aha! Swiss Allergy Centre - Good to know - Anaphylaxis

Anaphylaxis is a severe, immediate allergic reaction. The term anaphylaxis is generally used only for unexpected, rapid and severe reactions involving a drop in blood pressure, collapse, loss of consciousness and shock. Symptoms that can be life-threatening occur within seconds to minutes, rarely hours, after contact with the allergenic substance. 

Causes and triggers of anaphylaxis

Children most commonly react with anaphylaxis to foods (e.g. peanuts, nuts, fish, eggs, milk), followed by insect stings (bees, wasps) and medicines (e.g. pain-killers, antibiotics, contrast medium). The most common anaphylactic reactions in adults are triggered by insect stings, medicines and foods (e.g. peanuts, nuts, shellfish, soya). Treatment of anaphylaxis in children is based on the same principles as in adults. However, the dose of emergency medication needs to be adjusted according to bodyweight.

Symptoms of anaphylaxis

The reactions occur very quickly and unexpectedly after contact with the allergen. The first signs are:

  • Itching and swelling of the palms of the hands or soles of the feet, the eyelids, oral mucosa, lips or tongue
  • Itching weals (red, raised areas of skin)
  • Breathing difficulties, shortness of breath, coughing fits
  • Gastrointestinal complaints (stomach cramps, vomiting, diarrhoea)
  • Severe dizziness, feeling of debility. Anaphylactic shock is divided into different stages, depending on severity.
  • Further important information and questions can be found in the Anaphylaxis Check (in German, French or Italian).

Diagnosis and differential diagnosis

Anaphylaxis is diagnosed as a result of the typical symptoms (see above). After an anaphylactic reaction, allergy testing should be carried out a few weeks later to identify the trigger.

Therapy and treatment

The actual treatment depends on the stage of anaphylaxis. Essentially, however, the following action can be taken, see checklist:

  • If the person concerned is carrying a pre-filled adrenaline syringe, administer this (inject into the side of the thigh)
  • If possible, immediately stop intake or exposure to the allergen. If the patient is still unresponsive, administer the emergency medications in the form of tablets, drops or syrup and possibly the emergency asthma spray.
  • Seek medical assistance, alert a medical professional: 144

Sufferers need to know what triggers an anaphylactic reaction in them and be able to recognize the symptoms. Sufferers at risk of anaphylaxis must always have an emergency kit with them. Family, friends, teachers, fellow students or work colleagues should also be informed and instructed regarding the emergency measures.

The emergency kit contains one or two adrenaline auto-injectors, an antihistamine and a cortisone preparation in tablet or drop form and possibly an asthma spray. A second adrenaline auto-injector may be required if the first dose is not sufficient to alleviate the symptoms or if the symptoms worsen again. The doctor will determine the dosage for each medicine. The emergency kit must always be to hand. Both sufferers and their parents or carers should know and regularly practise how to use the kit in case of an emergency.

We recommend asking the doctor to prescribe several emergency kits in order to ensure that sufferers always have one with them, e.g. in their handbag, rucksack or school bag. Other kits can be kept at home, school or at work.

The doctor will give sufferers an emergency allergy card which they should have with them at all times.

Specific immunotherapy (desensitization) may be initiated in the case of an insect venom allergy. Further information can be found in the "Specific Immunotherapy" booklet (German, French, Italian).

Tips and tricks

  • School doctors may be brought into schools to ensure the best available information is provided.
  • Expiry date: The suppliers of pre-filled adrenaline syringes offer a push-up service (registration on internet sites). Notification that the syringe needs to be replaced is sent by e-mail or SMS.
  • Bees and wasps are rarely alone. Swarms of bees or wasps’ nests in close proximity to the home or place of work should be reported to the fire brigade, police or a beekeeper and the vicinity should be avoided; the following dos and don’ts should also be observed:
    • Keep your distance from flowers and plants in bloom, do not walk barefoot
    • Wear dark clothing as far as possible
    • Do not make any hasty movements in the vicinity of wasps
    • Be cautious when picnicking and eating outdoors, do not leave any left-over food uncovered
    • Beer attracts wasps, never drink straight out of cans or bottles
    • In the garden wear gloves and clothes with long sleeves as well as long trousers
    • Set up insect screens, especially in bedrooms
    • Do not use any strongly perfumed hairsprays, shampoos or sun creams
    • Only ride a motorcycle with your helmet closed; wear gloves and clothing that covers the body

Further information about bees and wasp venom allergies

  • To avoid severe reactions to foods, the following dos and don’ts are helpful:
    • In restaurants, at take-away stalls or in canteens always ask whether the food really is free of the trigger allergen. If you’re not sure, it’s better not to eat the food concerned.
    • This also applies when shopping at the baker’s or butcher’s. If the retailers of your choice still do not know about the subject of food allergies, offer information. They might be prepared to produce special products for you.
    • Always read the list of ingredients on packaged foods. If you’re not sure, ask the manufacturer or distributor of the product. If there is a risk of anaphylaxis, avoid foods that contain only traces of the trigger allergen (identifiable from the note: “may contain…”).

Further information about food allergies

  • Avoiding allergic reactions to drugs:
    • Tell all attending physicians, including dentists, medical practice nurses, pharmacists and pharmacy assistants about the drug allergy
    • Carry the allergy card at all times so that – if at all possible – you do not receive any drugs that can trigger allergic reactions, even in emergency situations
    • When new drugs are prescribed or bought, make sure these are tolerated

Further information about drug allergy

Facts and figures

According to estimates, around 10 people per 100,000 population per annum experience life-threatening allergic shock. Out of one million inhabitants, 1–3 people will die after a severe allergic reaction.

Editors: aha! Swiss Allergy Centre in co-operation with the Scientific Advisory Board. For prevalence figures, see source references.

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