What is Anaphylaxis

Our Guide to Severe Allergic Reactions

Almost half of adults and more than 40% of children in the UK have been diagnosed with at least one allergy, according to recent studies. Almost half of those who do suffer have more than one allergy, and research shows that it’s on the increase.

So if you don’t have at least one yourself, the chances are that you share a house or office with someone who does.

Fortunately for many of us, me included, they’re a comparatively slow-developing, mild annoyance - think hayfever, for example (don’t get me wrong, they can still be really unpleasant and debilitating) that can be managed using antihistamine medication. 

Anaphylaxis is Different

While anaphylaxis is also a reaction to an allergen, its severity is on a whole different scale.

Anaphylaxis affects the whole body and is life-threatening.

It typically comes on really quickly – within minutes of contact with the allergen, although more unusually, it can take a few hours to kick in. And when it does, its symptoms are really serious, involving airway, breathing and circulation problems.

Common Causes of Anaphylaxis

There are many different causes of anaphylaxis and as such, no list that I provide here could include all of the possibilities. But some causes are more common than others. They include:

Food related:

• Peanuts
• Tree Nuts
• Kiwi
• Milk
• Sesame
• Fish & Shellfish
• Lupin (related to peanuts)

Non-Food:

• Latex – often found in rubberised products such as rubber gloves, rubberised flooring, rubber bands, erasers, balloons, condoms, baby bottle teats and dummies, carpet backing etc
• Penicillin
• Other Drugs
• Wasp & Bee Stings

How Common is it?

Research published in 2021 in the British Medical Journal shows that hospital admissions due to anaphylaxis has been increasing over the past two decades. This is particularly found in the under-15s, and is due to both non-food and food-related causes, as shown in the graphs below from the BMJ. 

Graph from: BMJ 2021: Food anaphylaxis in the United Kingdom: analysis of national data, 1998-2018

Main Symptoms

The following lists the main symptoms of anaphylaxis. Anaphylaxis UK refer to them as the ABC symptoms. Note that not all symptoms need to be present for an attack to be really serious:

A – AIRWAY: swelling throat, tongue or airway, causing tightening in the throat resulting in increased difficulty in swallowing and changes to the voice
B – BREATHING: wheezing, noisy, difficult breathing
C – CIRCULATION: dizziness, tiredness, confusion, pale & clammy skin, loss of consciousness.

Sufferers may get one or more of the above symptoms, and can often also get skin rashes, itching, flushing or swelling skin, stomach pains and feeling or being sick.

If the sufferer’s condition is left untreated, collapse and unconsciousness will follow swiftly.

Treatment

A sufferer should have been prescribed an adrenaline auto-injector and should carry two in-date injectors at all times. These autoinjectors may have different brand names such as Epipen®, Jext® and Emerade®.
Treatment should be immediate, the moment a known sufferer gets any of the main ABC symptoms.

1. Sit the person down.
2. If they feel faint, they can lie down and raise their legs.
3. They should use the auto-injector as soon as any of the anaphylaxis symptoms are present. This will usually be self-administered by the sufferer.
4. As soon as the auto-injector is administered, an ambulance MUST be called, and the emergency services operator should be told that the person is suffering from anaphylaxis.
5. Make a note of the time that they self-administered the adrenaline.
6. If symptoms remain after 5 minutes, or if there is any doubt whether the patient has improved, the second dose should be given.
7. Whether there’s any improvement or not, the sufferer MUST be seen by a paramedic. Even if symptoms improve, they can return and prove fatal.
8. Stay with them until professional medical help arrives.
9. Be prepared to resuscitate them if necessary.

Minimising Risk

There are several things that can be done by the sufferer (or person helping them) to reduce risk. They include:

1. Make sure you know and avoid as many of the potential triggers as possible. So for food triggers, always check the ingredients lists, check with restaurants, cafes and takeaways about ingredients. Determine whether trigger foods are prepared on the same premises.
2. Always carry two in-date adrenaline auto-injectors at all times. If you need to go and find one during an attack, it may be too late.
3. Use your autoinjector if you think you’re having an attack, even if you’re not sure.
4. If you’re unsure about your particular triggers, it may be possible to be referred to an allergy clinic to have tests. These would help to identify the food and non-food items which may bring on an attack in your case, and could help you to avoid them.
5. If you’re allergic to certain medication, make sure you know which ones, and ensure that you let any medical professional know as they’re prescribing for you (they should always ask). This is particularly important if you’re seeing a medical professional who is not your regular GP, and who may not have access to your medical records.

Help from Specialist Support Organisations

In addition to your GP and hospital, there are several organisations in the UK that provide support and other services.

Anaphylaxis UK

Anaphylaxis UK has a comprehensive website giving lots of details about anaphylaxis. Particularly useful are the sections on living with serious allergies, where they talk about shopping, travelling, eating out, living at University, and their allergy alerts, which will automatically email you about food production and mislabelling issues. They also have an information and advice section specifically for schools.

Allergy UK

Allergy UK produce translation cards which you can use make non-English speakers aware of your allergies or that you’re suffering from a serious allergic reaction. They also have a resources section which includes free-from recipes and links to books, factsheets and videos.

Natasha Allergy Research Foundation

This is the charity that was borne out of the tragic death Of Natasha Ednan-Laperouse, who sadly died after eating sesame seeds that were baked into the dough of a baguette.

Natasha’s parents campaigned tirelessly to change the law to close a loophole on food labelling, and as a result, Natasha’s Law came into effect on 1st October 2021.

Their foundation now continues to campaign about and fundraising to fight allergies and anaphylaxis. You can read more, join their campaign or donate at the Natasha Allergy Research Foundation website. 

What Anaphylaxis training is available?

Several training courses are available for those who may be exposed to, or care for those who may be exposed to an anaphylactic reaction.

• The 3-day First Aid at Work course includes basic training in administering to a casualty with anaphylaxis. Anyone who works in an environment where they’re likely to encounter people with anaphylaxis should consider having first aiders trained to this level.
• The 2-day Paediatric First Aid course (including full face-to-face and blended versions) includes training in treating young people with anaphylaxis.
• We also offer anaphylaxis and epi-pen training courses suitable for those who care for or are responsible for anyone who is known to suffer from severe allergic reactions. Different versions of this course can be run with and without CPR skills updates.
• Finally, we also offer an anaphylaxis training top-up for GPs and other medical practitioners as an optional addon to your annual CPR training sessions.