anaphylaxis, you will need to use an epinephrine autoinjector, such as an EpiPen, as soon as possible. You will then need to be monitored at the hospital to ensure your symptoms do not return.

You cannot treat anaphylaxis with home remedies or over-the-counter medications. Once you are prescribed an epinephrine autoinjector, you should keep it with you at all times, just in case anaphylaxis reoccurs.

This article explains the immediate steps to take if you or another person develops anaphylaxis. It covers how to use an EpiPen and why you should go to the hospital after using one. It also provides several tips for preventing anaphylaxis.

Woman is making insulin injection in the stomach. Stock photo
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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, itching, wheezing, shortness of breath, and pale skin color are 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. There are two common types of autoinjectors—the EpiPen and the Auvi-Q. If you do not have an injector, the emergency responders may be able to administer epinephrine.

How To Use an EpiPen

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. Otherwise, you will end up injecting it into your own thumb instead of the person's thigh.
  2. Pull the blue safety cap off the back of the device.
  3. Press the orange end firmly into the person's thigh and hold it for at least 3 seconds. It's better to administer it directly to the skin, but you can inject it through clothing if necessary.
  4. Built-in needle protection automatically covers the needle after injection so it is never exposed and can be easily disposed of after use.

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. You can give it sooner if needed.

You should never use the same autoinjector twice. If you need a repeat dose, you will need to use a second, unused autoinjector.

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

While Waiting for 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 they are having trouble breathing or vomiting. Allow them to be in a position that is comfortable for them, 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. Use a blunt-edged object, such as a credit card, to gently scrape across the sting site. If you only have your fingers to remove it, be very careful not to squeeze the stinger and release more venom.

If the allergen is topical, such as poison ivy or poison oak, wash the skin thoroughly as soon as possible. With food or a drug that's ingested, stop eating or taking the offending substance.

Go to the Hospital

After injecting epinephrine, it is important to go to a hospital emergency department for evaluation. Healthcare providers 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 healthcare provider 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 early 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. Two autoinjectors are often recommended because up to 36% 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. Replace it if it turns brown or becomes crystallized or hazy.

Further Assessment and Testing

After an episode of anaphylaxis, your healthcare provider may schedule you for other testing or evaluations. You may be referred to an allergist who specializes in allergies and anaphylaxis.

Your allergist will likely order skin testing and blood tests to determine if you have a true allergy. This can help determine what the best treatment course might be to prevent future episodes of anaphylaxis.

If you have asthma, chronic pulmonary diseases, or heart disease, your healthcare provider 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 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 plan to prevent future anaphylaxis episodes.  

  • Food: Anytime a particular food leads to anaphylaxis, it needs to be eliminated from the diet. This may require you to learn how to search food labels for the ingredient(s) you are allergic to. You'll need to be hypervigilant in terms of asking about the preparation and makeup of foods when you are 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 the brands and generic names of any similar medications.

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.

Summary

There are no complementary remedies or over-the-counter treatments that can stop or treat anaphylaxis. It is a medical emergency that needs to be rapidly treated with an epinephrine autoinjector.

After using the autoinjector, you will need to be evaluated in the hospital. There, you may be given additional treatments for breathing difficulties or other symptoms you may have.

You should carry your autoinjector at all times. Take extra care to avoid coming in contact with the anaphylaxis trigger again.

A Word From Verywell

Many years can pass between the time you are prescribed an autoinjector and the moment that you need to use it. Since anaphylaxis is usually unexpected, it's critical that you frequently check to ensure your autoinjector is ready to use and that you are prepared to use it.

Set aside time to refresh your memory as needed and rehearse with a practice autoinjector, if you have one. An EpiPen or Auvi-Q can greatly reduce your risk of death, but it needs to be used properly and without delay.

Frequently Asked Questions

  • What is anaphylaxis?

    Anaphylaxis is a potentially life-threatening, whole-body allergy caused when the body overreacts to an allergy-causing substance (allergen).

    When this occurs, the immune system will flood the body with inflammatory compounds, including histamine and tryptase, that can lead to shock if not treated immediately.

  • What causes anaphylaxis?

    The allergens responsible for anaphylaxis can differ by age. Anaphylaxis in children is typically caused by foods like peanuts, tree nuts, milk, and seafood. In adults, food, insect bites, latex, and medications are common causes.

  • What are the signs and symptoms of anaphylaxis?

    Anaphylaxis is recognized by the following signs and symptoms:

    • Severe rash or hives
    • Shortness of breath
    • Wheezing
    • Nausea or vomiting
    • Weak, rapid heartbeat
    • Swelling of the face, tongue, or throat     
    • Dizziness or fainting
    • A feeling of impending doom
  • How long does it take for anaphylaxis symptoms to develop?

    In most cases, anaphylaxis will occur within 20 minutes to two hours of exposure to an allergen. Some reactions can be more delayed and may only manifest with symptoms one or several days later (making it difficult to identify the allergen culprit).

    Some people may experience biphasic anaphylaxis in which primary anaphylaxis symptoms will come and go, only to be followed by a severe secondary attack within 72 hours of the initial event.

  • Can anaphylaxis cause death?

    Anaphylaxis can cause death within minutes to hours if left untreated. Most deaths are the result of anaphylactic shock, in which an extreme drop in blood flow deprives organs of oxygen, leading to unconsciousness, coma, cardiac arrest, and even death.

    Anaphylaxis can also cause death by suffocation if the swelling of the larynx (windpipe) blocks airflow.

  • How is anaphylaxis treated?

    A rapid response is needed to avoid shock and other complications of anaphylaxis. The treatment of anaphylaxis may involve:

  • How long does anaphylaxis last if treated?

    With a rapid response, anaphylaxis can often improve within a few hours with no long-lasting consequence. Severe cases may take several days to resolve, particularly if the person has a pre-existing condition like COPD, chronic kidney disease, or heart failure.

    In cases like these, anaphylaxis can cause irreversible organ damage if not treated quickly and appropriately.

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9 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.
  1. Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal anaphylaxis: mortality rate and risk factorsJ Allergy Clin Immunol: In Pract. 2017;5(5):1169-1178. doi:10.1016/j.jaip.2017.06.031

  2. Johns Hopkins Medicine. Insect stings.

  3. Fischer D, Van der Leek TK, Ellis AK, Kim H. Anaphylaxis. Allergy Asthma Clin Immunol. 2018;14(2):54. doi:10.1186/s13223-018-0283-4

  4. O'Brien M, Koehl J, Raja A, Erickson T, Hayes B. Age-related cardiovascular outcomes in older adults receiving epinephrine for anaphylaxis in the emergency department. J Allergy Clin Immunol. 2019 May;7(8):2888-2890. doi:10.1016/j.jaip.2019.04.040

  5. Song T, Brown D, Karjalanainen M, Lehnigk U, Lieberman P. Value of a second dose of epinephrine during anaphylaxis: A patient caregiver survey. J Allergy Clin Immunol. 2018 Oct;6(5):1559-1567. doi:10.1016/j.jaip.2018.01.019

  6. Kołaczek A, Skorupa D, Antczak-marczak M, Kuna P, Kupczyk M. Safety and efficacy of venom immunotherapy: a real life study. Postepy Dermatol Alergol. 2017;34(2):159-167. doi:10.5114/ada.2017.67082

  7. Johns Hopkins Medicine. Anaphylaxis.

  8. Lee S, Bellolio MF, Hess E, Campbell R. Predictors of biphasic reactions in the emergency department for patients with anaphylaxis. J Allergy Clin Immunol Pract. 2014 Jun;2(3):281-287. doi:10.1016/j.jaip.2014.01.012

  9. Kim SY, Kim MH, Cho YJ. Different clinical features of anaphylaxis according to cause and risk factors for severe reactionsAllergol Int. 2018;67(1):96-102. doi:10.1016/j.alit.2017.05.005