Anaphylaxis

Here at our Allergy Clinic, we frequently address varying severity of Allergy ranging from mild to Life-Threatening Anaphylaxis. Unfortunately, from the Twenty -plus years I have been a practicing doctor, Allergy is becoming much more common and we frequently diagnose and manage many potentially life threatening allergies every day.

Here, it is our mission to accurately diagnose, treat and form a complete practice plan for the patient and their family- right from Emergency medication to training parents and caregivers about emergency treatments.

We also write to the child’s  school and manage travel letters for them when required for emergency medication:.

There are different degrees of allergy that take place in the very young to adult patients from Mild symptoms to Anaphylaxis (which is the most severe range of symptoms)

In General , Anaphylaxis is more dangerous in Asthmatics and those with severe history of Allergy.

Causes:

The most common causes of anaphylaxis are:

  • Peanut ( legume)
  • Tree nuts (walnut, cashew , pistachio, Brazil, pine nuts and almonds)
  • Fish and Shellfish
  • Milk
  • Eggs
  • Seeds eg Sesame, Mustard  etc.
  • Fruits, Vegetables


Patients with severe pollen allergy especially to certain grasses and Trees (Birch) pollen may get scary reactions which mimic anaphylaxis such as itching of the mouth, facial swelling and this is due similar proteins (Eg. Prolifin) found in the two substances.

Typical aero-allergen (airborne) food cross – reactions are:

Birch pollen: apple, raw potato, carrot, celery and hazelnut

  • Mugwort pollen: celery, apple, peanut and kiwifruit
  • Ragweed pollen: melons (watermelon, cantaloupe, honeydew) and banana
  • Latex: banana, avocado, kiwifruit, chestnut and papaya


Food-associated, exercise-induced anaphylaxis
may occur when individuals exercise within 2-4 hours after ingesting a specific food. The individual is, however, able to exercise without symptoms, as long as the incriminated food is not consumed before exercise. The patient is likewise able to ingest the incriminated food with impunity as long as no exercise occurs for several hours after eating the food

Anaphylaxis can also be triggered by:

  • Stinging or biting insecte : wasp / bee and sometimes even other biting insects can cause problems, frequently on exotic holidays.
  • Medicine – Antibiotics , Asprin, Nurofen (ibuprofen) and some medications for High Blood Pressure (I highlighted this because it is a non-biased common factor in Ireland or some other NSAID – Non steroidal anti inflammatory drug)
  • Latex – Gloves , condoms, etc
  • Sulphites / preservatives – Of which I have no way of testing !
  • Exercise
  • UNKNOWN CAUSES


Symptoms to observe in a mild/moderate reaction:

  • Swollen lips, face or eyes
  • Itchy/tingling mouth
  • Hives or itchy skin rash
  • Abdominal pain or vomiting
  • Sudden change in behaviour
  • Stay with the child, call for help

if necessary

  • Locate adrenaline autoinjector(s)
  • Give antihistamine: Zirtek / Xyzal is recommended instead of the older drowsy versions. This is my personal preference but any antihistamine at a double dose will help initially.
  • Phone parent/emergency contact


Action to take:

(If vomited, can repeat dose)

Symptoms

The signs and symptoms of anaphylaxis are listed below. Make sure you know what these symptoms are so that you know when to use your Adrenaline Autoinjector  These symptoms can develop rapidly within minutes, or over a period of hours.

Only a few of the following symptoms may be present, however some can be life-threatening.

  • Itchy rashes
  • Swelling lips
  • Dizziness
  • Racing heart
  • Shortness of breath
  • Feeling of impending doom


If you experience any or all of these symptoms,
you should use use your Adrenaline Autoinjector  and call 999 or 112 , ask for an ambulance and say ‘anaphylaxis’. Always use your medicine as you were instructed by your doctor. It is important to remember that the pattern of symptoms you experience may be different from previous reactions.

For information on when to use your Adrenaline Autoinjector and the symptoms of anaphylaxis click here.

Treatment

Adrenaline is the drug of choice for first-line treatment of anaphylaxis because it works quickly to reverse the symptoms of an anaphylactic reaction.

When adrenaline is injected into the muscle of the thigh it acts quickly to constrict blood vessels, which helps to stop swelling around the face and lips, and relaxes the lungs, which improves breathing. Adrenaline also stimulates the heart, and helps raise lowered blood pressure.

The sooner the injection is given the better and you should seek professional medical assistance immediately after using your Adrenaline Auto-injector. You should be prepared to administer a second injection after 5 -15 minutes if there is no improvement or if original symptoms return.

Each injector can only be used once. It is recommended you carry two injectors  in case you do need a second dose.

Causes

The most common causes of anaphylaxis are food and venom (wasp stings).

Common food triggers are:

  • Peanuts
  • Tree nuts
  • Fish and shellfish
  • Fruit
  • Dairy products such as milk and eggs

Anaphylaxis can also be triggered by:

  • Venom from stinging or biting insects. Wasp and bee venom are the most common insect allergens. On rare occasions stings from hornets and bumble bees can also cause allergic reactions
  • Medicine – most commonly antibiotics, aspirin or ibuprofen
  • Latex
  • Exercise


Sometimes the cause may be unknown.

Treatment

Adrenaline is the drug of choice for first-line treatment of anaphylaxis because it works quickly to reverse the symptoms of an anaphylactic reaction.

When adrenaline is injected into the muscle of the thigh it acts quickly to constrict blood vessels, which helps to stop swelling around the face and lips, and relaxes the lungs, which improves breathing. Adrenaline also stimulates the heart, and helps raise lowered blood pressure.

The sooner the injection is given the better and you should seek professional medical assistance immediately after using your Jext®. You should be prepared to administer a second Jext® after 5 -15 minutes if there is no improvement or if original symptoms return.

Each Jext® can only be used once. It is recommended you carry two Jext® in case you do need a second dose.

How to use your Jext®

And inform us if you have had a reaction

Allergy is the most common chronic disease in Europe. Up to 20% of patients with allergies struggle daily with the fear of a possible asthma attack, anaphylactic shock, or even death from an allergic reaction
(EAACI, 2016)

For more information:

Auto adrenaline injector brand Website Companies:

Emerade: www.emeradebausch.co.uk Bausch & Lomb
Epipen: www.epipen.co.uk MEDA Pharmaceuticals
Jext: www.jext.co.uk ALK-ABELLO UK
Anapen: https://www.anapen.ie/