"Anaphylaxis is a severe and sudden allergic reaction when a person is exposed to an allergen. The most common allergens are eggs, peanuts, tree nuts (e.g. cashews), cow's milk, fish and shellfish, wheat, soy, certain insect stings and medications."
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FEATURE ARTICLE: What is anaphylaxis?
Anaphylaxis is
the word used for serious and rapid allergic reactions
usually involving more than one part of the body which, if
severe enough, can kill.
The word anaphylaxis was coined when scientists tried
to protect dogs against a poison by immunising them with
small doses. Far from being protected, the dogs died
suddenly when they got the poison again. The word used for
protection by immunisation is 'prophylaxis', so the scientists coined the
word 'anaphylaxis'
to mean the opposite of protection. What the scientists saw
in the dogs helped them to understand that the same can
happen in humans. This helped us to understand asthma and
other allergies too, because they work in a similar
way.
Scientists now use the word 'anaphylaxis' to mean any
immune reaction of this type, even if it is not serious.
But most doctors use it to mean a life-threatening rapid
allergic reaction.
Unfortunately this kind of 'harmful immunisation' happens
to a few of us not just from injections but from ordinary
foods such as nuts. Quite literally, "one man's meat is
another man's poison". Our immune system, which is there to
protect us from infection, goes wrong and harms or even
kills us.
Injections of many kinds occasionally cause anaphylaxis.
Penicillin, injected clot-busting drugs used after heart
attacks, and a host of other kinds of injection can
occasionally do to human beings what the experiments did to
dogs. Thank goodness we now understand vastly more about
anaphylaxis, though we still need research to answer
important questions.
There are yet other causes of anaphylaxis. You will see
more about some of those below. Anaphylaxis has become an
important issue in medicine and for the increased numbers
of people who have had an attack of anaphylaxis.
Why the increase? When medicines are the cause, the
explanation is likely to be that we are simply using more
medicines, and that newer medicines which are proteins are
more likely to cause anaphylaxis. But this does not explain
why foods should be causing anaphylaxis more often. For
some reason all the common allergies such as hayfever,
allergic asthma and food allergy have become more common.
Researchers have definite ideas about why this might be
so.
The doctor said it was not anaphylaxis but an
'anaphylactoid reaction'. What's the difference?
There is not much difference to you as the sufferer.
There is not much difference to the doctor who is treating
you when it happens. It's serious. There is a tendency for
these reactions to be less dangerous than anaphylaxis, but
don't count on it.
There is a definite difference in the way it comes
about. Anaphylaxis is caused by antibodies called
'immunoglobulin E', abbreviated as 'IgE'. But exactly the
same end results can happen in various ways without IgE.
That is called an 'anaphylactoid' reaction.
Anaphylaxis and anaphylactoid reactions differ in the
things which cause them. For example nuts, fish and latex
cause anaphylaxis because of IgE. Injections given before
some X-rays, morphine-like drugs and some intravenous
liquids given to replace blood or fluid loss cause
anaphylactoid reactions without IgE.
From here on we are going to use the words anaphylactic
and anaphylaxis to cover both types of reaction, since the
immediate practical consequences and the immediate
treatment are similar.
What are the common
causes of anaphylaxis?
Amongst the commoner causes of anaphylaxis are:
- Foods:
especially nuts, some kinds of fruit, fish and less
commonly spices
- Drugs:
Especially penicillins, anaesthetic drugs, some intravenous
infusion liquids, and things injected during x-rays.
Aspirin and other painkillers (called NSAIDs) can produce
very similar reactions.
- Latex:
mainly in rubber latex gloves, catheters, other medical
products, but also in many things encountered in daily
life. Sufferers are nearly always health care workers,
mainly nurses, or have other occupational contact with
latex. They may get anaphylaxis from bananas, avocados,
kiwi fruit, figs, or other fruits and vegetables including
even potatoes and tomatoes.
- Bee or wasp
(yellow jacket) stings when these cause faintness,
difficulty in breathing, or rash or swelling of a part of the body which has
not been stung. If you just get a very large
swelling of the part of your body which was stung, you are
probably not going to have anaphylaxis if stung again.
- Unknown: A substantial proportion of
sufferers have no cause found despite all efforts, even in
the most expert clinics. Doctors call such unexplained
attacks 'idiopathic
anaphylaxis'. The word 'idiopathic' in practice
means we don't know the cause. Worrying as it is, death
from this is very rare indeed. However, there must be a
cause or causes. Some cases are bound to be simple failure
to find a cause and I always regard this diagnosis as
provisional, but if a recognised allergy specialist has
given you this label it is unlikely that another specialist
will do any better. The explanation is NOT psychological in
the vast majority. So in most cases this is a disease for
which medical science has not yet discovered the cause.
Some top experts who have studied hundreds of patients with
idiopathic anaphylaxis believe that it is a disorder of
mast cells, causing them to release histamine and chemicals
with similar actions too easily. There is an excellent book
on this condition, quite short, and intended for doctors
and patients. Title: 'Idiopathic Anaphylaxis', edited by
Roy Patterson, Published by OceanSide Publications Inc,
Providence, Rhode Island, 1997, ISBN 0-936587-10-5.
- Exercise may precipitate such reactions in
some ('exercise-induced
anaphylaxis'), and so may exercise after food, sometimes apparently
irrespective of what the food is, but in other people after
specific foods. This is called 'exercise-induced food-dependent
anaphylaxis'.
- Medicines
called beta blockers used for heart disease or high
blood pressure can change mild reactions from another cause
into severe anaphylaxis because they block the body's main
defence against anaphylaxis.
- Wrong
diagnosis of anaphylaxis: a proportion (about 10%)
of people sent to specialists with a diagnosis of
anaphylaxis have a mistaken diagnosis and have not had
anaphylaxis. If this might be true in your case, it is well
worth finding this out as you may be spared unnecessary
fear and wrong treatment.
How can you tell if
someone is having anaphylaxis?
Anaphylaxis usually happens quickly.
Anaphylaxis can produce:
- An itchy nettlerash
(urticaria, hives)
- Faintness and unconsciousness due to very low blood
pressure. Unlike an ordinary fainting attack, this does not
improve so dramatically on lying down.
- Swelling
(angioedema)
- Swelling in
the throat, causing difficulty in swallowing or
breathing
- Asthma symptoms
- Vomiting
- Cramping tummy
pains
- Diarrhoea
- A tingling feeling
in the lips or mouth if the cause was a food such as
nuts
- Death
due to obstruction to
breathing or extreme low blood pressure (anaphylactic shock)
Faintness with a nettlerash or swelling coming on
quickly is probably anaphylaxis, and if there is also
difficulty in breathing the danger is greater. Faintness
with difficulty in breathing alone will sometimes be due to
a panic attack, but can also be due to anaphylaxis.
In the early stages it may be difficult, even for a
doctor, to be sure whether the cause of symptoms is
anaphylaxis or fainting or a panic attack. If there is
doubt, it is sometimes best to use the treatment for
anaphylaxis, but the treatment should then be reviewed with
a doctor because unnecessary treatment for anaphylaxis is a
bad idea. Learn the rules for knowing when to treat, to
minimise the chance that you will use the treatment when
you should not.
People who are allergic to foods often notice the effect
in seconds, and their life may be in jeopardy within a few
minutes. Sometimes a reaction takes much longer to start,
an hour or so, but can still be extremely serious.
Improvement can also happen quickly, especially with the
right treatment. A few people then have a second wave of
anaphylaxis, so people who have had a serious anaphylactic
reaction to nuts should be observed medically for about six
hours or overnight.
Fortunately there is a
highly effective treatment: adrenaline
(epinephrine). But adrenaline (epinephrine) needs to
be given as an injection, and is dangerous if used
incorrectly. If you need to have adrenaline (epinephrine)
available for yourself or someone in your family, it is
important that you and anyone else who may have to give the
adrenaline (epinephrine) should be properly trained.
It is possible for
anaphylaxis to be mild and to need little or no
treatment. You would not think so from most of the
information you read. Of course a life-threatening attack
of anaphylaxis may look mild in its early stages, so you
need to go for medical help just in case, and need to have
the emergency treatment immediately available in case
things start to go more badly wrong. In most cases it is
better to err on the side of treating anaphylaxis early
rather than to leave treatment rather late. But the fact is
that many people get over anaphylaxis even without
treatment.
The fact that previous
anaphylaxis has been mild does not guarantee that it will
not be dangerous in future. Most sufferers with mild
attacks do seem to have relatively mild ones if they occur
again. But deaths have occurred in people who had only mild
attacks before. The answer is to be prepared.
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