ALLERGY AND ASTHMA CARE
Michael S. Blaiss, M.D. Jerald M. Duncan, M.D. Fred Grogan, M.D. Brandon Hill, M.D.
Phil Lieberman, M.D. Tammy Heinly McCulley, M.D. George Treadwell, M.D.
Ingrid Cantrell, PA Marcia Johnston, APN Regina Seaton, APN
ANAPHYLAXIS
You have been experiencing a generalized allergic reaction we call anaphylaxis. This term refers to an allergy that occurs throughout the body. Because it is generalized the symptoms involve many organ systems. The most common organ systems to be involved are the skin and fatty tissue under the skin, the respiratory tract, the gastrointestinal tract, and the blood vessels throughout the body.
When the skin is involved the patient usually experiences giant, red welts. These usually itch. In addition there is a sensation of feeling flushed and you may turn red all over. This flushing is usually most prominent in the area of the face and neck.
Respiratory tract symptoms can consist of shortness of breath that can be produced by swelling of the tongue, swelling in the lungs, or swelling of the voice box (larynx).
Gastrointestinal symptoms can consist of stomach pain, diarrhea, and occasionally nausea and vomiting.
When numerous blood vessels are involved the serum leaks out of the blood vessels and pools in the legs and abdominal area. This can cause dizziness, light-headedness, and even fainting. The reason for these symptoms is that there is a fall in blood pressure.
Anaphylaxis is usually due to something that you have eaten or that you have received by injection. For example, drugs are the most common cause of anaphylaxis. Foods and food additives can also cause anaphylaxis. Insect stings are a very common cause. Finally, some cases are associated with certain illnesses.
To evaluate a patient with anaphylaxis we first take an extensive history. Occasionally the history tells us the cause. More often than not the history does not tell us the cause and we have to do certain tests. These tests consist of allergy testing, blood tests, and sometimes other studies.
On rare occasion, no matter how hard we try, we cannot find the cause of anaphylaxis. In these instances we simply have to continue to treat the episodes as they occur.
You can be of some help to us in finding the cause of your case of anaphylaxis. For example it is important for you to note what you have eaten before an episode. If a food, food additive, or ingested medication caused the episode the symptoms usually will occur within a maximum of two hours after ingestion. In addition, when ingestants cause the problem, gastrointestinal symptoms often are prominent. Common ingestants that cause anaphylactic episodes are drugs (you should know that any drug can do this, including aspirin), certain foods such as peanuts, shellfish, and nuts and, rarely, food additives.
If the cause of anaphylaxis cannot be found and therefore avoided, we simply have to treat each attack as it occurs or try to prevent an attack with medication.
The most important drug to treat an attack is epinephrine. You will be supplied with an epinephrine self-injector kit and taught how to use it. You should keep this kit with you at all times. Should you develop any symptoms you should take it immediately and proceed to the nearest medical facility.
Sometimes anaphylactic episodes can be prevented or lessened in severity by taking antihistamines on a regular basis. Antihistamines are not the drug of choice to treat the acute episode, but, if you take them regularly, they may lessen the severity of any episode that does occur.