S.A.F.E. Facts About Anaphylaxis for Physicians

Severe allergic emergencies affect an estimated 3 million to 40 million Americans (1.21 percent to 15.04 percent). Anaphylaxis due to severe allergic reactions to food, insect stings, medication and latex cause up to 1,500 deaths each year.
Symptoms of anaphylaxis include hives, itchiness and redness, wheezing and/or difficulty breathing, swelling of the tongue, throat and nose, dizziness and fainting or loss of consciousness, and nausea, stomach cramping and vomiting or diarrhea.
The symptoms can occur within minutes of exposure to the offending allergen or may develop up to two hours later. In some cases, a second reaction may occur eight to 12 hours after the initial reaction. If symptoms develop quickly, the condition is more likely to be severe and potentially fatal.
Patients who have a history of allergic conditions or have had a previous severe allergic reaction are at greater risk for anaphylaxis, but anyone can have a severe allergic reaction.
Identifying the cause of anaphylaxis requires a detailed history of all food and medication ingested before the reaction and a review of all activities. Exercise and seminal fluid can sometimes trigger or contribute to anaphylaxis. While a patient’s history is often the most important tool, skin tests or other diagnostic tests also may be performed to identify specific triggers, confirm a diagnosis or rule out other causes.
Food allergy accounts for about half of anaphylactic reactions with peanuts, tree nuts, shellfish, milk and eggs being the most common trigger.
Allergic reactions to insect stings are the cause of more than 500,000 hospital emergency room visits and at least 40 deaths in the United States each year. For people who are allergic to insect stings, an allergist can provide a preventive treatment called venom immunotherapy (or venom allergy shots). It works by introducing gradually increasing doses of purified insect venom, and has been shown to be 97 percent effective in preventing future allergic reactions to insect stings.
Penicillin is the most common cause of drug-induced anaphylaxis; aspirin and non-steroidal anti-inflammatory pain relievers also are common causes.
Up to 6 percent of the general population has an allergic sensitivity to latex, with health care workers, children with spina bifida and genitourinary abnormalities, and workers with occupational exposures to latex at higher risk.
In nearly half of cases, no cause of a reaction is determined. This condition is called idiopathic anaphylaxis.
Heart attacks, anxiety disorders, seizure disorders and poisoning are some of the conditions that may be mistaken for anaphylaxis.
Immediate emergency treatment is required for all patients who experience any anaphylactic symptoms. Epinephrine (adrenalin) is the standard of care for anaphylaxis.
Patients who have had an anaphylactic reaction should see an allergist. An allergist can determine the risk for future reactions, take a detailed history, conduct diagnostic tests, review avoidance techniques and provide instruction on the use of self-administered epinephrine.