Anaphylaxis - Emergencies
- What are the Signs and Symptoms of Anaphylaxis?
- How does one Prevent Anaphylaxis?
- What does one do in an Emergency?
Severe reactions to environmental agents which are inhaled, ingested or injected constitute on ALLERGIC EMERGENCY. Unless these reactions are recognised and properly treated certain allergic reactions could lead to the death of the patient.
Return to Top The term anaphylaxis refers to the sudden collapse of an individual following exposure to some agent in his environment. The three most common agents leading to severe anaphylaxis are drugs (e.g. penicillin), insect stings (e.g. bees) and certain foods, such as eggs, nuts, seafoods and blood products. Anaphylactic reactions to medications are rare, e.g. an incidence of 1: 10 000 penicillin injections require urgent attention. It is always important to have a plan of action, since speed is of great importance.
What are the Signs and Symptoms of Anaphylaxis?
Return to Top In mild cases the first symptoms are a tingling of the hands and feet accompanied by a warm feeling, fullness of the mouth and throat within minutes of exposure to the agent. Congestion of the nose and swelling of the eyes may also occur at this stage. If this progresses to tightness of the chest, an itchy rash or dizziness, it is a severe reaction. Severe anaphylactic reactions are often abrupt and usually associated with severe tightness of the chest, dizziness, cramping diarrhoea, swelling of the face, fainting and collapse due to a drop in blood pressure. Reactions such as these will lead to death if not treated.
How does one Prevent Anaphylaxis?
Return to Top If you have had any kind of reaction to a medicine, food or to an insect sting, you should consult your doctor who will take a detailed history fro you and evaluate your risk. He will then perform blood tests called RASTs to confirm your allergy. Skin tests may be dangerous if you are very sensitive. Having confirmed the cause and evaluated the risk, you should obtain a Medic Alert disk stating your allergy, and take all steps to avoid becoming exposed again.
Your family or close friends should be informed about your allergy and should also know what to do in an emergency.
In the case of bee-venom allergy, individuals at risk should avoid bee-hives and other areas which bees frequent such as flower gardens and rubbish bins. It is also important not to wear scented perfumes as they attract or annoy bees.
What does one do in an Emergency?
Return to Top The most important thing is to stay clam. The doctor and ambulance must be summoned immediately. The patient should lie down and the legs should be elevated. Patients at risk for anaphylaxis must carry an adrenaline inhaler on their person which should be used immediately (6-10 puffs)). This can be repeated after 10 minutes if no improvement occurs. Do not delay using adrenaline. This is the most important form of treatment for anaphylaxis.
It is also important to carry a rapidly acting anti-histamine tablet such as Phenergan that should also be taken orally at once. A pre-filled adrenaline syringe called the is available in South Africa and you should ask your doctor about obtaining this. The Ana-Guard contains an easily administered infection of adrenaline which can be lifesaving. If the patient has been stung by a bee, the sting should be carefully removed without compressing it and a tourniquet can be applied above the area of the sting or injection if it is on the arms or legs. It is important to release the tourniquet for 1 to 2 minutes after every 10 minutes.
If these measures are applied rapidly and effectively the patient will respond in more than 80% of cases. It is vital that all of these measures are applied before the doctor arrives.
The other allergic emergency is the acute asthmatic attack. Again it is essential to remain calm and to have a plan of action. Asthmatic patients must always carry a bronchodilator inhaler on their person which must be used when they develop an acute asthmatic attack. It is important to start treatment with the inhaler to prevent progression of the attack. Make sure that you have also taken your maintenance medication for that day (e.g. theophyllin, beta-2 agonist or steroids). Call a friend or neighbour to help. If the wheeze or shortness of breath gets worse and there is no noticeable improvement within 15 minutes you should repeat the inhaler.
If you have a peak flow meter you can objectively assess whether you are responding. Failure to improve by 30 minutes, struggling to breathe, inability to walk or the development of a blue colour of fingernails or lips constitutes an emergency which cannot be treated at home. You will need oxygen and steroid therapy and nebulisation and should go directly to the nearest hospital or emergency room. It is always a good idea to phone the emergency room to tell them you're on your way.
Copyright: Allergy Society of South Africa.
Written by Prof. Paul Potter
Endorsed by ALLSA.
This information sheet is obtainable from:
P.O. Box 88
Cape Town, R.S.A.
Background: Large Grey Mongoose