Anaphylaxis

Anaphylaxis sounds more like a complex word from Spell Bee; however, it’s nothing but an allergic reaction. Of course, anaphylaxis is a condition everyone must be aware of as it is a life-threatening allergic reaction that can occur rapidly after exposure to an allergen and lead to severe side effects.

An Anaphylactic reaction is triggered by the immune system overreacting to a substance, such as food, medication, or insect venom. The reaction involves the release of chemicals (like histamine) which cause widespread inflammation and systemic effects. Allergens include:

  • Milk (dairy) found in cow’s milk, cheese, yogurt, and butter; often termed as lactose intolerance. It is common in children, though many outgrow it.
  • Eggs when in baked goods, mayonnaise, and some processed foods. Egg whites are more allergenic than yolks.
  • Peanuts are one of the most severe allergens, common in children and adults. They may be found in peanut butter, candies, and sauces.
  • Tree nuts, which include almonds, walnuts, cashews, pistachios, hazelnuts, and pecans, often cause severe reactions.
  • Fish is a common allergen for adults; reactions can occur with any type of fish including salmon and tuna.
  • Shellfish including shrimp, crab, lobster, and clams can cause severe reactions even from inhaling the steam that emanates while cooking them.
  • Soy found in soy milk, tofu, soy sauce, and processed foods. Allergy to soy is common in infants but often infants outgrow it.
  • Wheat including bread, pasta, cereals, and baked goods. This is not the same as gluten intolerance or celiac disease.

In our region, peanut, brinjal and sea food are the common ingredients that people often name in their history for skin rash, swelling of face, etc.

History of allergy has to be mentioned when you are getting your medication prescribed and when you are hospitalised. Allergy is most commonly seen when taking antibiotics and tablets for pain relief. Once a patient is allergic, they are more prone to be allergic to other drugs as well. It’s a challenging task when a patient undergoing surgery develops allergic reactions as the patient will be under general anesthesia and unconscious. If sedated, they won’t be able to convey their symptoms. Even our regular paracetamol and pantoprazole can cause allergic reactions and lead to critical reactions. The changes will be increase in heart rate, drop in blood pressure, drop in oxygen saturation due to oedema in airway tract which will lead to stiffness of lungs i.e., bronchospasm and wheeze.

What Will Be the Physical Reactions Seen in Our Body as a Result of an Allergic Reaction?

Skin:

* Hives (raised, itchy welts)

* Flushing or redness

* Swelling (angioedema), especially of the face, lips, tongue, or throat

Respiratory:

* Difficulty breathing or wheezing

* Swelling in the throat or airway (leading to obstruction)

* Nasal congestion or runny nose

Cardiovascular:

* Drop in blood pressure (shock)

* Rapid or weak pulse

* Dizziness or fainting

Gastrointestinal:

* Nausea or vomiting

* Diarrhoea

* Abdominal pain or cramping

Neurological:

* Anxiety or sense of impending doom

* Confusion

* Loss of consciousness in severe cases

Common Triggers

  • Consumption of peanuts, tree nuts, shellfish, dairy and eggs.
  • Medications: Antibiotics (like penicillin), NSAIDs, or contrast dyes. Any medicine per se, mostly pain killers – opioids and drugs used for anesthesia.
  • Insect Venom: Bee or wasp stings.
  • Latex: Found in gloves, balloons, and some medical supplies.
  • Packed foods combined with food preservatives for long shelf life.
  • Cosmetic products, causing skin inflammation and swelling.

What Do We Do When Anaphylaxis Occurs?

The patient should be brought to the emergency medical care facility immediately. Administration of epinephrine (adrenaline) is required when the patient has breathing difficulty, drop in blood pressure and more symptoms which indicate hemodynamic instability. Delay can significantly increase the risk of complications.

Identification of Triggers: Allergy testing to determine and avoid the specific allergens (e.g., foods, insect stings, medications, etc.).

For patients who are prone to severe allergic reactions, carrying emergency supplies is advised. People at risk should always have an epinephrine auto-injector and a personalized action plan.

Education and awareness on how anaphylaxis can put a life at stake is essential. When someone says they are allergic, we should always remember that it is something serious. Do not force them to eat something they are allergic to. Also, avoid cross-contamination of allergens in food preparation or environments.

Social and Psychological Implications

Lifestyle changes are a must; dietary or environmental restrictions (e.g., avoiding nuts, latex, or bee-prone areas) have to be followed.

Practice increased caution when traveling to remote places and eating out, especially when you are not sure about the contents which can be an allergen to your body system.

Anaphylaxis also has an emotional impact – fear of future reactions can lead to anxiety or avoidance behaviours when it comes to eating or taking medicines.

Additional treatment in the hospital may include oxygen, antihistamines, corticosteroids, or intravenous fluids. Patients with severe reactions will require monitoring. Symptoms can return (biphasic reaction) after initial treatment, so observation for several hours is necessary.

To conclude – a quote from Roman philosopher Titus Lucretius Carus: “What is food to one, is to others bitter poison.” effectively captures the idea that something harmless to most can trigger a strong reaction in someone with an allergy.

When there are mild symptoms, do recognise the allergy trigger and avoid the food/drugs.

Help your loved ones, stay cautious about their allergic triggers. STAY AWARE and STAY AWAY from allergens.

Dr. K. Mahalakshmi

Dr. K. Mahalakshmi
Consultant Anaesthetist,
Kauvery Hospital, Chennai

Kauvery Hospital