Essential information - how to deal with a serious allergic reaction

Mar 7 2006

Hundreds of Americans die each year from anaphylaxis which is a serious allergic reaction that is rapid in onset and may cause death.

The American Academy of Allergy, Asthma and Immunology (AAAAI) aims to bring this health concern to the attention of the nation through education and new research.

Estelle Simons, MD, President of the AAAAI says people who suffer from allergies to foods, medications, insect stings, or natural rubber latex need to be aware of the potential for an anaphylactic reaction.

Dr. Simmons believes the keys to decreasing deaths caused by anaphylaxis are: assess risk in people who have experienced previous severe allergic reactions, begin long-term risk-reduction strategies for these people, and provide anaphylaxis education.

Simons and her team asked people at a Food Allergy and Anaphylaxis Network conference to describe treatment both in the community and in the healthcare setting, of anaphylaxis for their family's most severely food-allergic individual.

According to the results of the survey most children with food allergies children resulting in severe throat, respiratory and cardiovascular symptoms of anaphylaxis, a potentially fatal allergic reaction, do not receive epinephrine and many do not seek medical attention.

For those children who do, the treatment is often sub-optimal.

Dr. Elinor Simons from Mount Sinai School of Medicine in New York, and colleagues suggest the survey results show the management of allergic reactions in the community and medical setting leave a lot to be desired.

Simons says of the 507 food-allergic individuals identified, 96 percent were children younger than age 18.

During initial anaphylactic reactions, 38 percent of these children experienced severe, potentially life-threatening symptoms such as throat tightness or swelling, lower airway symptoms such as coughing or wheezing, and cardiovascular symptoms such as fainting or low blood pressure.

But despite the severity of their symptoms, only 6 percent received pre-hospital epinephrine and only 57 percent sought medical attention, says Simons.

She also found that during 271 subsequent "worst reactions", 66 percent had severe anaphylactic symptoms, 33 percent received pre-hospital epinephrine, and 75 percent sought medical attention.

Simons says although the children had slightly improved management with subsequent reactions, many of them with severe throat, respiratory or cardiovascular symptoms due to anaphylaxis from food, did not receive optimal management.

It appears the predominant reasons for not seeking medical attention were that the reaction did not seem to be severe enough (45 percent) or that the reaction was not recognized as severe (33 percent).

Simons says it was interesting that in 16 percent of reactions, parents were advised by a physician that their child's symptoms did not require medical attention.

For children with severe symptoms of anaphylaxis who did receive care in the ER or a medical office, observation periods were too brief (50 percent were less than 2 hours), epinephrine was under-prescribed, and training on how to self-administer epinephrine and food avoidance instructions were "not ideal", says Simons.

In conclusion Simons says doctors and families must be educated to ensure that all food allergic individuals have self-injectable epinephrine available to them at all times, and that they are trained to use their epinephrine and seek medical attention promptly for any symptoms of anaphylaxis.

The AAAAI emphasizes the following important information about anaphylaxis:

• Anyone, especially people allergic to foods such as peanuts, tree nuts,seafood, fin fish, milk or egg, or to insect stings, natural rubber latex or medications, can suffer from an anaphylactic reaction.
• An anaphylactic reaction can happen within minutes of an allergic person coming into contact with his or her specific trigger.
• Several symptoms occur at the same time and include: itching, hives,flushing, difficulty breathing, vomiting diarrhea, dizziness,confusion, or shock.
• When a person develops an anaphylactic reaction, epinephrine should be injected, and 911 or emergency medical services should be called.
• It is important to act quickly, because it is difficult to predict whether the anaphylaxis episode will be mild, life-threatening, or fatal.
• Follow-up is needed because anaphylaxis can occur repeatedly.
• Risk-assessment needs to be performed, and the trigger needs to be confirmed.
• Risk-reduction (a long-term preventive strategy) needs to be implemented.

While anaphylaxis poses a serious health risk, new research offers insights into how often anaphylaxis occurs, what behaviors put allergy sufferers more at risk of suffering an anaphylactic episode, as well as a new test to confirm the diagnosis of an anaphylaxis episode.

The AAAAI is the largest professional medical specialty organization in the United States representing allergists, asthma specialists, clinical immunologists, allied health professionals and others with special interest in the research and treatment of allergic disease.

Information on the AAAAI can be accessed through its web site.