How to Save Lives: Recognizing and Treating Anaphylaxis

By Neena Chawla, MD
Edited by Megan Black, Marketing Specialist

Summer is finally here, and with it comes weekends full of exciting events with family and friends, outdoor adventures and more. It is also a time that opens us up to risk factors for allergic reactions, like bee stings and picnic foods with unfamiliar ingredients. For some individuals, this can lead to a severe allergic reaction called anaphylaxis.

In this article, Dr. Neena Chawla will examine the risk factors, symptoms, and the life-saving steps to take when you or someone you know is experiencing anaphylaxis. Knowing the signs, risk factors, and what to do in an emergency can save lives.

What Is Anaphylaxis?

Anaphylaxis is a rapid, severe allergic reaction that can be fatal if not treated immediately. It can happen within minutes of exposure to an allergen and affects multiple parts of the body, including the respiratory and cardiovascular systems.

Anaphylaxis is the body’s overreaction to a trigger — usually something the immune system mistakenly identifies as harmful, such as certain foods, insect stings, or medications. Unlike a mild allergic reaction, anaphylaxis involves the entire body and progresses quickly. Without quick intervention, it can lead to blocked airways, a dangerous drop in blood pressure, and even death.

Risk Factors of Anaphylaxis

There aren’t many known risk factors for anaphylaxis, but some things that might increase the risk include: 

• Previous anaphylaxis: If you’ve had anaphylaxis once, your risk of having this serious reaction increases. Future reactions might be more severe than the first reaction. 
• Allergies or asthma: People who have either condition are at increased risk of having anaphylaxis.
• Certain other conditions: These include heart disease and an irregular accumulation of a certain type of white blood cell (mastocytosis).

Symptoms of Anaphylaxis

Symptoms of anaphylaxis can vary but usually begin within minutes of exposure to the allergen. In some cases, the reaction may be delayed. Common signs include:

• Tightness in the throat, wheezing, coughing, or difficulty breathing or swallowing
• Swelling of the lips, tongue, face, or throat (or of any other body parts)
• Hives, redness, or itching
• Red, watery eyes, runny nose
• Vomiting, nausea, stomach cramps, or diarrhea
• Dizziness, fainting, or change of color/voice
• Feeling a sense of doom or like something is very wrong

If someone shows signs of anaphylaxis, do not wait to see if it gets better — immediate treatment is essential.

Prevention of Anaphylaxis

The best way to prevent anaphylaxis is to stay away from substances that cause this severe reaction. Also: 

• Wear a medical alert necklace or bracelet to indicate you have an allergy to specific drugs or other substances. 
• Keep an emergency kit with prescribed medications available at all times. Your provider can advise you on the contents. If you have an epinephrine auto injector, check the expiration date and be sure to refill the prescription before it expires. Do not refrigerate your auto injectors.
• Alert all your providers to medication reactions you’ve had. 
• If you’re allergic to stinging insects, use caution around them. Wear long-sleeved shirts and pants; don’t walk barefoot on grass; don’t wear bright colors; don’t wear perfumes, colognes or scented lotions; and don’t drink from open soda cans outdoors. Stay calm when near a stinging insect. Move away slowly and don’t slap at the insect. 
• If you have food allergies, carefully read the labels of all the foods you buy and eat. Manufacturing processes can change, so it’s important to periodically recheck the labels of foods you commonly eat. When eating out, ask how each dish is prepared, and find out what ingredients it contains. Even small amounts of food you’re allergic to can cause a serious reaction. 

Treatment of Anaphylaxis

Once anaphylaxis has begun, the treatment of choice is an immediate intramuscular injection of epinephrine, which is effective for 10-to-15 minutes (according to the manufacturer of epinephrine auto-injectors, Dey Labs), followed by emergency medical attention.

1. Use an epinephrine auto injector immediately (see instructions below).
2. Call 911. Even if symptoms improve after the injection, the person must be seen by medical professionals.*
3. Keep the person lying down with legs elevated, unless they are having trouble breathing.
4. If there is no improvement after 5-to-15 minutes and emergency help has not yet arrived, a second dose may be needed. Use a second auto-injector if available.

*Please note that it’s very important to seek medical attention after experiencing anaphylaxis. Some individuals have an anaphylactic reaction and the symptoms go away only to return a few hours later. This is called a bi-phasic reaction. Often the symptoms of the biphasic reaction occur in the respiratory system and take the individual by surprise. Therefore, according to the American Academy of Asthma Allergy and Immunology, after a serious reaction “observation in a hospital setting is necessary for at least four hours after initial symptoms subside because delayed and prolonged reactions may occur even after proper initial treatment.”

How to Use an Autoinjector

An epinephrine auto injector is a disposable drug delivery system that contains the proper dose of epinephrine and is used to treat anaphylaxis. It is supplied as a spring-loaded syringe that can be easily transported. Always follow the specific directions of the manufacturer. Epinephrine autoinjectors (like EpiPen, Auvi-Q, or others) are designed to be easy to use. Here’s how they typically work:

1. Remove the safety cap. Hold the device firmly in your fist with the orange tip (needle end) pointing downward.

2. Place it against the outer thigh. It can go through clothing if necessary. Choose the middle of the thigh.

3. Inject. Push down hard at a 90 degree angle from the thigh until you hear a click. Hold the device in place for 10 seconds to allow the medicine to enter the muscle. DO NOT inject intravenously or into your buttock as this may not be effective for a severe allergic reaction.

4. Remove and massage. Take the injector out (replace orange cap) and rub the injection site for 10 seconds.

5. Call 911. Inform responders that epinephrine has been administered. Give them the used device for proper disposal.

If you’re prescribed an epinephrine auto injector, keep it with you at all times — at home, at school, at work, or during travel. Make sure those around you know how to use it in case you are unable to. It is generally recommended that two epinephrine autoinjectors be kept on-hand as back-up.

Anaphylaxis is serious, but with prompt recognition and treatment, it is manageable. If you or someone you know is at risk, speak with a healthcare provider about carrying an auto injector and creating an emergency action plan. Let us know if you’d like help developing a custom plan or accessing training on how to use an EpiPen effectively. Make an appointment with your PCP today by calling 253-848-5951.

Sources: OHSU Allergy and Immunology Epinephrine, American Academy of Asthma Allergy and Immunology, Everyday Health, Sound Family Medicine