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Hospital admissions for anaphylactic shock in adults increased from 3,751 to 4,756 from 2019 to 2020. The number of adult patients who were admitted to hospital because of allergies has more than doubled since 2013, reaching a record high of 27,172 in 2019/2020.
Scientists believe that accurate and reliable data on food allergy and anaphylaxis is lacking, and there may be an under-reporting of food allergy-related reactions and deaths. We can’t say for sure why allergy rates are increasing; however, researchers have some theories. One theory is that improved hygiene is to blame, as children are not getting as many infections, therefore with fewer parasites to fight, the immune system perceives a threat against things that should be harmless. Other theories are vitamin D deficiency, changes in diet including eating more processed foods, environmental factors and increased awareness and diagnosis.
What is anaphylaxis?
Anaphylaxis happens when your body has a serious, life-threatening reaction to something you are allergic to. An allergy is your immune system responding to a substance that is usually harmless. The immune system’s job is to defend your body against things such as bacteria and viruses. However, in the case of allergies, your immune system mistakenly identifies a substance, known as an allergen, as being harmful to you and reacts to it. Allergies can vary in severity from mild to severe, and the symptoms can range from being slightly irritating to being life-threatening.
Anaphylaxis can come on very quickly, so it is important to know what to do in an emergency. It requires immediate medical attention. Anaphylaxis can cause the immune system to release an excess of chemicals which can cause serious symptoms and can result in the person going into shock. This is known as anaphylactic shock, which is where there is a sudden drop in blood pressure and there is a narrowing of the airways which can make it difficult or impossible to breathe. If left untreated, anaphylaxis can develop into anaphylactic shock which can result in serious complications or even death in some cases.
Anaphylaxis is typically triggered by exposure to an allergen, which is a substance that the immune system identifies as harmful even though it is generally harmless to most people.
If you suspect someone is experiencing anaphylaxis, you should follow these steps:
- Call an ambulance immediately.
- Administer an adrenaline auto-injector, if available. This is sometimes called an EpiPen. You should use it as directed, which usually involves injecting the person into the outer thigh and holding it in place for 10 seconds.
- If their symptoms have not improved after 5 minutes, use a second adrenaline auto-injector.
- Lie the person down and elevate their legs.
- Stay with the person and monitor their breathing.
- Do not offer any food or drinks as this could potentially make their condition worse.
- Do not ask the person to stand or walk at any time, even if they feel better.
- If the person has been stung by an insect, try to remove the sting if it’s still in the skin.
- Administer CPR if the person has stopped breathing or their heart has stopped.
Symptoms of anaphylaxis happen very quickly and include:
- Swelling of the throat and tongue.
- Difficulty breathing or breathing very fast.
- Wheezing, coughing or noisy breathing.
- Difficulty swallowing or tightness in the throat.
- Feeling faint, dizzy or fainting.
- Feeling tired or experiencing confusion.
- Skin that feels cold to the touch.
- Blue, grey or pale lips or face.
- A drop in blood pressure.
- Becoming unconscious.
Anaphylaxis needs to be treated in a hospital straight away. Treatment may include oxygen, adrenaline given by an injection or drip into your vein and fluids given by a drip into your vein.
Common allergens that can cause anaphylaxis include:
- Certain foods – these can include things like peanuts, tree nuts, shellfish and eggs. These are known as food allergies.
- Insect bites and stings – there are certain insects whose bites or stings are commonly associated with allergies, including bees, wasps, mosquitos, fire ants, bedbugs, ticks and fleas.
- Certain medications – allergic reactions to different medications can vary widely, and people may react differently to the same medication. People may be allergic to standard painkillers or antibiotics.
Allergy UK offer a helpful factsheet about anaphylaxis.
Communication – explaining to family and friends what anaphylaxis is
Managing allergies can be very difficult, both in terms of the risks to your physical health and coping emotionally. Having the support and understanding of friends and family can be really important to someone navigating a serious allergy. When explaining to friends and family what anaphylaxis is, be as clear and as thorough as possible.
Some of the most important things to consider are:
- Communicating – if you have a food allergy, let your friends and family know what you can and can’t have, how the food should be prepared, explain about cross-contamination and the importance of reading food labels. Ask them to keep any food packaging for you to read to label yourself.
- Explain your allergies – ensure they know exactly what you are allergic to.
- Explain the symptoms of anaphylaxis – ensure they know what the symptoms are and explain that the symptoms can progress rapidly.
- Stress the importance of acting quickly – let them know what steps should be taken in case of an allergic reaction, such as using an epinephrine auto-injector and seeking emergency medical help.
- Adrenaline auto-injector – explain how this should be used and where they can find it.
- Share your emergency action plan – ensure that they understand the plan and ask if they have any questions.
- Share educational resources – let them know where they could learn more about anaphylaxis. You could even suggest that they take a course. St John Ambulance offer an Anaphylaxis First Aid course.
- If you have a food allergy, explain to them how to prepare food safely – it is important to read the ingredients of packaged foods and to prepare food separately so that cross-contamination does not occur.
- Explain to them about the importance of not sharing food if you have a food allergy – this is important as even small amounts of an allergen can cause a reaction, potentially a serious reaction if you have a severe food allergy. To ensure your safety, it is best for people with allergies not to share food. It’s also a good idea for them to be aware not to share utensils, so that you are not accidentally exposed to your allergen.
Sharing your experience of anaphylaxis
If you have experienced anaphylaxis, it’s important to communicate this to family and friends. This will ensure that everyone is aware of the severity of the situation and how they should respond. As well as educating them about the condition in general, you should also share your own personal experience of what happened. Discuss the emotions, challenges and the impact it has had on your life. This can help others understand the seriousness of the condition, how you feel about it and how they can support you moving forward.
Talking about your symptoms
Discussing the symptoms of anaphylaxis with friends and family is an important step. You should discuss your specific allergy and your specific early symptoms.
You should consider:
- Educating them about your common triggers.
- Ensuring that they understand the early symptoms.
- Ensuring they understand how quickly symptoms can progress.
- Stressing the urgency of treatment and calling for help.
Addressing family and friends’ concerns
Your friends and family members may have some anxiety about how they would cope in an emergency situation. You can reassure them by letting them know that the more they understand about your risks and prevention, the better equipped they will be in helping you. You can address any concerns they may have by:
- Ensuring that they have understood the information that you have given them.
- Providing them with resources – do not expect them to do their own research.
- Creating a plan in collaboration with them.
- Practising what would happen in an emergency situation.
- Ensuring they feel as confident as they can about using an EpiPen.
- Letting them know how grateful you are to them for helping to keep you safe.
- Having open and honest communication – this is key, as by providing them with information, sharing your experiences, and finding solutions together, you can help your family and friends better understand and support you in managing your allergies.
Discuss and identify allergens
When discussing your allergens with friends and family members, it is important for them to understand how serious it could be if you came into contact with an allergen and what steps can be taken to prevent this from happening.
You can help them to understand what an allergy is and what the common allergens are, as well as what the specific triggers are for you.
It may help to write things down, particularly if your situation is complex. Be clear about any medical advice you may have been given, particularly if the advice has been specific to your situation.
Explaining how to avoid allergens
You can discuss how to avoid allergens with your family and friends. Key things that you may need to think about if you have a food allergy are:
- Explaining how to read food labels properly. Food manufacturers are required to list common allergens, such as milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish. You should educate family and friends about always reading food labels carefully.
- Being aware of hidden ingredients. You should familiarise yourself with alternative names for common allergens. Some foods may contain hidden allergens in the form of additives, flavourings or colourings.
- Educating them about cross-contamination. They should know to avoid using shared utensils, cutting boards and kitchen equipment that may have been in contact with allergens.
- How they can communicate with restaurants and other food outlets about food allergies if they are booking a table.
- Safe meal planning and preparation.
- Choosing fresh food where possible as processed, pre-packaged foods are more likely to contain additives and allergens.
- Where to source alternative ingredients and snack foods.
Create an emergency plan with family and friends
As anaphylaxis is a severe, potentially life-threatening allergic reaction that requires immediate medical attention, it is important to have an emergency plan in place and for your family and friends to be part of creating this plan. An emergency plan should include:
- Identify the allergen – ensure that everyone understands what your allergies are and how serious each one is.
- Education is key – ensure that everyone in your family or group of friends is educated about the specific allergen and understands the symptoms of anaphylaxis.
- Ensure that people are aware of where medication is kept and how to use it.
- Develop a written emergency action plan.
- Practise the emergency plan with family and friends.
- Keep them up to date with any changes to your medical situation.
Show family and friends how to use an epinephrine auto-injector
In an emergency situation, an epinephrine auto-injector, also known as an EpiPen, could be what saves your life. An epinephrine auto-injector is a medical device designed to deliver a measured dose of the hormone epinephrine, also known as adrenaline, in the event of a severe allergic reaction, known as anaphylaxis. The device is portable and easy to use, making it ideal for emergency situations. It typically comes in a pen-like form with a spring-loaded needle that automatically injects a predetermined dose of epinephrine when used. It works by helping to reverse the symptoms of anaphylaxis by constricting blood vessels, relaxing the muscles in the airways, and improving blood flow to vital organs.
It is therefore vital that your friends and family members understand its purpose and feel confident using it. You should start by:
- Explaining its purpose.
- Showing them the EpiPen and the different parts of it.
- Showing them how to remove the safety cap.
- Demonstrating how to hold it.
- Showing them how to position the EpiPen.
- Explaining how to inject the EpiPen. Explaining to them that they should inject the EpiPen firmly into the thigh until it clicks. The click indicates that the injection has started.
- Explaining they should hold the pen in place for 10 seconds while the dose is delivered.
- Explaining they should then remove the EpiPen and massage the area, as this will help the medication to be absorbed.
- Explaining they should seek emergency help, whether or not the symptoms have improved.
- Allowing them to practise and become familiar with a trainer pen.
Let them know that the instructions are included on the side of the injector if they forget how to use it.
Ongoing communication about any changes in allergen triggers
Ensuring that you regularly check in with your family members and friends is vital. You should keep them updated with any changes in your allergies, triggers and symptoms and regularly review with them your plan in an emergency situation.
If you think you or your child has an allergy, you should see your GP. A GP may arrange some allergy tests or refer you to a specialist allergy clinic to have them.
Treatments for allergies can include:
- Avoiding whatever you are allergic to where possible.
- Medicines which are available for mild allergic reactions, for example antihistamines, steroid tablets and steroid creams.
- Emergency medicines called adrenaline auto-injectors, such as an EpiPen, for severe allergic reactions.
- Immunotherapy for severe allergic reactions. This involves carefully exposing you to the thing you are allergic to over time, so your body gradually gets used to it and does not react so badly. This should only be done by a medical professional.
Allergy UK offer advice about living with allergies whilst still maintaining your quality of life.