Anaphylactic Reactions Allergies can affect people differently. While one person might have a mild reaction to a certain allergen, someone else might experience more severe symptoms. Mild allergies are an inconvenience, but severe allergies can be life-threatening. The substances that cause allergies are called allergens. Although pollen, dust mites, and mold spores are common allergens, it’s rare for a person to have a severe allergy to them, because they’re everywhere in the environment.
Possible severe allergens include:
- Animal dander, such as that of a dog or cat
- Insect stings, such as bee stings
- Certain medicines such as penicillin
These foods cause the most allergic reactions:
- tree nuts
Mild vs. severe allergy symptoms: Mild allergy symptoms may not be extreme, but they can affect the entire body. Mild symptoms may include:
- skin rash
- runny nose
- itchy eyes
- stomach cramping
Severe allergy symptoms are more extreme. Swelling caused by the allergic reaction can spread to the throat and lungs, leading to allergic asthma or a serious condition known as anaphylaxis.
Allergies that last a lifetime: Some childhood allergies can grow less severe over time. This is particularly true for egg allergy. However, most allergies last throughout life.
You can also develop allergies as a result of repeated exposure to a toxin, such as bee stings or poison oak. With enough cumulative exposures over a lifetime, your immune system can become hypersensitive to the toxin, giving you a severe allergy.
- Allergy symptoms occur when your immune system overreacts to allergens in your body. Your immune system mistakenly believes that an allergen from a portion of food, such as peanut, is a harmful substance invading your body. The immune system releases chemicals, including histamine, to fight off the foreign invader.
- When your immune system releases these chemicals, it causes your body to have an allergic reaction. Swelling and breathing difficulties When the immune system overreacts, it can cause body parts to swell, particularly these:
If your lips and tongue swell too much, they can block your mouth and prevent you from speaking or breathing easily.
If your throat or airways also swell, it may cause additional problems such as:
- trouble swallowing
- trouble breathing
- shortness of breath
Antihistamines and steroids can help bring the allergic reaction back under control.
Allergic asthma: Asthma occurs when the tiny structures in your lungs become inflamed, causing them to swell and restrict airflow. Because allergic reactions often cause swelling, they can trigger a form of asthma called asthma. Allergic asthma can be treated the same way as regular asthma: with a rescue inhaler, containing a solution such as albuterol (Accuneb). Albuterol makes your airways expand, allowing more air to flow into your lungs. However, inhalers aren’t effective in cases of anaphylaxis, because anaphylaxis closes off the throat, preventing the medication from reaching the lungs.
Anaphylaxis occurs when an allergic swelling gets so extreme that it causes your throat to close, preventing air from getting through. In anaphylaxis, your blood pressure can drop, and your pulse can become weak or thread. If the swelling restricts airflow for long enough, you can even fall unconscious.
If you think you’re starting to experience anaphylaxis, use epinephrine (adrenaline) injector, such as EpiPen, Auvi-Q, or Adrenaclick. Epinephrine helps to open your airways, allowing you to breathe again.
Get diagnosed and be prepared: If you have severe allergies, an allergist can evaluate your condition and help you manage your symptoms. They can run a series of tests to find out what you’re allergic to. They may give you an epinephrine injector to carry with you in case of anaphylaxis.
You can also work with an allergist to develop an anaphylaxis emergency care plan, which can help you track your symptoms and medication. You may also want to wear an emergency medical bracelet, which can help inform emergency health workers of your condition.
Many kids have allergies. As a parent, you’ll want to know what to expect.
For instance, if your child has a mild allergy, such as hay fever, you can expect symptoms such as:
- Watery, runny eyes
- Runny nose
- Nasal congestion
These symptoms can make your child feel bad, but it’s not life-threatening.
But sometimes a child can have what’s known as anaphylaxis, a severe allergic reaction that needs immediate medical treatment. Many cases are caused by food allergies, medications, or insect stings.
Most anaphylactic reactions have symptoms in two or more areas of the body.
- Trouble breathing or noisy breathing
- Coughing, wheezing
- Tightness in the lungs
Heart and Blood Vessels
- Chest pain
- Low blood pressure
- Weak, rapid pulse
- Dizziness, fainting Skin
- Pale or flushed skin
- Hives or welts
- Itchy skin
- Swelling of the throat, face, lips, or tongue
- Stomach and Digestion
- Abdominal pain
- Nausea, vomiting
What Happens During Anaphylaxis?
The person’s airways narrow and their throat swells, which can make it hard to breathe. Their blood vessels widen, making their blood pressure fall, sometimes to dangerous levels. Anaphylactic reactions usually happen fast. Symptoms often become the most serious within 3 to 30 minutes of exposure to the allergy trigger. Quicker reactions are usually more severe.
A child who has had a severe allergic reaction should carry an emergency kit
that includes an epinephrine auto-injector.
You should know how to use the injector. So should your child’s teacher. Your child may also be old enough to use it on herself. As soon as possible after the allergic reaction starts, give the child at one shot of the drug and dial 911. Even if you are not sure the symptoms are allergy-related, don’t hesitate to give her the injection. Waiting can be much more harmful than the medication. She may need more than one dose, so be prepared to follow up with another within 10 to 20 minutes.
The injection isn’t a cure. It won’t stop a severe allergic reaction. Even if your child seems OK, emergency medical care is a must. Restock any items you use from the emergency kit so it’s ready at all times. Like all drugs, epinephrine has an expiration date, so check the dates on each injector.
Allergies are hypersensitive responses from the immune system to substances that either enter or come into contact with the body.
These substances commonly include materials such as pet dander, pollen, or bee venom. Anything can be an allergen if the immune system has an adverse reaction. A substance that causes an allergic reaction is called an allergen. Allergens can be found in food, drinks, or the environment. Many allergens are harmless and do not affect most people. If a person is allergic to a substance, such as pollen, their immune system reacts to the substance as if it was foreign and harmful, and tries to destroy it. Research indicates that 30 percent of adults and 40 percent of children in the United States have allergies.
- Allergies are the result of an inappropriate immune response to a normally harmless substance.
- Some of the most common allergens are dust, pollen, and nuts. They can cause sneezing, peeling skin, and vomiting.
- Anaphylaxis is a serious allergic reaction that can be life-threatening.
- To diagnose an allergy, a clinician may take a blood sample.
- The symptoms of an allergy can be treated with drugs. However, the allergy itself requires desensitization.
- Anaphylaxis requires emergency treatment. Epinephrine injectors can help reduce the severity of an anaphylactic reaction.
The doctor will ask the patient questions regarding symptoms when they occur, how often, and what seems to cause them. They will also ask the person with symptoms whether there is a family history of allergies and if other household members have allergies.
The doctor will either recommend some tests to find out which allergen is causing symptoms or refer the patient to a specialist.
Below are some examples of allergy tests:
- Blood test: This measures the level of IgE antibodies released by the immune system. This test is sometimes called the radioallergosorbent test (RAST)
- Skin prick test: This is also known as puncture testing or prick testing. The skin is pricked with a small amount of a possible allergen. If the skin reacts and becomes itchy, red, and swollen, it may mean an allergy is present.
- Patch test: A patch test can identify eczema. Special metal discs with very small amounts of a suspected allergen are taped onto the individual’s back. The doctor checks for a skin reaction 48 hours later and then again after a couple of days.
Even if the patient knows what triggers the allergy, the doctor will carry out tests to determine which particular substance is causing symptoms.
The most effective treatment and management of an allergy is the avoidance of the allergen. However, sometimes it is not possible to completely avoid an allergen. Pollen, for example, is constantly floating in the air, especially during hay fever season.
Drugs can help treat the symptoms of an allergic reaction, but they will not cure the allergy. The majority of allergy medications are over-the-counter (OTC). Before taking a particular type of medication, speak to a pharmacist or doctor.
- Antihistamines: These block the action of histamine. Caution is recommended, as some antihistamines are not suitable for children.
- Decongestants: These can help with a blocked nose in cases of hay fever, pet allergy, or dust allergy. Decongestants are short-term medications.
- Leukotriene receptor antagonists or anti-leukotrienes: When other asthma treatments have not worked, anti-leukotrienes can block the effects of leukotrienes. These are the chemicals that cause swelling. The body releases leukotrienes during an allergic reaction.
- Steroid sprays: Applied to the inside lining of the nose, corticosteroid sprays help reduce nasal congestion.
- Immunotherapy: Immunotherapy is also known as hyposensitization. This type of therapy rehabilitates the immune system. The doctor administers gradually increasing doses of allergens over a period of years. The aim is to induce long-term tolerance by reducing the tendency of the allergen to trigger IgE production. Immunotherapy is only used to treat severe allergies.
Treatment for Anaphylaxis
The EpiPen is one example of an epinephrine injector. They can be vital for stopping anaphylactic reactions. Anaphylaxis is a medical emergency. The patient may require resuscitation, including airway management, supplemental oxygen, intravenous fluids, and close monitoring. The person experiencing anaphylaxis will need an injection of adrenaline into the muscle. Antihistamines and steroids are often used alongside the adrenaline injection. After the patient has been stabilized, doctors may recommend remaining in the hospital under observation for up to 24 hours to rule out biphasic anaphylaxis. Biphasic anaphylaxis is the recurrence of anaphylaxis within 72 hours with no further exposure to the allergen. Patients who have had severe allergic reactions should carry an epinephrine auto-injector with them, such as the EpiPen, EpiPen Jr, Twinject, or Anapen.
Many doctors and health authorities advise patients to wear a medical information bracelet or necklace with information about their condition.
How to prevent allergies
There is no way to prevent an allergy. However, it is possible to limit symptoms. Even though treatments can help alleviate allergy symptoms, patients will need to try to avoid exposure to specific allergens. In some cases, this is not easy. Avoiding pollen in late spring and summer is virtually impossible, and even the cleanest houses have fungal spores or dust mites. If you have friends or family with pets, avoiding them might be difficult. Food allergies can be challenging to manage because traces of allergens can appear in unlikely meals. However, being vigilant about checking food packages can be a key way to avoid consuming certain allergens. Make sure you receive proper allergy testing and know what substances to avoid.
Unmet needs in allergic care
In most populations around the world, there is a lack of adequate education on the definition, etiology, pathogenesis, proper therapies, and prevention of allergic diseases. Awareness of the morbidity and potential mortality associated with allergic diseases, the chronic nature of those conditions, and the importance of consulting a physician knowledgeable in allergic diseases, asthma, and clinical immunology are often lacking. This translates into patients with allergic diseases not being managed by physicians with the necessary training and skills in the appropriate use of efficacious medications required for optimal management.
There is an increasing need to expand the number of allergy/clinical immunology specialists as well as local and regional diagnostic and treatment centers in order to facilitate timely referrals for patients with complex allergic diseases. A goal should be established to guarantee universal access to affordable and cost-effective therapies as well as novel medications used in the management of allergic diseases.
Presently, there are millions of people worldwide who do not have access to care by specialists in allergy Moreover, epinephrine auto-injectors, some drugs for severe asthma, allergen-specific immunotherapy, and some drugs for adverse reactions to biological and chemotherapeutic agents in desensitization centers are not available in many parts of the world.
Public health officers should provide for optimal allergy/clinical immunology services, including access to specialists and diagnostic and treatment centers. Allergists should be able to prescribe the most cost-effective medications to manage the specific clinical findings of each allergic patient.
Consultations with allergists to assure correct diagnosis and treatment are indispensable to improve long-term patient outcomes and their quality of life and reduce the unnecessary additional direct and indirect costs passed on to the patient, payer, and society.
What can be done to improve the current situation?
Increasing awareness of the relevance of allergic diseases as a major public health problem could lead to better recognition by governments and health authorities. Programs to increase awareness of allergic diseases should focus on the causes, prevention, control, and economic impact. The main goal would be better care of allergic diseases around the world with the aim to effectively engage regional, country, and local authorities. An important step forward supported by the major allergy organizations resides in current efforts to obtain World Health Organization (WHO) recognition of allergy through the new nomenclature of allergic diseases included in the ICD-11 classification of diseases Because allergic diseases are systemic multi-organ diseases, allergists are in the best position to diagnose and manage the allergic patient, in contrast to the classic organ-based approach of most other medical specialties. Allergic disease management by allergists based on the new technological advancements could be more efficacious and cost-effective when compared to the care provided by generalists or other specialists.
In addition, allergists have significant experience in the implementation of preventive measures which have been shown to diminish or eliminate allergic symptoms, including environmental control measures and allergen-specific immunotherapy, which could reduce the costs of disease management.
Focus on the patient
Educational efforts focused on allergic diseases should be specifically directed to patients and their families as the final targets of these awareness programs. In order to obtain better results regarding disease prevention and control, it will be strictly necessary to reach the community at various levels, including regional, local, and state agencies as well as schools and patient organizations with straight forward and understandable messaging. At the same time, approaching governments, politicians, and public health officers should be part of the strategy in order to promote the allocation of sufficient resources for the diagnosis, control, treatment, and prevention of allergic diseases.
- Roughly 7.8% of people 18 and over in the U.S. have hay fever.
- In 2010, white children in the U.S. were more likely to have had hay fever (10%) than black children (7%).
- Worldwide, allergic rhinitis affects between 10% and 30 % of the population.
- Worldwide, sensitization (IgE antibodies) to foreign proteins in the environment is present in up to 40% of the population.
- In 2012, 7.5% or 17.6 million adults were diagnosed with hay fever in the past 12 months.
- In 2012, 9.0% or 6.6 million children reported hay fever in the past 12 months.
- In 2010, 11.1 million visits to physician offices resulted with a primary diagnosis of allergic rhinitis.
- Worldwide, adverse drug reactions may affect up to 10% of the world’s population and affect up to 20% of all hospitalized patients.
- Worldwide, drugs may be responsible for up to 20% of fatalities due to anaphylaxis.
- Findings from a 2009 to 2010 study of 38,480 children (infant to 18) indicated 8% have a food allergy
o Approximately 6% aged 0-2 years have a food allergy
o About 9% aged 3-5 years have a food allergy
o Nearly 8% aged 6-10 years have a food allergy
o Approximately 8% aged 11-13 years have a food allergy
o More than 8.5% aged 14-18 years have a food allergy
- 38.7% of food allergic children have a history of severe reactions
- 30.4% of food allergic children have multiple food allergies
- Of food allergic children, peanut is the most prevalent allergen, followed by milk and then shellfish
- In 2012, 5.6% or 4.1 million children reported food allergies in the past 12 months.
- Worldwide, the rise in prevalence of allergic diseases has continued in the industrialized world for more than 50 years.3
- Worldwide, sensitization rates to one or more common allergens among school children are currently approaching 40%-50%.3
- In 2012, 10.6% or 7.8 million children reported respiratory allergies in the past 12 months.6
- Worldwide, in up to 50% of individuals who experience a fatal reaction there is no documented history of a previous systemic reaction.
- Roughly 13% of people 18 and over in the U.S. have sinusitis.
- In 2010, black children in the U.S. were more likely to have had skin allergies (17%) than white (12%) or Asian (10%) children.
- Worldwide, urticaria occurs with lifetime prevalence above 20%.
- In 2012, 12.0% or 8.8 million children reported skin allergies in the past 12 months.
Some more facts
- In the 12 months preceding the 2010 U.S. National Health Interview, there were 17.9 million adults diagnosed with hay fever (allergic rhinitis), which is equal to approximately 7.8 percent of the population of the country.
- Children are diagnosed almost as frequently in a one-year period as adults, with approximately 7.1 million diagnosed, or 9.5 percent of the children in the population.
- There were 8.6 million children, or 11.5 percent of the children in the population, reported to have had respiratory allergies in a 12-month period in 2010.
- Children also experience a rate of reported food allergies of approximately 3.4 million, or 4.6 percent of the children in the population, in a 12-month period in 2010.
- Skin allergies in children were reported in 9.4 million cases, or a total of 12.6 percent of the children in the population, in 2010.
- More than half (54.6 percent) of the people reporting a survey completed in the U.S. indicated that they had positive reactions to one or more allergens. Allergic rhinitis (hay fever) affects between 10 and 30 percent of all adults in the U.S. and as many as 40 percent of children.
- There are estimates that over 60 million people in the U.S. that have symptoms of allergic rhinitis and this number is increasing.
- Approximately 40 people per year die in the U.S. because of allergic reactions to bee stings.
Age, Gender and Other Factors
- Eight specific types of foods are responsible for over 90 percent of all reported food allergies. These include eggs, milk, peanuts, tree nuts, shellfish, soy, wheat, and fish.
- Food allergies are more prominent in children than adults with a total of 4.7 percent of children under the age of 5 having a reported food allergy, and 3.7 percent of children between the ages of 5 to 17 reporting allergies. Often food allergies can decrease as the child ages.
- Females are slightly more likely to have food allergies than males with percentages of reported reactions at 4.1 and 3.8 respectively.
- Non-Hispanic white children have the highest percentage of reported food allergies at 4.1, non-Hispanic blacks at 4.0, and Hispanic children at 3.1.
- In about 50 percent of all homes in the U.S., there are at least 6 detectable allergens present in the environment.
- Adults are more likely to have life-threatening reactions to insect stings than children with 3 percent of adults and only 0.4 to 0.8 percent of children. Healthcare workers are at higher risk for developing a latex allergy than the general population. In the general population, there is less than a 1 percent incidence, while in the healthcare industry, the rate is 5 to 15 percent.
- Milk allergies are most common in children with 2.5 percent of children under the age of 3 having an allergic reaction to milk.
- Peanut allergies doubled in numbers diagnosed between the years 1997 to 2003.