Introduction

Anaphylaxis is a severe and potentially life-threatening reaction to a trigger such as an allergy.

It's also known as anaphylactic shock.

Symptoms of anaphylaxis

Anaphylaxis usually develops suddenly and gets worse very quickly.

The symptoms include:

  • feeling lightheaded or faint
  • breathing difficulties – such as fast, shallow breathing
  • wheezing
  • a fast heartbeat
  • clammy skin
  • confusion and anxiety
  • collapsing or losing consciousness

There may also be other allergy symptoms, including an itchy, raised rash (hives), feeling or being sick, swelling (angioedema), or stomach pain.

What to do if someone has anaphylaxis

Anaphylaxis is a medical emergency. It can be very serious if not treated quickly.

If someone has symptoms of anaphylaxis, you should:

  • use an adrenaline auto-injector if the person has one – but make sure you know how to use it correctly first
  • call 999 for an ambulance immediately (even if they start to feel better) – mention that you think the person has anaphylaxis
  • remove any trigger if possible – for example, carefully remove any wasp or bee sting stuck in the skin
  • lie the person down flat – unless they're unconscious, pregnant or having breathing difficulties
  • give another injection after 5-15 minutes if the symptoms don't improve and a second auto-injector is available

If you're having an anaphylactic reaction, you can follow these steps yourself if you feel able to.

Triggers of anaphylaxis

Anaphylaxis is the result of the immune system – the body's natural defence system – overreacting to a trigger.

This is often something you're allergic to, but isn't always.

Common anaphylaxis triggers include:

  • foods – including nuts, milk, fish, shellfish, eggs and some fruits
  • medicines – including some antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin
  • insect stings – particularly wasp and bee stings
  • general anaesthetic
  • contrast agents – special dyes used in some medical tests to help certain areas of your body show up better on scans
  • latex – a type of rubber found in some rubber gloves and condoms

In some cases, there's no obvious trigger. This is known as idiopathic anaphylaxis.

Preventing anaphylaxis

If you have a serious allergy or have experienced anaphylaxis before, it's important to try to prevent future episodes.

The following can help reduce your risk:

  • identify any triggers – you may be referred to an allergy clinic for allergy tests to check for anything that could trigger anaphylaxis
  • avoid triggers whenever possible – for example, you should be careful when food shopping or eating out if you have a food allergy
  • carry your adrenaline auto-injector at all times (if you have two, carry them both) – give yourself an injection whenever you think you may be experiencing anaphylaxis, even if you're not completely sure
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Treatment

Anaphylaxis is a medical emergency that requires immediate medical assistance and treatment.

What to do

If someone has symptoms of anaphylaxis, you should:

  1. use an adrenaline auto-injector if the person has one – but make sure you know how to use it correctly first
  2. call 999 for an ambulance immediately (even if they start to feel better) – mention that you think the person has anaphylaxis
  3. remove any trigger if possible – for example, carefully remove any wasp or bee sting stuck in the skin
  4. lie the person down flat – unless they're unconscious, pregnant or having breathing difficulties
  5. give another injection after 5-15 minutes if the symptoms don't improve and a second auto-injector is available

If you're having an anaphylactic reaction, you can follow these steps yourself if you feel able to.

Adrenaline auto-injectors

People with potentially serious allergies are often prescribed adrenaline auto-injectors to carry at all times. These can help stop an anaphylactic reaction becoming life threatening.

They should be used as soon as a serious reaction is suspected, either by the person experiencing anaphylaxis or someone helping them.

Make sure you're aware how to use your type of auto-injector correctly.

There are three main types of adrenaline auto-injector, which are used in slightly different ways.

These are:

Instructions are also included on the side of each injector if you forget how to use it or someone else needs to give you the injection.

Positioning and resuscitation

Someone experiencing anaphylaxis should be placed in a comfortable position.

  • most people should lie flat
  • pregnant women should lie on their left side to avoid putting too much pressure on the large vein that leads to the heart
  • people having trouble breathing should sit up to help make breathing easier
  • people who are unconscious should be placed in the recovery position to ensure the airway remains open and clear – place them on their side, making sure they're supported by one leg and one arm, and open their airway by lifting their chin
  • avoid a sudden change to an upright posture such as standing or sitting up – this can cause a dangerous fall in blood pressure

If the person's breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed immediately.

In hospital

You will need to go to hospital for observation – usually for 6-12 hours – as the symptoms can occasionally return during this period.

While in hospital:

  • an oxygen mask may be used to help breathing
  • fluids may be given directly into a vein to help increase blood pressure
  • additional medications such as antihistamines and steroids may be used to help relieve symptoms
  • blood tests may be carried out to confirm anaphylaxis

You should be able to go home when the symptoms are under control and it's thought they won't return quickly. This will usually be after a few hours, but may be longer if the reaction was severe.

You may be asked to take antihistamine and steroid tablets for a few days after leaving hospital to help stop your symptoms returning.

You will also probably be asked to attend a follow-up appointment with an allergy specialist so you can be given advice about how you can avoid further episodes of anaphylaxis.

Adrenaline auto-injectors may be provided for emergency use between leaving hospital and attending the follow-up appointment.

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Prevention

If you have a serious allergy or have experienced anaphylaxis, it's important to try to prevent future episodes.

The main thing you can do to reduce your risk are outlined below.

Identify triggers

Finding out if you're allergic to anything that could trigger anaphylaxis can help you avoid these triggers in future.

If you've had anaphylaxis and haven't already been diagnosed with an allergy, you should be referred to an allergy clinic for tests to identify any triggers.

The most commonly used tests are:

  • a skin prick test - your skin is pricked with a tiny amount of a suspected allergen to see if it reacts
  • a blood test - a sample of your blood is taken to test its reaction to a suspected allergen

Avoid triggers

If a trigger has been identified, you'll need to take steps to avoid it in the future whenever possible.  See below for advice about avoiding some specific triggers.

Food

You can reduce the chances of being exposed to a food allergen by:

  • checking food labels and ingredients
  • letting staff at a restaurant know what you're allergic to so it's not included in your meal
  • remembering some types of food may contain small traces of potential allergens - for example, some sauces contain wheat and peanuts

Insect stings

You can reduce your risks of being stung by an insect by taking basic precautions, such as:

  • moving away from wasps, hornets or bees slowly without panicking - don't wave your arms around or swat them
  • using an insect repellent if you spend time outdoors, particularly in the summer
  • being careful drinking out of cans when there are insects around - insects may fly or crawl inside the can and sting you in the mouth when you take a drink
  • not walking around outside with bare feet

Some specialist allergy centres can also offer special treatment to help desensitise you to insect stings (immunotherapy).

Medicines

If you're allergic to certain types of medicines, there are normally alternatives that can be safely used.

For example, if you're allergic to:

  • penicillin – you can normally safely take a different group of antibiotics known as macrolides
  • non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin – you can normally safely take paracetamol; read the ingredients of things like colds medicines carefully to make sure they don't contain NSAIDs
  • one type of general anaesthetic – others are available, or it may be possible to perform surgery using a local anaesthetic or an epidural injection

Always tell any healthcare professional about medicine allergies you have, as they may not be aware of them.

Carry adrenaline auto-injectors

You may be prescribed an adrenaline auto-injector if there's an ongoing risk you could develop anaphylaxis. 

There are three types of auto-injector – EpiPenJext and Emerade – that are each slightly different.

It's important to remember the following:

  • carry an auto-injector at all times (if you have two, carry them both) – there should be no exceptions; you may also be advised to get an emergency card or bracelet with full details of your allergy and doctor's contact details to alert others
  • extremes of heat can make adrenaline less effective – so don't leave your auto-injector in the fridge or your car's glove compartment, for example
  • check the expiry date regularly – an out-of-date injector will offer limited protection
  • manufacturers offer a reminder service, where you can be contacted near the expiry date – check the information leaflet that comes with your medicine for more information
  • don't delay injecting yourself if you think you may be experiencing anaphylaxis, even if your initial symptoms are mild – it's better to use adrenaline early and then find out it was a false alarm than delay treatment until you're sure you're experiencing severe anaphylaxis

If your child has an auto-injector, they will need to change over to an adult dose once they reach 30kg (approximately 4.5 stone).

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 20/02/2019 13:53:13