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Severe Allergic Reactions: Signs, Symptoms, Risk Factors, and Treatment09-10-15

The most serious form of allergic reaction is called ANAPHYLAXIS. This form of reaction has a rapid onset and can cause death if not detected and treated quickly. By a process called sensitization, re-exposure to an allergen may result in this extreme form of an allergic reaction.

Signs and Symptoms of Anaphylaxis

Signs and symptoms of a severe allergic reaction occur within minutes of exposure. Most commonly, children react to foods. Adults, on the other hand, are more likely to react this way from insect bites and stings. Symptoms generally include two or more body systems: skin, respiratory, gastrointestinal and/or cardiovascular.

Skin manifestations are typical including hives, swelling of the face, lips and tongue, itching, warmth and redness. Respiratory or breathing symptoms may include coughing, wheezing, shortness of breath, chest pain or tightness, throat tightness, hoarse voice, and trouble swallowing. Cardiovascular symptoms may be the most ominous including pale color, weak pulse, passing out, dizziness and even shock (as a result of significant loss in blood pressure). Gastrointestinal symptoms and neurological symptoms are less common and may include nausea, pain, vomiting, diarrhea, anxiety, headache or a sense of dread.

The most dangerous symptoms of an allergic reaction involving breathing difficulties or a drop in blood pressure indicated by dizziness, feeling faint, or passing out. All symptoms of an allergic reaction should be taken seriously.

Common Triggers of Allergic Reactions

The most common triggers are foods and insect stings (e.g. yellow jackets, hornets, wasps, honey bees). The most common foods are peanuts, tree nuts, milk, eggs, soy, wheat, and seafood (both fish and shellfish).

Anaphylaxis at a Glance

Risk Factors

Some factors increase the risk of a severe reaction. Children with asthma are more likely to experience life-threatening allergies. Delayed use of epinephrine when a reaction occurs increases the likelihood that a reaction will progress to anaphylaxis. Children with underlying cardiovascular disease are at increased risk of anaphylaxis. Finally, children with a known history of anaphylaxis are at higher risk of future events. However, 65% of children presenting with anaphylaxis have never had a prior episode. The highest incidence of anaphylaxis occurs in children aged 0 to 19 years.

Treatment of Anaphylaxis

Epinephrine is the drug form of a hormone (adrenaline) that the body produces naturally. Epinephrine is the treatment or drug of choice to treat anaphylaxis and as a result is widely prescribed for those at risk for anaphylaxis. All efforts should be directed to its immediate use. Epinephrine works by opening the airways, improving blood pressure, and accelerating heart rate. Epinephrine, better known as EpiPen and EpiPen Jr. comes in two dosages or strengths, 0.15mg and 0.30mg, and is prescribed based on the person’s weight. Epinephrine should be injected into the muscle of the mid-outer thigh. A second dose of epinephrine may be administered within 5 to 15 minutes after the first dose IF symptoms have not improved.

All individuals receiving epinephrine must be transported to a hospital immediately for evaluation and observation. It is recommended that a person suffering from an anaphylactic reaction be observed in an emergency facility for an appropriate period because of the possibility of either a “biphasic” reaction (a second reaction) or a prolonged reaction. A reasonable length of observation is usually 4 to 6 hours. More caution should be exercised in people with asthma.

Individuals with anaphylaxis who are feeling faint and dizzy because of impending shock should lie down with their legs elevated unless they are vomiting or experiencing severe respiratory distress.

Antihistamines and asthma medications should not be used instead of epinephrine for treating anaphylaxis. Antihistamines are useful in treating hives and skin symptoms when present alone.

Epinephrine Auto-Injectors must be kept in locations which are easily accessible but out of the reach of young children. It is beneficial for schools to have an epinephrine auto-injector as a standard item in their emergency or first-aid kit. Children who have demonstrated maturity should carry their own epinephrine when there is a known history of anaphylaxis.

The Role of Schools

The most important role of schools is the prevention of severe allergic reactions and avoidance is the cornerstone of preventing an allergic reaction. Very small amounts of certain foods can cause severe reactions when eaten. Direct ingestion of an allergy-causing food poses the greatest risk though. Effective ingredient labeling, special precautions for food preparation, proper hand washing and cleaning go a long way toward reducing the risk of an accidental exposure. Children with known food allergies should not trade or share food, food utensils, or food containers. The use of food in crafts and cooking classes may need to be modified or restricted. Many schools have “no eating” rule during daily travel for this very reason. All children should wash their hands with soap and water before and after eating. Surfaces such as tables, toys, etc. should be carefully cleaned of contaminating foods.

All school staff, including supply or substitute teachers and volunteers, must be aware of students at risk for anaphylaxis, have access to their allergy information and individualized health plan, and be instructed in the proper management strategies including the correct use of an epinephrine auto-injector.

Severe Allergic Reactions (Anaphylaxis): Signs, Symptoms, Risks, Treatment and School’s Response from ICON Pediatrics