Anaphylaxis: It can kill you quickly

Oct 07, 2018 Dr Zulfikar Bux, Features / Columnists

By Dr Zulfikar Bux
Assistant Professor of Emergency Medicine

Anaphylaxis is an extreme form of allergic reaction. It is a medical emergency that can quickly take a life if untreated. It usually causes swelling of the lips and tongue, breathing problems, collapse and loss of consciousness. Typically, it occurs very suddenly and without warning. The symptoms get rapidly worse and, without treatment, can cause death. The symptoms affect many parts of the body.
It is mainly children and young adults who are affected by anaphylaxis. Food is a common cause in children; however, medicines seem to be more common triggers in adults. Today we will discuss this medical emergency. The more you know about it the more you can help save yourself or someone else if you ever encounter this condition.
What causes anaphylaxis?
Anaphylaxis can potentially be caused by any allergen. Most allergens are proteins, but some, such as medications, are not. Many cases of anaphylaxis have no known cause. This is referred to as idiopathic anaphylaxis.
Causes of anaphylaxis:
• Idiopathic (unknown).
• Food – common examples include nuts, shellfish and eggs.
• Venom (for example, bee or wasp stings).
• Medicines – common examples include:
-. Antibiotics – for example, penicillin.
-Painkillers – for example, opioids such as morphine or codeine, or non- steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen
What are symptoms of anaphylaxis?
Early symptoms of anaphylaxis include:
• Wheezing and hoarseness. This happens as the airways narrow.
• Swelling of the lips, tongue and throat. The swelling involves the deeper layers of the skin. Whilst it can occur around the eyes, and in the hands and feet, it is more significant when it affects the lips, tongue and throat. Swelling here can completely block your airway, meaning air (and therefore oxygen) cannot be breathed into the lungs. Without emergency treatment, this results in suffocation and death.
• An itchy rash, like nettle rash – commonly called hives. The rash is raised and generally pale pink in colour. The raised areas are called wheals. Not everyone having an anaphylactic reaction gets this rash.
Other symptoms include:
• Feeling faint – due to dropping of your blood pressure.
• A sense of impending doom.
• A fast heart rate or the sensation of a ‘thumping’ heart (flattering) as your heart tries to pump faster to maintain your blood pressure.
• Symptoms involving the gut. These include feeling sick (nausea), being sick (vomiting) and belly pains.
Are tests needed for anaphylaxis?
Anaphylaxis is primarily a clinical diagnosis. This means that it is diagnosed based on the recognition of symptoms and the manner in which they occur – that is, quickly and rapidly worsening. It does need to be distinguished from other medical conditions that may have some similar symptoms.
It is important to realize that the treatment for anaphylaxis is an emergency, so anyone with presumed anaphylaxis is treated as such. Blood test has no role in the immediate management of someone with a severe allergic reaction. After life-saving emergency treatment has been started and the situation is stable, this blood test can be taken.
What should I do if I witness anaphylaxis?
Always remember that anaphylaxis is a life-threatening emergency and needs to be treated in a hospital. Here are steps you should take if someone is getting an anaphylaxis reaction:
• Immediately call 912 for an ambulance if it’s available in your area. Otherwise you will have to rush the patient yourself to the hospital.
• Ask the person if he or she is carrying an epinephrine auto-injector (EpiPen, Auvi-Q, others) to treat an allergic attack.
• If the person says he or she needs to use an auto-injector, ask whether you should help inject the medication. This is usually done by pressing the auto-injector against the person’s thigh.
• Remove the allergen if possible e.g removing a bee stinger from the skin
• Have the person lie still on his or her back.
• Loosen tight clothing and cover the person with a blanket. Don’t give the person anything to drink.
• If there’s vomiting or bleeding from the mouth, turn the person on his or her side to prevent choking.
• If there are no signs of breathing, coughing or movements, begin CPR. Do uninterrupted chest presses — about 100 every minute — until you can get the patient to a hospital.
• Get emergency treatment even if symptoms start to improve. After anaphylaxis, it’s possible for symptoms to recur.
If you’re with someone having signs and symptoms of anaphylaxis, don’t wait to see whether symptoms get better. Seek emergency treatment right away. In severe cases, untreated anaphylaxis can lead to death within half an hour. An antihistamine pill, such as Benadryl or piriton, will not be sufficient to treat anaphylaxis. These medications can help relieve allergy symptoms, but work too slowly in a severe reaction.