Allergy attack what to do
A physician will consider patient history and act out a thorough physical examination if a person reports having hay-fever-like symptoms. If necessary, the physician will do an allergy test. According to the Mayo Clinic, people can get a skin-prick test, in which doctors prick the skin on a person’s arm or upper back with diverse substances to see if any cause an allergic reaction, such as a raised bump called a hive. [7 Strange Signs You’re Having an Allergic Reaction]
Blood tests for allergies are also available. This test rates the immune system’s response to a specific allergen by measuring the quantity of allergy-causing antibodies in the bloodstream, according to the Mayo Clinic.
The most common allergen is pollen, a powder released by trees, grasses and weeds that fertilize the seeds of neighboring plants.
As plants rely on the wind to do the work for them, the pollination season sees billions of microscopic particles fill the air, and some of them finish up in people’s noses and mouths.
Spring bloomers include ash, birch, cedar, elm and maple trees, plus numerous species of grass. Weeds pollinate in the tardy summer and drop, with ragweed being the most volatile.
The pollen that sits on brightly colored flowers is rarely responsible for hay fever because it is heavier and falls to the ground rather than becoming airborne.
Bees and other insects carry flower pollen from one flower to the next without ever bothering human noses.
Mold allergies are diverse. Mold is a spore that grows on rotting logs, dead leaves and grasses. While dry-weather mold species exist, numerous types of mold thrive in moist, rainy conditions, and release their spores overnight. During both the spring and drop allergy seasons, pollen is released mainly in the morning hours and travels best on dry, warm and breezy days.
The symptoms of allergic rhinitis may at first feel love those of a freezing.
But unlike a freezing that may incubate before causing discomfort, symptoms of allergies generally appear almost as soon as a person encounters an allergen, such as pollen or mold.
Symptoms include itchy eyes, ears, nose or throat, sneezing, irritability, nasal congestion and hoarseness. People may also experience cough, postnasal drip, sinus pressure or headaches, decreased sense of smell, snoring, sleep apnea, fatigue and asthma, Josephson said.
[Oral Allergy Syndrome: 6 Ways to Avoid an Itchy, Tingling Mouth]
Many of these symptoms are the immune system’s overreaction as it attempts to protect the vital and sensitive respiratory system from exterior invaders. The antibodies produced by the body hold the foreign invaders out, but also cause the symptoms characteristic of allergic responses.
People can develop hay fever at any age, but most people are diagnosed with the disorder in childhood or early adulthood, according to the Mayo Clinic. Symptoms typically become less severe as people age.
Often, children may first experience food allergies and eczema, or itchy skin, before developing hay fever, Josephson said.
«This then worsens over the years, and patients then develop allergies to indoor allergens love dust and animals, or seasonal rhinitis, love ragweed, grass pollen, molds and tree pollen.»
Hay fever can also lead to other medical conditions. People who are allergic to weeds are more likely to get other allergies and develop asthma as they age, Josephson said. But those who get immunotherapy, such as allergy shots that assist people’s bodies get used to allergens, are less likely to develop asthma, he said.
Hay fever treatments
Sarita Patil, an allergist with Massachusetts General Hospital’s Allergy Associates in Boston, talked to Live Science about strategies for outdoor lovers with seasonal allergies.
Patil suggested figuring out exactly what type of pollen you’re allergic to, and then avoiding planning outdoor activities during peak pollinating times in the months when those plants are in bloom. Numerous grasses, for example, typically pollinate in tardy spring and early summer and release most of their spores in the afternoon and early evening.
Her other strategies: Be capable to identify the pollen perpetrator by sight; monitor pollen counts before scheduling outdoor time; go exterior at a time of day when the plants that make you go achoo are not pollinating; and wear protective gear love sunglasses, among other tips.
[7 Strategies for Outdoor Lovers with Seasonal Allergies]
Allergy sufferers may also select to combat symptoms with medication designed to shut below or trick the immune sensitivity in the body. Whether over-the-counter or prescription, most allergy pills work by releasing chemicals into the body that bind naturally to histamine — the protein that reacts to the allergen and causes an immune response — negating the protein’s effect.
Other allergy remedies attack the symptoms at the source.
Nasal sprays contain athletic ingredients that decongest by soothing irritated blood vessels in the nose, while eye drops both moisturize and reduce inflammation. Doctors may also prescribe allergy shots, Josephson said.
For kids, allergy medications are tricky. A 2017 nationally representative poll of parents with kids between ages 6 and 12 found that 21% of parents said they had trouble figuring out the correct dose of allergy meds for their child; 15% of parents gave a kid an adult form of the allergy medicine, and 33% of these parents also gave their kid the adult dose of that medicine.
Doctors may also recommend allergy shots, a neti pot that can rinse the sinuses, or a Grossan Hydropulse — an irrigating system that cleans the nose of pollens, infection and environmental irritants, Josephson said.
Alternative and holistic options, along with acupuncture, may also assist people with hay fever, Josephson said.
People can also avoid pollen by keeping their windows closed in the spring, and by using air purifiers and air conditioners at home.
Probiotics may also be helpful in stopping those itchy eyes and runny noses. A 2015 review published in the journal International Forum of Allergy and Rhinology found that people who suffer from hay fever may benefit from using probiotics, or «good bacteria,» thought to promote a healthy gut. Although the jury is still out on whether probiotics are an effective treatment for seasonal allergies, the researchers noted that these gut bacteria could hold the body’s immune system from flaring up in response to allergens — something that could reduce allergy symptoms.
[5 Myths About Probiotics]
This article was updated on April 30, 2019, by Live Science Contributor Rachel Ross.
An allergic reaction may happen anywhere in the body but generally appears in the nose, eyes, lungs, lining of the stomach, sinuses, throat and skin. These are places where special immune system cells are stationed to fight off invaders that are inhaled, swallowed or come in contact with the skin.
Causes of Anaphylaxis
Modulators of Arachidonic Acid Metabolism
Food-associated, exercise-induced anaphylaxis
This is more common in females, and over 60% of cases happen in individuals less than 30 years of age.
Patients sometimes own a history of reacting to the food when younger and generally own positive skin tests to the food that provokes their anaphylaxis.
Antibiotics and Other Drugs
PENICILLIN, CEPHALOSPORIN, AND SULPHONAMIDE ANTIBIOTICS
Penicillin is the most common cause of anaphylaxis, for whatever reason, not just drug-induced cases. Penicillin and other antibiotics are haptens, molecules that are too little to elicit immune responses but which may bind to serum proteins and produce IgE antibodies. Serious reactions to penicillin happen about twice as frequently following intramuscular or intravenous istration versus oral istration, but oral penicillin istration may also induce anaphylaxis.
Neither atopy, nor a genetic history of allergic rhinitis, asthma or eczema, is a risk factor for the development of penicillin allergy.
Muscle relaxants, for example, suxamethonium, alcuronium, vecuronium, pancuronium and atracurium, which are widely used in general anesthesia, account for 70-80% of every allergic reactions occurring during general anesthesia. Reactions are caused by an immediate IgE-mediated hypersensitivity reaction.
B = Breathing
Assess adequacy of ventilation and provide the patient with sufficient oxygen to maintain adequate mentation and an oxygen saturation of at least 91% as sure by pulse oximetry.
Treat bronchospasm as necessary. Equipment for endotracheal intubation should be available for immediate use in event of respiratory failure and is indicated for poor mentation, respiratory failure, or stridor not responding immediately to supplemental oxygen and epinephrine.
In theory, any food glycoprotein is capable of causing an anaphylactic reaction. Foods most frequently implicated in anaphylaxis are:
- Milk (cow, goat)
- Peanut (a legume)
- Seeds (cotton seed, sesame, mustard)
- Tree nuts (walnut, hazel nut/filbert, cashew, pistachio nut, Brazil nut, pine nut, almond)
- Chicken eggs
- Shellfish (shrimp, crab, lobster, oyster, scallops)
- Fruits, vegetables
Food sensitivity can be so severe that a systemic allergic reaction can happen to particle inhalation, such as the odors of cooked fish or the opening of a package of peanuts.
A severe allergy to pollen, for example, ragweed, grass or tree pollen, can indicate that an individual may be susceptible to anaphylaxis or to the oral allergy syndrome (pollen/food syndrome) (manifested primarily by severe oropharyngeal itching, with or without facial angioedema) caused by eating certain plant-derived foods.
This is due to homologous allergens found between pollens and foods. The main allergen of every grasses is profilin, which is a pan-allergen, found in numerous plants, pollens and fruits, and grass-sensitive individuals can sometimes react to numerous plant-derived foods.
Typical aero-allergen food cross-reactivities are:
- Mugwort pollen: celery, apple, peanut and kiwifruit
- Birch pollen: apple, raw potato, carrot, celery and hazelnut
- Ragweed pollen: melons (watermelon, cantaloupe, honeydew) and banana
- Latex: banana, avocado, kiwifruit, chestnut and papaya
Food-associated, exercise-induced anaphylaxis may happen when individuals exercise within 2-4 hours after ingesting a specific food.
The individual is, however, capable to exercise without symptoms, as endless as the incriminated food is not consumed before exercise. The patient is likewise capable to ingest the incriminated food with impunity as endless as no exercise occurs for several hours after eating the food.
One percent to 5% of courses of penicillin therapy are complicated by systemic hypersensitivity reactions.
Point two percent is associated with anaphylactic shock, and mortality occurs in 0.02% of the cases. If a patient has a strongly positive skin test or circulating IgE antibody to penicillin, there is a 50-60% risk of an anaphylactic reaction upon subsequent challenge. In patients with a case history suggestive of penicillin allergy and negative skin tests, the risk of anaphylaxis is extremely low. Atopy and mold sensitivity are not risk factors for the development of penicillin allergy.
Insect venom anaphylaxis
Studies from Australia, France, Switzerland and the USA propose incidences of systemic reactions to Hymenoptera stings ranging from 0.4% to 4% of the population.
In the USA, at least 40 allergic deaths happen each year as a result of Hymenoptera stings.
Can food allergies be prevented?
In 2013, the American Academy of Pediatrics published a study which supported research suggesting that feeding solid foods to extremely young babies could promote allergies. It recommends against introducing solid foods tobabies younger than 17 weeks. It also suggests exclusively breast-feeding “for as endless as possible,” but stops short of endorsing earlier research supporting six months of exclusive breast-feeding.
Research on the benefits of feeding hypoallergenic formulas to high-risk children – those born into families with a strong history of allergic diseases – is mixed.
In the case of peanut allergy, the National Institute for Allergy and Infectious Disease (NIAID) issued new updated guidelines in 2017 in order to define high, moderate and low-risk infants for developing peanut allergy. The guidelines also address how to proceed with introduction based on risk.
The updated guidelines are a breakthrough for the prevention of peanut allergy.
Peanut allergy has become much more prevalent in recent years, and there is now a roadmap to prevent numerous new cases.
According to the new guidelines, an baby at high risk of developing peanut allergy is one with severe eczema and/or egg allergy.
The guidelines recommend introduction of peanut-containing foods as early as 4-6 months for high-risk infants who own already started solid foods, after determining that it is safe to do so. Parents should know that most infants are either moderate- or low-risk for developing peanut allergies, and most can own peanut-containing foods introduced at home. Whole peanuts should never be given to infants because they are a choking hazard.
If your kid has no factors to be at high risk, the best way to introduce peanuts is to make certain first of every your kid is healthy – they don’t own a freezing, fever or anything else.
Make certain it’s not the first food you’ve introduced to them.
Ruchi Gupta, MD, ACAAI member
Clinical studies are ongoing in food allergy to assist develop tolerances to specific foods. Askyour board-certified allergistif you or your kid may be a candidate for one of these studies.
Updated: April, 2019
Updated: September, 2012
Originally Posted: July 2004
Richard F. Lockey, MD
Professor of Medicine, Pediatrics and Public Health
Director of the Division of Allergy and Immunology
Joy McCann Culverhouse Chair of Allergy and Immunology
University of South Florida College of Medicine and the James A.
Haley Veterans' Hospital
Tampa, Florida, USA
This disease summary is provided for informational purposes for physicians only.
What It Means to Be Allergic to Peanuts
When you’re allergic to peanuts, you’re actually allergic to the proteins found in peanuts. Antibodies in your immune system float around waiting to jump into action if they come into contact with these proteins. This occurs when you eat a peanut—even a miniscule amount.
“When you own someone who’s allergic and ingests peanuts, the antibodies in the person’s immune system discover and grab onto this peanut and cause your body to release certain chemicals, the most significant of which is histamine,” says Edwin Kim, MD, director of the UNC Food Allergy Initiative.
Histamine can cause symptoms ranging from itching and hives to a severe, life-threatening reaction known as anaphylaxis.
Anaphylaxis must be treated with epinephrine, which comes in an injectable pen, often called an EpiPen, followed by an emergency medical evaluation.
Symptoms and Signs of Anaphylaxis
The initial manifestation of anaphylaxis may be loss of consciousness. Patients often describe "a sense of doom." In this instance, the symptoms and signs of anaphylaxis are isolated to one organ system, but since anaphylaxis is a systemic event, in the vast majority of subjects two or more systems are involved.
Gastro-intestinal: Abdominal pain, hyperperistalsis with faecal urgency or incontinence, nausea, vomiting, diarrhea.
Oral: Pruritus of lips, tongue and palate, edema of lips and tongue.
Respiratory: Upper airway obstruction from angioedema of the tongue, oropharynx or larynx; bronchospasm, chest tightness, cough, wheezing; rhinitis, sneezing, congestion, rhinorrhea.
Cutaneous: Diffuse erythema, flushing, urticaria, pruritus, angioedema.
Cardiovascular: Faintness, hypotension, arrhythmias, hypovolemic shock, syncope, chest pain.
Ocular: Periorbital edema, erythema, conjunctival erythema, tearing.
Genito-urinary: Uterine cramps, urinary urgency or incontinence.
Severe initial symptoms develop rapidly, reaching peak severity within 3-30 minutes.
There may occasionally be a quiescent period of 1–8 hours before the development of a second reaction (a biphasic response). Protracted anaphylaxis may happen, with symptoms persisting for days. Death may happen within minutes but rarely has been reported to happen days to weeks after the initial anaphylactic event.
Smelling Peanuts Is Not the Same as Ingesting Them
While it is possible to breathe in a little bit of food protein, such as a peanut protein, that exposure is not enough to trigger a severe allergic reaction.
“The way I attempt to visualize it is it comes below to a threshold amount,” Dr. Kim says. “In order to get enough of an exposure to trigger a large reaction, it really takes ingestion.
It is extremely, extremely, extremely, extremely rare for someone to just inhale it and then actually own an all-out anaphylactic attack.”
And while this thought holds for both peanuts and tree nuts, it’s significant for people who are allergic to seafood to be aware: Reactions without ingestion do occasionally happen, Dr. Kim says. But the circumstances own to be just right; simply sitting next to someone eating shellfish, for example, won’t be a problem.
“There are reports where patients who are allergic to shellfish may be exposed to a steaming pot, perhaps at a clambake, and develop hives or asthma symptoms,” Dr.
Kim says. “This is not (from) being in the same room as someone eating shrimp, but from directly breathing in the steam as it’s being cooked or boiled.”
Emergency Treatment of Anaphylaxis
Exercise alone can cause anaphylaxis as can food-induced anaphylaxis, Exercise-induced anaphylaxis can happen during the pollinating season of plants to which the individual is allergic.
Hymenoptera venoms (bee, wasp, yellow-jacket, hornet, fire ant) contain enzymes such as phospholipases and hyaluronidases and other proteins which can elicit an IgE antibody response.
Anaphylaxis to muscle relaxants occurs in approximately 1 in 4,500 of general anesthesia, with fatalities occurring in 6% of these cases.
Risk factors are female sex (80% of cases). Atopy is not a risk factor; previous drug allergy may be a risk factor. In patients with a history of anaphylaxis, skin tests to diverse muscle relaxants may be helpful. If the test result is positive, the muscle relaxant should not be used. A negative result provides evidence that the muscle relaxant can probably be istered safely.
Narcotics are mast cell activators capable of causing elevated plasma histamine levels and non-allergic anaphylaxis.
They are most commonly observed by anesthesiologists.
A = Adrenalin = epinephrine
Epinephrine is the drug of choice for anaphylaxis. It stimulates both the beta-and alpha-adrenergic receptors and inhibits further mediator release from mast cells and basophils. Animal and human data indicate that platelet activating factor (PAF) mediates life-threatening manifestations of anaphylaxis. The early use of epinephrine in vitro inhibits the release of PAF in a time-dependent manner, giving support to the use of this medication with the first signs and symptoms of anaphylaxis.
The usual dosage of epinephrine for adults is 0.3-0.5 mg of a 1:1000 w/v solution given intramuscularly, preferably in the anterolateral thigh, every 10-20 minutes or as necessary. The dose for children is 0.01 mg/kg to a maximum of 0.3 mg intramuscularly, preferably in the anterolateral thigh, every 5-30 minutes as necessary. Lower doses, e.g., 0.1 mg to 0.2 mg istered intramuscularly, preferably in the anterolateral thigh, as necessary, are generally adequate to treat mild anaphylaxis, often associated with skin testing or allergen immunotherapy.
Epinephrine should be given early in the course of the reaction and the dose titrated to the clinical response. For severe hypotension, 1 cc of a 1:10,000 w/v dilution of epinephrine given slowly intravenously is indicated. The patient's response determines the rate of infusion.
Flushing, tachycardia, angioedema, upper airway obstruction, urticaria and other signs and symptoms of anaphylaxis can happen without a recognizable cause.
Diagnosis is based primarily on the history and an exhaustive search for causative factors. Serum tryptase and urinary histamine levels may be useful, in specific, to law out mastocytosis.
Atopic and Contact Dermatitis/Hives/Skin Allergies
Atopic and contact dermatitis, eczema and hives are skin conditions that can be caused by allergens and other irritants. Often the reaction may take hours or days to develop, as in the case of poison ivy. The most common allergic causes of rashes are medicines, insect stings, foods, animals and chemicals used at home or work.
Allergies may be aggravated by emotional stress.
Allergy / immunology specialists frolic a uniquely significant role to confirm the etiology of anaphylaxis, prepare the patient for self istration of epinephrine, educate the patient and/or family about allergen avoidance, and law out any underlying condition, such as mastocytosis, which can predispose a patient to develop anaphylaxis. Referral to an allergist / immunologist is indicated for patients with this disease.
A UNC allergist addresses the risk of airborne peanut allergies.
Your carry-on bag is safely stowed overhead, your little one is buckled in and playing with her favorite toy, and you’re ready to dive into the thriller you brought to read on your flight when you smell it.
Peanuts. You start to panic. Her EpiPen is somewhere in the carry-on above, but the “fasten seat belt” sign is glaring at you. What should you do?
Take a deep breath and relax. Even if you are allergic to peanuts, touching, smelling or inhaling particles from peanuts cannot cause an allergic reaction—at least not the serious, life-threatening type that everyone with a peanut allergy fears. You are not in harm unless you eat them.
Asthma symptoms happen when airway muscle spasms block the flow of air to the lungs and/or the linings of the bronchial tubes become inflamed.
Excess mucus may clog the airways. An asthma attack is characterized by labored or restricted breathing, a tight feeling in the chest, coughing and/or wheezing. Sometimes a chronic cough is the only symptom.
Asthma trouble can cause only mild discomfort or it can cause life-threatening attacks in which breathing stops altogether.
Prevention of Anaphylaxis
Agents causing anaphylaxis should be identified when possible and avoided. Patients should be instructed how to minimize exposure.
Beta-adrenergic antagonists, including those used to treat glaucoma, may exacerbate anaphylaxis and should be avoided, where possible. Angiotensin-converting enzyme (ACE) inhibitors may also increase susceptibility to anaphylaxis, particularly with insect venom-induced anaphylaxis.
Epinephrine is the drug of choice to treat anaphylaxis.
Individuals at high risk for anaphylaxis should be issued epinephrine syringes for self-istration and instructed in their use.
Intramuscular injection into the anterolateral thigh is recommended since it results in immediate elevation of plasma concentrations and has immediate physiological effects. Subcutaneous injection results in delayed epinephrine absorption. Patients must be alerted to the clinical signs of impending anaphylaxis and the need to carry epinephrine syringes at every times and to use it at the earliest onset of symptoms. Unused syringes should be replaced when they reach their use-by/expiration date, as epinephrine content and bioavailability of the drug decreases in proportion to the number of months past the expiration date.
Pre-treatment with glucocorticosteroids and H1 and H2 antihistamines is recommended to prevent or reduce the severity of a reaction where it is medically necessary to ister an agent known to cause anaphylaxis, for example, radio-contrast media.
Other significant patient instructions include:
a) Personalized written anaphylaxis emergency action plan
b) Medical Identification (e.g., bracelet, wallet card)
c) Medical record electronic flag or chart sticker, and emphasis on the importance of follow-up investigations by an allergy/immunology specialist
The differential diagnosis for anaphylaxis includes:
- globus hystericus
- overdose of medication
- respiratory difficulty or circulatory collapse, including vasovagal reactions
- myocardial infarction
- status asthmaticus
- cold urticaria
- cholinergic urticaria
- carcinoid syndrome
- hereditary angioedema
- pulmonary embolism
- foreign body aspiration
- sulfite or monosodium glutamate ingestion
Upper airway obstruction, bronchospasm, abdominal cramps, pruritus, urticaria and angioedema are absent in vasovagal reactions.
Pallor, syncope, diaphoresis and nausea generally indicate a vaso-vagal reaction but may happen in either condition.
If a reaction occurs during a medical procedure, it is significant to consider a possible reaction to latex or medication used for or during anesthesia.
Definition of Anaphylaxis
Anaphylaxis is an acute, potentially life-threatening hypersensitivity reaction, involving the release of mediators from mast cells, basophils and recruited inflammatory cells.
Anaphylaxis is defined by a number of signs and symptoms, alone or in combination, which happen within minutes, or up to a few hours, after exposure to a provoking agent. It can be mild, moderate to severe, or severe. Most cases are mild but any anaphylaxis has the potential to become life-threatening.
Anaphylaxis develops rapidly, generally reaching peak severity within 5 to 30 minutes, and may, rarely, final for several days.
Anaphylaxis is a rare, potentially fatal allergic reaction that affects numerous parts of the body at the same time.
The trigger may be an insect sting, a food (such as peanuts) or a medication. Symptoms may include:
- difficulty breathing
- vomiting or diarrhea
- swelling of the throat and/or tongue
- a dangerous drop in blood pressure
- redness of the skin and/or hives
- loss of consciousness.
Frequently these symptoms start without warning and get worse rapidly. At the first sign of an anaphylactic reaction, the affected person must go immediately to the closest Emergency Room or call 911.
The primary way to manage a food allergy is to avoid consuming the food that causes you problems. Carefully check ingredient labels of food products, and study whether what you need to avoid is known by other names.
The Food Allergy Labeling and Consumer Protection Act of 2004 (FALCPA) mandates that manufacturers of packaged foods produced in the United States identify, in simple, clear language, the presence of any of the eight most common food allergens — milk, egg, wheat, soy, peanut, tree nut, fish and crustacean shellfish — in their products.
The presence of the allergen must be stated even if it is only an incidental ingredient, as in an additive or flavoring.
Some goods also may be labeled with precautionary statements, such as “may contain,” “might contain,” “made on shared equipment,” “made in a shared facility” or some other indication of potential allergen contamination. There are no laws or regulations requiring those advisory warnings and no standards that define what they mean. If you own questions about what foods are safe for you to eat, talk with your allergist.
Be advised that the FALCPA labeling requirements do not apply to items regulated by the U.S. Department of Agriculture (meat, poultry and certain egg products) and those regulated by the Alcohol and Tobacco Tax and Trade Bureau (distilled spirits, wine and beer). The law also does not apply to cosmetics, shampoos and other health and beauty aids, some of which may contain tree nut extracts or wheat proteins.
Avoiding an allergen is easier said than done. While labeling has helped make this process a bit easier, some foods are so common that avoiding them is daunting. A dietitian or a nutritionist may be capable to assist.
These food experts will offer tips for avoiding the foods that trigger your allergies and will ensure that even if you exclude certain foods from your diet, you still will be getting every the nutrients you need. Special cookbooks and support groups, either in person or online, for patients with specific allergies can also provide useful information.
Many people with food allergies wonder whether their condition is permanent. There is no definitive answer. Allergies to milk, eggs, wheat and soy may vanish over time, while allergies to peanuts, tree nuts, fish and shellfish tend to be lifelong.
C = Circulation
Minimize or eliminate continued exposure to causative agent by discontinuing the infusion, as with radio-contrast media, or by placing a venous tourniquet proximal to the site of the injection or insect sting.
Assess adequacy of perfusion by taking the pulse rate, blood pressure, mentation and capillary refill time. Establish I.V. access with large bore (16- to 18-gauge) catheter and ister an isotonic solution such as normal saline. A second I.V. may be established as necessary. If a vasopressor, such as dopamine becomes necessary, the patient requires immediate transfer to an intensive care setting.
The same ABC mnemonic can be used for the pharmacologic management of anaphylaxis:
B = Benadryl (diphenhydramine)
Antihistamines are not useful for the initial management of anaphylaxis but may be helpful once the patient stabilizes.
Diphenhydramine may be istered intravenously, intramuscularly or orally. Cimetidine offers the theoretical benefit of reducing both histamine-induced cardiac arrhythmias, which are mediated via H2 receptors, and anaphylaxis-associated vasodilation, mediated by H1 and H2 receptors. Cimetidine, up to 300 mg every 6 to 8 hours, may be istered orally or slowly I.V. Doses must be adjusted for children.
Anaphylaxis caused by radio-contrast media
Mild adverse reactions are experienced by approximately 5% of subjects receiving radio-contrast media. U.S. figures propose that severe systemic reactions happen in 1:1000 exposures with death in 1:10,000-40,000 exposures.
Sodium and Potassium Sulfites, Bisulfites, Metabisulfites, and Gaseous Sulfur Dioxides
These preservatives are added to foods and drinks to prevent discoloration and are also used as preservatives in some medications.
Sulfites are converted in the acid environment of the stomach to SO2 and H2SO3, which are then inhaled. They can produce asthma and non-allergic hypersensitivity reactions in susceptible individuals.
Cytoxic and Immune Complicated – Complement-Mediated Reactions
Aspirin, Ibuprofen, Indomethacin and other Non-steroidal Anti-inflammatory Agents (NSAIDs)
IgE antibodies against aspirin and other NSAIDs own not been identified. Affected individuals tolerate choline or sodium salicylates, substances closely structurally related to aspirin but diverse in that they lack the acetyl group.
Latex is a milky sap produced by the rubber tree Hevea brasiliensis.
Latex-related allergic reactions can complicate medical procedures, for example, internal examinations, surgery, and catheterization. Medical and dental staff may develop occupational allergy through use of latex gloves.
Radiocontrast Media, Low-molecular Weight Chemicals
Mast cells may degranulate when exposed to low-molecular-weight chemicals. Hyperosmolar iodinated contrast media may cause mast cell degranulation by activation of the complement and coagulation systems. These reactions can also happen, but much less commonly, with the newer contrast media agents.
The prevalence of food-induced anaphylaxis varies with the dietary habits of a region.
A United States survey reported an annual occurrence of 10.8 cases per 100,000 person years. By extrapolating this data to the entire population of the USA, this suggests approximately 29,000 food-anaphylactic episodes each year, resulting in approximately 2,000 hospitalizations and 150 deaths. Similar findings own been reported in the United Kingdom and France. Food allergy is reported to cause over one-half of every severe anaphylactic episodes in Italian children treated in emergency departments and for one-third to one-half of anaphylaxis cases treated in emergency departments in North America, Europe and Australia.
It is thought to be less common in non-Westernized countries. A study in Denmark reported a prevalence of 3.2 cases of food anaphylaxis per 100,000 inhabitants per year with a fatality rate of approximately 5%.
Risk factors for food anaphylaxis include asthma and previous allergic reactions to the causative food.
Examples of miscellaneous agents which cause anaphylaxis are insulin, seminal proteins, and horse-derived antitoxins, the latter of which are used to neutralize venom in snake bites.
Individuals who own IgA deficiency may become sensitized to the IgA provided in blood products. Those selective IgA deficient subjects (1:500 of the general population) can develop anaphylaxis when given blood products, because of their anti-IgA antibodies (probably IgE-anti-IgA).
Whole Blood, Serum, Plasma, Fractionated Serum Products, Immunoglobulins, Dextran
Anaphylactic responses own been observed after the istration of whole blood or its products, including serum, plasma, fractionated serum products and immunoglobulins. One of the mechanisms responsible for these reactions is the formation of antigen-antibody reactions on the red blood cell surface or from immune complexes resulting in the activation of complement.
The athletic by-products generated by complement activation (anaphylatoxins C3a, C4a and C5a) cause mast cell (and basophil) degranulation, mediator release and generation, and anaphylaxis. In addition, complement products may directly induce vascular permeability and contract smooth muscle.
Cytotoxic reactions can also cause anaphylaxis, via complement activation. Antibodies (IgG and IgM) against red blood cells, as occurs in a mismatched blood transfusion reaction, activate complement. This reaction causes agglutination and lysis of red blood cells and perturbation of mast cells resulting in anaphylaxis.
Non-immunologic Mast Cell Activators
A = Airway
Ensure and establish a patent airway, if necessary, by repositioning the head and neck, endotracheal intubation or emergency cricothyroidotomy.
Put the patient in a supine position and elevate the lower extremities. Patients in severe respiratory distress may be more comfortable in the sitting position.
Elective Medical Procedures
Catamenial anaphylaxis is a syndrome of hypersensitivity induced by endogenous progesterone secretion. Patients may exhibit a cyclic pattern of attacks during the premenstrual part of the cycle.
C = Corticosteroids
Corticosteroids do not benefit acute anaphylaxis but may prevent relapse or protracted anaphylaxis. Hydrocortisone (100 to 200 mg) or its equivalent can be istered every 6 to 8 hours for the first 24 hours.
Doses must be adjusted for children.
The term anaphylaxis is often reserved to describe immunological, especially IgE-mediated reactions. A second term, non-allergic anaphylaxis, describes clinically identical reactions that are not immunologically mediated. The clinical diagnosis and management are, however, identical.
Be additional careful when eating in restaurants.
Waiters (and sometimes the kitchen staff) may not always know the ingredients of every dish on the menu. Depending on your sensitivity, even just walking into a kitchen or a restaurant can cause an allergic reaction.
Consider using a “chef card” — available through numerous websites — that identifies your allergy and what you cannot eat. Always tell your servers about your allergies and enquire to speak to the chef, if possible. Stress the need for preparation surfaces, pans, pots and utensils that haven’t been contaminated by your allergen, and clarify with the restaurant staff what dishes on the menu are safe for you.
Allergic Rhinitis (Hay Fever)
Allergic rhinitis is a general term used to describe the allergic reactions that take put in the nose.
Symptoms may include sneezing, congestion, runny nose, and itching of the nose, the eyes and/or the roof of the mouth. When this problem is triggered by pollens or outdoor molds, during the Spring, Summer or Drop, the condition is often called «hay fever.» When the problem is year-round, it might be caused by exposure to home dust mites, household pets, indoor molds or allergens at school or in the workplace.
Symptoms caused by a food allergy can range from mild to life-threatening; the severity of each reaction is unpredictable. People who own previously experienced only mild symptoms may suddenly experience a life-threatening reaction called anaphylaxis, which can, among other things, impair breathing and cause a sudden drop in blood pressure.
This is why allergists do not love to classify someone as “mildly” or “severely” food allergic — there is just no way to tell what may happen with the next reaction. In the U.S., food allergy is the leading cause of anaphylaxis exterior the hospital setting.
Epinephrine (adrenaline) is the first-line treatment for anaphylaxis, which results when exposure to an allergen triggers a flood of chemicals that can send your body into shock. Anaphylaxis can happen within seconds or minutes of exposure to the allergen, can worsen quickly and can be fatal.
Once you’ve been diagnosed with a food allergy, your allergist should prescribe an epinephrine auto-injector and teach you how to use it.
You should also be given a written treatment plan describing what medications you’ve been prescribed and when they should be used. Check the expiration date of your auto-injector, note the expiration date on your calendar and enquire your pharmacy about reminder services for prescription renewals.
Anyone with a food allergy should always own his or her auto-injector shut at hand. Be certain to own two doses available, as the severe reaction can recur in about 20 percent of individuals. There are no data to assist predict who may need a second dose of epinephrine, so this recommendation applies to every patients with a food allergy.
Use epinephrine immediately if you experience severe symptoms such as shortness of breath, repetitive coughing, feeble pulse, hives, tightness in your throat, trouble breathing or swallowing, or a combination of symptoms from diverse body areas, such as hives, rashes or swelling on the skin coupled with vomiting, diarrhea or abdominal pain.
Repeated doses may be necessary. You should call for an ambulance (or own someone nearby do so) and inform the dispatcher that epinephrine was istered and more may be needed. You should be taken to the emergency room; policies for monitoring patients who own been given epinephrine vary by hospital.
If you are uncertain whether a reaction warrants epinephrine, use it correct away; the benefits of epinephrine far outweigh the risk that a dose may not own been necessary.
Common side effects of epinephrine may include anxiety, restlessness, dizziness and shakiness. In extremely rare instances, the medication can lead to abnormal heart rate or rhythm, heart attack, a sharp increase in blood pressure and fluid buildup in the lungs.
If you own certain pre-existing conditions, such as heart disease or diabetes, you may be at a higher risk for adverse effects from epinephrine. Still, epinephrine is considered extremely safe and is the most effective medicine to treat severe allergic reactions.
Other medications may be prescribed to treat symptoms of a food allergy, but it is significant to note that there is no substitute for epinephrine: It is the only medication that can reverse the life-threatening symptoms of anaphylaxis.
Managing food allergies in children
No parent wants to see their kid suffer. Since fatal and near-fatal food allergy reactions can happen at school or other places exterior the home, parents of a kid with food allergies need to make certain that their child’s school has a written emergency action plan.
The plan should provide instructions on preventing, recognizing and managing food allergies and should be available in the school and during activities such as sporting events and field trips. If your kid has been prescribed an auto-injector, be certain that you and those responsible for supervising your kid understand how to use it.
In November 2013, President Barack Obama signed into law the School Access to Emergency Epinephrine Act (PL 113-48), which encourages states to adopt laws requiring schools to own epinephrine auto-injectors on hand.
As of tardy 2014, dozens of states had passed laws that either require schools to own a supply of epinephrine auto-injectors for general use or permit school districts the option of providing a supply of epinephrine. Numerous of these laws are new, and it is uncertain how well they are being implemented. As a result, ACAAI still recommends that providers caring for food-allergic children in states with such laws maintain at least two units of epinephrine per allergic kid attending the school.
When Exposure to Peanuts Can Cause a Physical Reaction
While just smelling peanuts won’t cause a severe reaction, if you’re allergic to peanuts, the smell can trigger a response in your body because it senses danger.
“Peanuts own a extremely potent smell.
The smell may be enough to trigger some of the anxiety, concerns and fear that rightfully come because you anticipate a reaction,” Dr. Kim says. “It’s a survival instinct. Your body knows there is something around that it should not be eating.”
Dr. Kim says that if you are allergic to peanuts, you can experience nausea or just feel a little off if you smell them. “And if the person who sat in an airplane seat before you happened to eat peanuts and was not extremely clean, you could potentially touch it in a chair and own a little bit of a rash or irritation” on the skin, he says.
So whether it’s on a plane or at the lunchroom table, wipe below the area if you smell peanuts or are concerned about residue.
Also, if you own a kid who is allergic to peanuts, make certain you teach him or her early not to share food with friends.
“If they’re too young to know not to share foods, then that might be the one time where an actual separated table (for children with peanut allergies) could make sense,” Dr. Kim says. “But as they get older and you feel love they own learned this and can control their instincts, there’s no reason they can’t sit alongside their friends.”
Talk to your or your child’s doctor if you’re concerned about food allergies. If you need a doctor, discover one near you.
Edwin Kim, MD, MS, is an allergist at the UNC Allergy and Immunology Clinic in Chapel Hill and an assistant professor of allergy and immunology at the UNC School of Medicine.
He is also the director of the UNC Food Allergy Initiative.
How do scientists know how much pollen is in the air? They set a trap. The trap — generally a glass plate or rod coated with adhesive — is analyzed every few hours, and the number of particles collected is then averaged to reflect the particles that would pass through the area in any 24-hour period. That measurement is converted to pollen per cubic meter. Mold counts work much the same way.
A pollen count is an imprecise measurement, scientists confess, and an arduous one — at the analysis stage, pollen grains are counted one by one under a microscope.
It is also highly time-consuming to discern between types of pollen, so they are generally bundled into one variable. Given the imprecise nature of the measurement, entire daily pollen counts are often reported simply as low, moderate or high.
The American Academy of Allergy, Asthma & Immunology provides up-to-date pollen counts for U.S. states.