In this article
Approximately 44% of the UK’s population has at least one allergy. The incidence of serious allergies and the number of people experiencing anaphylaxis, a severe allergic reaction that could be life-threatening, is significantly increasing, with nearly 26,000 hospital admissions in the last year for anaphylaxis, compared to just over 12,000 anaphylaxis admissions 20 years ago.
With this concerning rise in anaphylaxis in the UK, more research into future treatments and anaphylaxis innovations is required.
What is Anaphylaxis?
Anaphylaxis is a serious allergic reaction that can be potentially life-threatening. Within seconds or minutes of being exposed to an allergen, your body releases an excessive amount of chemicals that can cause severe symptoms and potentially life-threatening reactions that can cause you to go into anaphylactic shock. Anaphylaxis can be fatal and can occur at any age, even if you have previously never experienced it before. Anaphylaxis requires immediate medical treatment.
Many people in the UK have allergies. Allergies occur when your body is exposed to an allergen and overreacts by producing chemicals, including histamine, causing an inflammatory reaction, your blood vessels to dilate and fluid to enter your tissues. However, anaphylaxis only occurs in a small number of people with allergies.
Anaphylactic shock occurs when there is a sudden drop in your blood pressure. Your airways will narrow which can seriously impede your breathing. Without rapid treatment, you may then become unconscious and experience serious complications, or even death.
As well as a sudden drop in your blood pressure and narrowing of your airwaves, anaphylaxis can also cause the following symptoms:
- A weak pulse.
- A rapid pulse.
- Feeling lightheaded or faint or losing consciousness.
- Difficulties breathing.
- Feeling like your tongue or throat are swollen.
- Feeling confused or anxious.
- Wheezing.
- Other symptoms typically associated with allergies include a rash, itching, vomiting or diarrhoea.
Current Treatments for Anaphylaxis
The main treatment for anaphylaxis is currently an adrenaline autoinjector (AAI). This is a medical device that is designed to quickly release a dose of epinephrine (also known as adrenaline) during emergency situations. The AAI is injected into the thigh and will be prescribed to anyone with severe allergies. If you have been prescribed an AAI, it should be kept on your person at all times, as it could potentially save your life.
The AAI is a pre-filled syringe that has a spring-loaded mechanism. It is designed to be easy to use so that even people without medical training can successfully administer adrenaline. An AAI can be administered by the person experiencing anaphylaxis or someone else.
The adrenaline in an AAI acts as a rapid-acting bronchodilator and vasoconstrictor, which can help to relieve some of the symptoms of anaphylaxis by constricting your blood vessels, increasing your blood pressure and relaxing the muscles in your airway. This can reduce your symptoms enough to enable you to seek medical attention, either by calling 999 or by immediately visiting Accident and Emergency (A&E).
In the hospital, you will likely be given intravenous fluids, which will help to raise your blood pressure, an oxygen mask, which will help to improve your breathing, and medication to improve any physical symptoms (such as rashes, hives or swelling).
Other types of treatment that could be used alongside an adrenaline autoinjector include:
- Bronchodilators: If you are in respiratory distress, a bronchodilator can be used to help open up your airwaves.
- Intravenous (IV) fluids: IV fluids may be used to help restore blood flow if there has been a significant drop in your blood pressure.
- Antihistamines: These may be administered alongside adrenaline to relieve other symptoms of your allergic reaction, such as rashes, hives and itching.
Innovations in the Treatment of Anaphylaxis – Needle-Free Treatments
Although adrenaline autoinjectors (AAIs) can be extremely effective in treating anaphylaxis, there is often a delay in them being used, which significantly increases the risk of death. Because an AAI involves an injection, hesitation, either when injecting yourself or someone else, can result in a detrimental delay in treatment. Additionally, a lack of knowledge regarding AAIs can result in the treatment being administered incorrectly, which can have significant implications.
Innovations in the treatment of anaphylaxis have been focusing on treatments that are easier to use, more convenient and less invasive – specifically, needle-free treatments.
Some future innovations in the treatment of anaphylaxis focus on adrenaline being administered by other means, such as:
Nasal sprays
Nasal sprays and nasal powder sprays could be a great potential needle-free treatment for someone experiencing anaphylaxis. A nasal spray delivers adrenaline or dry powder epinephrine into your body through your nostrils. It can increase your blood pressure and treat the symptoms of anaphylaxis with less of a delay compared to an AAI.
Sublingual film
The sublingual film is designed to be taken orally and it dissolves in your saliva. The epinephrine or adrenaline can be stored in the film and released into your mouth. Because these films are very small, approximately the size of a postage stamp, they can be easier to carry around with you. In many cases, people who die from anaphylaxis do not have two adrenaline autoinjectors on their person. Sublingual film treatments can reduce the likelihood of someone experiencing anaphylaxis and having no treatment on their person.
The film doesn’t need to be swallowed, it just needs to be placed in the person’s mouth whilst they are experiencing anaphylaxis. It will quickly deliver epinephrine which can effectively treat anaphylaxis. This could be a promising non-invasive treatment for anaphylaxis.
What are the Future Treatments?
With the significant rise in allergies and cases of anaphylaxis, there are many future treatments currently being developed for treating allergies. If the allergy is successfully treated, this can reduce the severity of an allergic response or prevent an allergic reaction altogether. This will significantly decrease the number of cases of anaphylaxis that occur.
Some treatments currently being developed include:
Acalabrutinib
Acalabrutinib is a type of medication that is usually used to treat cancer. It is a BTK inhibitor that works by blocking Bruton’s tyrosine kinase (BTK) which is an enzyme that is present in multiple immune cells involved in allergic reactions. Acalabrutinib has been tested as a potential treatment for peanut allergies. A study has shown that acalabrutinib can increase the tolerance to peanuts on a short-term basis for people with a peanut allergy, suggesting acalabrutinib may be able to significantly increase someone’s tolerance to an allergen within a short space of time. This type of treatment may be recommended for those with IgE-mediated food allergies.
Peptide Immunotherapy
Peptide immunotherapy involves small synthetic peptides containing allergen-derived immunodominant T-cell epitopes. T-cells are the region of an allergen that can trigger an immune response. The synthetic peptides used in this type of treatment represent the T-cells of the allergen, which can create a regulatory response to the exposure to an allergen. Peptide immunotherapy has shown the potential to treat a number of different allergies, including:
- Food allergies.
- Pollen allergies.
- House allergies, such as dust mite allergies.
- Allergies to bee and wasp venom.
- Pet allergies, e.g. an allergy to cats.
Research suggests that peptide immunotherapy can have long-term clinical effects and a significant reduction of allergic reactions.
Oral Mucosal Immunotherapy
Oral mucosal immunotherapy (OMIT) involves a specially formulated toothpaste that is designed to deliver allergenic proteins to the area of the mouth where more cells that can take up the allergen are located. These areas are known as immunologically active areas. Delivering allergenic proteins to these areas gives your body maximum potential for allergy desensitisation. OMIT is designed to treat food allergens. Some research studies have shown that 100% of people with a food allergy who underwent OMIT could tolerate the highest dose of the allergen.
Electromechanical dosage devices with allergen cartridges
This device is designed to treat the allergy that causes anaphylaxis. It administers a very small, controlled dose of the allergen, allowing the patient to undergo oral immunotherapy treatment in their homes.
New Guidance Update on the Use of AAIs
Specific guidance has been released by the Medicines and Healthcare Products Regulatory Agency (MHRA), in conjunction with the UK government. The new guidance launched in 2023 is designed to improve the safe use of adrenaline autoinjectors (AAIs). This guidance was designed to raise awareness about anaphylaxis and provide information about how to safely and correctly use adrenaline autoinjectors.
The guidance offers the following information:
Recognising the signs of anaphylaxis:
- Airways – Swelling in the throat, tongue or upper airways, including tightening in the throat, difficulties speaking normally and difficulties swallowing.
- Breathing – A sudden onset of wheezing, breathing difficulties, rapid or shallow breathing and noisy breathing.
- Circulation – Feeling dizzy, lightheaded or faint, sudden sleepiness or confusion, pale or clammy skin and loss of consciousness.
Treatment of anaphylaxis:
If you have any signs of anaphylaxis, particularly if there is any possibility you have been exposed to an allergen, you should use your AAI immediately. If in doubt, use your AAI.
Anaphylaxis is considered a medical emergency. If you or someone else is experiencing anaphylaxis, you should:
- Use your AAI immediately.
- Call 999 as soon as possible and say the word ‘anaphylaxis’.
- Lie down flat and raise your legs. If you are pregnant, lie down on your left side. If you are struggling to breathe, slowly prop yourself up and lie down as soon as you can. Do not stand up, even if you are feeling better. This is because lying down will assist the blood flow to your heart and vital organs.
- If there are no improvements within five minutes, use your second AAI.
The guidance also specifies how to ensure your adrenaline autoinjectors are ready to be used.
- Ensure you know how to use your specific AAI (there are three different types of AAIs commonly used in the UK).
- Follow the instructions (e.g. inject into the outer mid-thigh, injecting through clothes is possible). Consult the instructions, usually listed on the side of the AAI device.
- Always carry two AAIs with you at all times.
- Periodically check the expiry dates of your AAIs and ensure you replace them before they expire.
- If there is a problem with your AAI or you suspect there may be a fault, report this problem or fault to the MHRA Yellow Card scheme.
Food Immunotherapy Treatments
For people with a severe food allergy that could cause anaphylaxis, food immunotherapy treatment could be an effective way of managing their allergy and reducing the likelihood of anaphylaxis. According to the NHS, the most common food allergies are:
- Cow’s milk.
- Eggs.
- Peanuts.
- Soybeans, peas and chickpeas.
- Tree nuts, including walnuts, almonds, hazelnuts, pecans, cashews, pistachios and Brazil nuts.
- Shellfish, including prawns, crab and lobster.
- Wheat.
The majority of food allergies affect children under the age of three. Food allergies occur when your body’s immune system incorrectly classifies the proteins in a food as a threat and releases chemicals to deal with this threat. For people with mild food allergies, this could result in symptoms such as rashes, itching and stomach pain. However, for someone with a severe food allergy, the chemicals released into the bloodstream can cause such a significant drop in blood pressure and swelling that even a small exposure to the food could be life-threatening or even fatal.
Food immunotherapy treatment includes a controlled exposure to a very small amount of the allergen. This is designed to desensitise your immune system and increase your tolerance to the food. Because allergens occur because of an overreaction from your immune system, food immunotherapy is designed to train your immune system to tolerate the food you are allergic to, reducing the severity of your allergic reactions or preventing reactions from occurring altogether.
During food immunotherapy treatment, you will ingest a very small amount of food every day to gradually increase your body’s resistance. After a specified amount of time, the dosage will be increased. The amount of food you ingest every day will gradually increase until you can safely ingest a pre-specified amount without experiencing an extreme allergic reaction. Food immunotherapy treatment usually takes about a year to complete, although you may reach your maintenance dose of the allergen before this time.
There are three main types of food immunotherapy treatments:
- Oral immunotherapy (OIT): This involves eating or drinking small amounts of the food you are allergic to.
- Sublingual immunotherapy (SLIT): This involves holding a small amount of the food you are allergic to under your tongue but not swallowing it.
- Epicutaneous immunotherapy (EPIT): This involves being exposed to the food allergen through your skin. This is done using a skin patch containing the allergen.
It is estimated that food immunotherapy treatment works successfully for approximately 80% of people. Although someone who undergoes food immunotherapy treatment may not be able to enjoy the food allergen as a normal part of their diet, the treatment is designed to prevent a severe allergic reaction or anaphylaxis if you are exposed to the allergen in the future (for example, through cross-contamination).
However, many food immunotherapy treatment programmes do not allow people who have previously experienced severe anaphylaxis to take part in the treatment.
