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Topic of the Month: June 2006: Avoiding severe allergic reactions this summer
In this month's topic you will learn:
- What anaphylaxis is
- Symptoms of anaphylaxis
- How to avoid anaphylaxis
- When to see an allergy/immunology specialist
- Additional resources
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Summer is in full bloom and people are enjoying fun outdoor activities. Allergy sufferers should keep in mind that along with the warm weather, comes exposure to allergens that could trigger a potentially life-threatening attack. This is why people with severe allergies need to take extra precautions this summer to avoid a severe type of allergic reaction called anaphylaxis.
Anaphylaxis is a severe allergic reaction that may involve the entire body. It can result in trouble breathing, loss of consciousness and even death. Anaphylaxis is a medical emergency that requires immediate medical treatment and follow-up care by an allergist/immunologist.
Anaphylaxis is triggered in the same way as allergies. The immune system—which serves as the body's defense against potentially dangerous substances such as germs—overreacts to a harmless substance (an allergen) and in that process can damage the body. As part of the normal immune response, proteins called antibodies are produced that can detect and help destroy “invaders” in the body. A specific antibody called Immunoglobulin E (IgE), is responsible for the adverse reactions in people with allergies.
When allergens first enter the body of a person predisposed to allergies, the immune system produces the allergen-specific IgE antibodies. The IgE antibodies attach themselves to the surface of cells called mast cells. The next time that allergic individual comes into contact with the allergen, the IgE identifies it and quickly initiates the release of chemicals, such as histamine, from the mast cells. These potent chemicals cause the symptoms seen in allergic reactions and anaphylaxis.
Symptoms
Anaphylaxis is a "systemic reaction," which means that various parts of the body are affected that are a distance from the allergen's initial entry site (e.g., Being stung in the foot but having trouble breathing). Symptoms of anaphylaxis can vary from mild to severe and are potentially deadly. Here is a list of possible symptoms that may occur alone or in any combination:
- Skin: hives, swelling, itch, warmth, redness, rash
- Breathing: wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, nasal congestion/hay fever-like symptoms, trouble swallowing
- Stomach: nausea, pain/cramps, vomiting, diarrhea, itchy mouth/throat
- Circulation: pale/blue color, poor pulse, passing-out, dizzy/lightheaded, low blood pressure, shock
- Other: anxiety, feeling of "impending doom," red/itchy/watery eyes, headache, cramping of the uterus
Reactions usually begin within minutes of exposure, but may be delayed. Sometimes symptoms resolve, only to recur or progress a few hours later. The most dangerous symptoms are low blood pressure, breathing difficulties, shock and loss of consciousness, all of which can be fatal.
There are a variety of medical conditions that may mimic anaphylaxis. These include heart attacks, anxiety attacks, choking and seizures, among others. If you experience any unusual symptoms, it is vitally important to seek immediate medical attention (e.g., call 911) for prompt treatment and to determine the cause of the symptoms.
Triggers
Common substances that trigger anaphylaxis are foods, insect stings, and medications. It has been estimated that up to 15% of the population is at risk for anaphylaxis, and each year, about 40 people die after an anaphylactic reaction to insect stings, and about 100 people die from reactions to food. Below are tips to help avoid these triggers this summer.
 Eating away from home
Summer vacation is a great time to go for a picnic or eating at a restaurant, but for the 2 million or 8% of children, and 2% of adults in the United States are estimated to have food allergies. It is very important for people with severe food allergies to know what they are putting into their mouths; eating the wrong food could cause an anaphylactic attack. When eating away from home remember the following:
- Know which foods you are allergic to. The most common are: milk, eggs, peanuts, wheat and shellfish
- Always inform your friends' parents of any food allergies to avoid contact
- Don't be afraid to ask what something is made of, knowing the ingredient could help avoid an attack
- Make sure the table you are eating at is clean; the slightest contamination could trigger an attack
- Always carry injectable epinephrine and make sure someone around you knows how to administer it in case you are unable to do it yourself
 Bee-ware of insects
Summer is also the time of year when people are stung by bees, wasps, hornets, yellow jackets or fire ants. Common reactions to most stinging insects are temporary redness, swelling and itching at the site of the sting. But for people who are severely allergic to stinging insects, their immune systems may overreact to the venom injected by the insects resulting in a life-threatening reaction. Follow these tips to avoid stinging insects:
- Stay away from areas that the insects inhabit, this includes hives, nests and ant hills
- Hire a trained exterminator to destroy any hives and nests around your home
- Move slowly when encountered by a flying insect, do not "swat" them
- Avoid wearing bright colored clothing and heavy, sweet scented perfume when outdoors
- Keep all food covered until eaten
Medications
Virtually any medication can trigger an allergic reaction. Common categories of drugs that cause anaphylaxis are antibiotics and anti-seizure medicines. Medical therapies such as certain post-surgery fluids, vaccines, blood and blood products, radiocontrast dyes, pain medications and other drugs may cause anaphylactic reactions.
If you have had any reactions to medications in the past, make sure to keep a personal record so any physicians treating you in the future can be well informed. You should discuss with your doctor whether you need to also avoid related drugs and whether you need to wear a Medic-Alert tag to alert others of your drug allergy.
 Exercise
Summer is also a great time to be outside swimming, biking, playing ball or running. Although rare, exercise can also trigger anaphylaxis. It does not occur after every exercise session, and in some cases, only occurs after eating certain foods before exercise. For more information on exercise-induced anaphylaxis, check out the Exercise-induced asthma Tip to Remember or talk to your allergist/immunologist.
If you have severe allergies, or have ever experienced an anaphylactic reaction, remember to always carry injectable epinephrine and make sure someone around you knows how to administer it in case you are unable to.
When to see an allergy/asthma specialist
The AAAAI's How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:
- Have a severe allergic reaction (anaphylaxis) without an obvious or previously defined trigger.
- Have had anaphylaxis attributed to food, drugs, or insect stings.
- Have had exercise-induced anaphylaxis or food-dependent exercise induced anaphylaxis.
Additional Resources
This topic was reviewed on 6/1/2006 by Stuart Friedman, MD, FAAAAI, Patients & Consumers Web Editor
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