What is Anaphylaxis

What is an Allergy?

An allergy is when a person’s immune system reacts to triggers (allergens) that the person is hypersensitive to and is usually harmless to most other people. Symptoms of an allergy can range from mild to potentially life-threatening (severe). It occurs when the body mistakes something as harmful and creates a defence system (antibodies) to fight it.

The ways allergens can enter the body:

• Ingested (most common, in the mouth)
• Inhaled (breathed in)
• Injected (bees, wasps, ants or medication)
• Absorbed (through touching the skin)
• Allergy symptoms develop when the antibodies are battling the “invading” allergen

What is anaphylaxis?

Anaphylaxis is a severe and sometimes sudden allergic reaction. It can occur when a susceptible person is exposed to an allergen (such as food or an insect sting). Reactions usually begin within minutes of exposure and can progress rapidly over a period of up to two hours or more.

Anaphylaxis is potentially life-threatening and always requires an emergency response.

Common Causes of Anaphylaxis:

• Food allergies, such as peanuts, tree nuts, fish, lactose, eggs, wheat, seafood, fish, soy
• Insect stings, such as bees, wasps or even ants
• Tick bites
• Some materials, such as latex
• Medications, both over the counter and prescribed, can cause life-threatening allergic reactions, e.g. aspirin, antibiotics such as penicillin
• Some herbal remedies can also induce reactions
• Exercise
  

Signs and Symptoms (Allergy):

• Initial signs (these can be used as warning signs to get help)
• May begin with itchy hands, mouth or feet
• Eyes may become red, watery and puffy
• Tingly around the mouth
• Swollen lips and face
• Rash or hives can develop, especially on the chest, armpits and groin (hives are white itchy bumps that look and feel like insect bites)
• Stomach pain, vomiting, diarrhoea

Soon after hives develop, more serious symptoms (Anaphylaxis) may occur, including:

• Shock
• Altered mental status
• Difficulty breathing, or shortness of breath and gasping
• The casualty may become very anxious and have a great sense of fear
• Respiratory or cardiac arrest and unconsciousness
• Difficulty and/or noisy breathing
• Swelling of the tongue
• Swelling or tightness in the throat
• Difficulty talking or hoarse voice
• Wheeze or persistent cough
• Loss of consciousness and/or collapse
• Pale and floppy (young children)

Management of an Allergic Reaction (Mild to Moderate):

• Follow DRS ABCD as required
• For insect allergy, flick out the sting if visible. In the case of a tick bite, if there is no history of tick allergy, immediately remove the tick
• If the casualty has a history of tick allergy, the tick must be killed where it is, rather than removed.
• Apply a cold compress to the bite/sting site
• Stay with casualty and reassure
• Call for help. Get someone to contact 000 / 112
• If prescribed, give other medications as noted on Personal Action Plan for Allergic Reactions
• Continue to monitor the casualty for signs of anaphylaxis
• Contact parent/guardian or other emergency contacts
  

Management of Anaphylaxis (Severe Allergic Reaction):

• Follow DRS ABCD
• Lay the casualty flat. If having difficulty breathing, sit them upright and try to calm them
• If known and possible, remove the source of the allergy
• Bring the EpiPen to the casualty. Use the autoinjector (EpiPen) to inject adrenaline. Specific training is required (Note that EpiPens have been designed for use by anyone in an emergency as instructions are shown on the label)
• Call 000 / 112 for an ambulance
• Continually monitor the casualty’s airways, breathing and respiration, as a sudden change may occur which may need CPR at any time. Ensure that the EpiPen has been administered before commencing CPR.
• Contact parent/guardian or other emergency contacts
• If available, further adrenaline doses may be given if there is no response after 5 minutes
• If uncertain whether it is asthma or anaphylaxis, give adrenaline autoinjector FIRST, then asthma reliever

EpiPen:

• An EpiPen is a small, hand-held, automatic injection device.
• It contains adrenaline and is injected into the fleshy part of the casualty’s thigh when experiencing an anaphylactic reaction.
• EpiPens are prescribed to people with known allergies and they may be able to inject themselves or may need assistance from the first aider
• Note: Single use only

Child Green Auto-Injector (<20kg).
Adult Yellow Auto-Injector (>20kg)

Anaphylaxis Management Plan

Ensure that all patients prescribed an adrenaline autoinjector has an anaphylaxis management plan that includes:

• Referral to an appropriate specialist
• Identification of the relevant allergen(s)
• Education on avoiding allergen(s)
• An anaphylaxis action plan (see image)
• Appropriate follow-up and review
• Train patients to recognise the symptoms of anaphylaxis and how to use their adrenaline auto-injector correctly

Parents should advise preschools or schools of their child’s adrenaline autoinjector prescription, and provide a completed anaphylaxis action plan illustrating the use of the device prescribed.

Some high-risk patients can be prescribed two adrenaline autoinjectors, but they must be of the same brand.

Advise patients to check the expiry date of their adrenaline auto-injector regularly.

See the Australasian Society of Clinical Immunology and Allergy (ASCIA) website for health professionals and consumer anaphylaxis resources.

Note: Symptoms of severe allergic reactions or anaphylaxis can occur when there is no history of known allergies. This situation should be treated as an emergency. An adrenaline Autoinjector should be administered, if available, an ambulance called and first aid provided until expert help arrives.

CONCLUSION

Anaphylaxis is a serious allergic reaction that can be deadly. It’s important to know the signs and symptoms so you can get help right away if someone experiences anaphylaxis. If you have an EpiPen, it’s also important to know how to use it properly in case of an emergency. Make sure you have a plan in place for managing anaphylaxis in case of an emergency. Knowing what to do could save someone’s life.

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