Symptoms
Anaphylaxis can be scary and is a serious medical emergency! Many different signs and symptoms may indicate that a systemic anaphylactic reaction is happening. The amount of time before the signs and symptoms appear is variable as it can be seconds or minutes (with IV medications, allergy tests, insects, foods) to hours afterwards (most occur within 10 hours but it can appear up 72 hours later) (DynaMed Plus, 2018). The signs and symptoms that occur depend on the extent of the reaction and whether it is just local (e.g. in one place or organ) or systemic (e.g. throughout your digestive, or circulatory system) (Lewis et al., 2019). Anaphylaxis typically affects more than one body part and system. The systemic signs and symptoms are discussed below. Knowing what signs and symptoms to look for can help you determine when to seek treatment immediately!
1. Skin
Some of the initial symptoms of an anaphylactic reaction result from the skin reactions which are quickly visible. These reactions might include redness, hives/welts, itching and swelling (Lewis et al., 2019). Chemical mediators change how the blood vessels in the skin act, leading to the visible reactions (Lewis et al., 2019). Swelling around the face, eyes, lips, and throat are visible signs of a serious reaction.
2. Gastrointestinal (GI) - Digestive system
An anaphylactic reaction might upset your stomach, make you feel nauseous, and even cause vomiting and diarrhea (Lewis et al., 2019). Here, the chemical mediators also affect the blood vessels, as well as the muscles which move food through your stomach and intestines (Lewis et al., 2019).
3. Cardiovascular - Heart and Circulation
The main cardiovascular symptoms are dangerously reduced blood pressure (hypotension), a change in heart rhythm (dysrhythmias), or an increased heart rate (tachycardia) (Lewis et al., 2019). Chemical mediators cause blood vessels to dilate (as in the other systems) and all that extra space leads to a drop in blood pressure, and the heart tries to beat harder to compensate (Lewis et al., 2019). This is quickly tiring for the heart and as it tires, the body can go into shock and cardiac arrest.
4. Neurological- Nervous system
Neurological symptoms include headache, dizziness, paresthesia (an abnormal tingling, pricking, chilling, burning sensation in the skin), and a feeling of impending doom (Lewis et al., 2019). The combination of the various physiological changes that occur during anaphylaxis play a role in the neurological symptoms.
5. Respiratory - Lungs and Breathing
Respiratory reactions can also be quite serious. Wheezing, stridor (crowing breath sounds), hoarseness, and coughing are all caused by swelling in the air passages (Lewis et al., 2019). Difficulty breathing (dyspnea) or quick breathing (tachypnea) can lead to respiratory arrest as well (Lewis et al., 2019). Chemical mediators in this system stimulate contraction of smooth muscle in your lungs, and secretion of mucus which cause the respiratory reactions (Lewis et al., 2019)
Anaphylaxis can be scary and is a serious medical emergency! Many different signs and symptoms may indicate that a systemic anaphylactic reaction is happening. The amount of time before the signs and symptoms appear is variable as it can be seconds or minutes (with IV medications, allergy tests, insects, foods) to hours afterwards (most occur within 10 hours but it can appear up 72 hours later) (DynaMed Plus, 2018). The signs and symptoms that occur depend on the extent of the reaction and whether it is just local (e.g. in one place or organ) or systemic (e.g. throughout your digestive, or circulatory system) (Lewis et al., 2019). Anaphylaxis typically affects more than one body part and system. The systemic signs and symptoms are discussed below. Knowing what signs and symptoms to look for can help you determine when to seek treatment immediately!
1. Skin
Some of the initial symptoms of an anaphylactic reaction result from the skin reactions which are quickly visible. These reactions might include redness, hives/welts, itching and swelling (Lewis et al., 2019). Chemical mediators change how the blood vessels in the skin act, leading to the visible reactions (Lewis et al., 2019). Swelling around the face, eyes, lips, and throat are visible signs of a serious reaction.
2. Gastrointestinal (GI) - Digestive system
An anaphylactic reaction might upset your stomach, make you feel nauseous, and even cause vomiting and diarrhea (Lewis et al., 2019). Here, the chemical mediators also affect the blood vessels, as well as the muscles which move food through your stomach and intestines (Lewis et al., 2019).
3. Cardiovascular - Heart and Circulation
The main cardiovascular symptoms are dangerously reduced blood pressure (hypotension), a change in heart rhythm (dysrhythmias), or an increased heart rate (tachycardia) (Lewis et al., 2019). Chemical mediators cause blood vessels to dilate (as in the other systems) and all that extra space leads to a drop in blood pressure, and the heart tries to beat harder to compensate (Lewis et al., 2019). This is quickly tiring for the heart and as it tires, the body can go into shock and cardiac arrest.
4. Neurological- Nervous system
Neurological symptoms include headache, dizziness, paresthesia (an abnormal tingling, pricking, chilling, burning sensation in the skin), and a feeling of impending doom (Lewis et al., 2019). The combination of the various physiological changes that occur during anaphylaxis play a role in the neurological symptoms.
5. Respiratory - Lungs and Breathing
Respiratory reactions can also be quite serious. Wheezing, stridor (crowing breath sounds), hoarseness, and coughing are all caused by swelling in the air passages (Lewis et al., 2019). Difficulty breathing (dyspnea) or quick breathing (tachypnea) can lead to respiratory arrest as well (Lewis et al., 2019). Chemical mediators in this system stimulate contraction of smooth muscle in your lungs, and secretion of mucus which cause the respiratory reactions (Lewis et al., 2019)
What you might see:
- Swelling in the face, especially around the eyes, lips and tongue. It might look red, purple or blotchy.
- Red or blotchy marks on the skin anywhere on the body.
- Difficulty breathing or speaking properly, noises when breathing.
- Itchy feelings in mouth, eyes, throat, ears or skin.
- Stomachache, nausea, feeling sick and sore.
Risk Factors
Risk factors are things that increase your chances of developing a particular disease. Below are a list of some of the risk factors that increase your chances of having anaphylaxis.
1. Sensitization / Exposure to Allergen
One major risk factor is being exposed to or ingesting the allergen, as individuals who are highly sensitized to the allergen are at a greater risk of having an anaphylactic reaction. Your body will produce antibodies (IgE) that attach to mast cells in your blood after exposure to the allergen. These antibodies circulate in your bloodstream and when they encounter the allergen in the future the antibodies will trigger an immune response that is responsible for the clinical manifestations of anaphylaxis.
On the other hand, early exposure to certain allergens may lower the risk of having anaphylaxis. There was a research study that found that early introduction of peanuts to high-risk infants greatly lowered, but did not eliminate the chance of developing peanut allergy (Chipps, 2015).
There are many allergens that can cause Anaphylaxis including certain drugs, insect venoms, foods, and latex (Lewis et al., 2019). Examples of these allergens are listed below.
Common Triggers
- Food (eggs, nuts, shellfish, chocolate, milk, fish, strawberries)
- Insect venoms (Bees)
- Medications (antibiotics, NSAIDS (Tylenol, Advil, Ibuprofen), Insulins, Aspirin, Local anaesthetics, dyes used for CT scans, or other medical procedures)
- Latex (Latex rubber gloves or condoms)
2. Family/Personal History
Having a family history of allergic diseases increases your chances of developing anaphylaxis because individuals can inherit certain genetic traits from their parents that predisposes them to having allergic reactions (Lewis et al., 2019). Also, having previous anaphylactic reactions and atopic conditions (e.g. eczema, asthma, allergic rhinitis) increases the risk of having anaphylaxis in the future (Lewis et al., 2019).
3. Age
There are a few reasons why age is considered a risk factor for anaphylaxis. Teenagers are at a greater risk as they engage in risk taking behaviours, have poor judgement of actions during reactions, and don’t use the prescribed medication such as self-administered intramuscular adrenaline (epinephrine) due to fear, lack of knowledge, or lack of practice (Nwaru & Sheikh, 2015).
References
Chipps, B. E. (2015) Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. Pediatrics, 136 (Supplement 3) S238-S239; DOI: 10.1542/peds.2015-2776FF
DynaMed Plus. (2018, Nov 30). Anaphylaxis. Ipswich, MA: EBSCO Information Services. Retrieved May 4, 2019, from http://www.dynamed.com/login.aspx?direct=true&site=DynaMed&id=113862
Goodridge, D., Lewis, S., Goldworthy, S., & Barry, M. (2014) Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems (3rd Canadian Ed.). Toronto, ON: Elsevier Canada.
Lewis, S., Bucher, L., Heitkemper, M., & Harding, M. (2019). Medical-surgical nursing in Canada: Assessment and management of clinical problems (4th ed.). M.A. Barry, J. Lok, J. Tyerman, & S. Goldsworthy (Eds.). Toronto, ON: Elsevier Mosby.
Nwaru, B. I., & Sheikh, A. (2015). Anaphylaxis in adolescents. Current Opinion in Allergy and Clinical Immunology,15(4), 344-349. doi:10.1097/aci.0000000000000176
Chipps, B. E. (2015) Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. Pediatrics, 136 (Supplement 3) S238-S239; DOI: 10.1542/peds.2015-2776FF
DynaMed Plus. (2018, Nov 30). Anaphylaxis. Ipswich, MA: EBSCO Information Services. Retrieved May 4, 2019, from http://www.dynamed.com/login.aspx?direct=true&site=DynaMed&id=113862
Goodridge, D., Lewis, S., Goldworthy, S., & Barry, M. (2014) Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems (3rd Canadian Ed.). Toronto, ON: Elsevier Canada.
Lewis, S., Bucher, L., Heitkemper, M., & Harding, M. (2019). Medical-surgical nursing in Canada: Assessment and management of clinical problems (4th ed.). M.A. Barry, J. Lok, J. Tyerman, & S. Goldsworthy (Eds.). Toronto, ON: Elsevier Mosby.
Nwaru, B. I., & Sheikh, A. (2015). Anaphylaxis in adolescents. Current Opinion in Allergy and Clinical Immunology,15(4), 344-349. doi:10.1097/aci.0000000000000176