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Hives throat closing. Understanding Anaphylaxis: Causes, Symptoms, and Emergency Treatment

by alexxlab

What are the common triggers of anaphylaxis. How can you recognize the signs of a severe allergic reaction. What steps should you take during an anaphylactic emergency. How can teens with allergies stay prepared and safe.

What is Anaphylaxis and What Causes It?

Anaphylaxis is a severe, potentially life-threatening allergic reaction that can occur within minutes of exposure to an allergen. While any substance can theoretically trigger anaphylaxis, certain allergens are more commonly associated with this dangerous reaction.

The most frequent causes of anaphylaxis include:

  • Foods (especially peanuts, tree nuts, fish, shellfish, eggs, and milk)
  • Insect stings (such as from bees, wasps, and fire ants)
  • Medications (including antibiotics and over-the-counter pain relievers)
  • Latex

In some cases, exercise or exposure to extreme temperatures can also trigger anaphylaxis in susceptible individuals. It’s important to note that anaphylaxis can occur even in people with no prior history of allergies.

Recognizing the Signs and Symptoms of Anaphylaxis

Anaphylaxis can affect multiple body systems simultaneously, leading to a range of symptoms that can vary in severity and progression. Identifying these symptoms quickly is crucial for prompt treatment.

Common Symptoms of Anaphylaxis:

  • Difficulty breathing or shortness of breath
  • Throat tightness or the sensation of throat closing
  • Hoarseness or trouble speaking
  • Wheezing, coughing, or nasal congestion
  • Nausea, abdominal pain, vomiting, and/or diarrhea
  • Trouble swallowing or excessive drooling
  • Low blood pressure (which can cause dizziness or fainting)
  • Skin reactions such as itching, redness, or swelling
  • Hives (raised, itchy welts on the skin)
  • A sense of impending doom
  • Loss of consciousness

Do all of these symptoms need to be present for a reaction to be considered anaphylaxis? No. An allergic reaction is classified as anaphylaxis if a person experiences either one severe symptom (such as difficulty breathing or loss of consciousness) or two or more mild symptoms (like hives combined with vomiting).

The Importance of Immediate Action in Anaphylaxis

When anaphylaxis occurs, every second counts. The rapid progression of symptoms can quickly become life-threatening, making immediate treatment essential.

Why is speed so critical in responding to anaphylaxis? The allergic reaction can cause the airways to swell and narrow, potentially leading to respiratory failure. Additionally, a drop in blood pressure can result in shock, causing vital organs to be deprived of oxygen.

Delayed treatment increases the risk of severe complications or even death. This is why healthcare professionals emphasize the importance of recognizing symptoms early and acting swiftly.

Epinephrine: The First-Line Treatment for Anaphylaxis

Epinephrine is the primary and most effective treatment for anaphylaxis. This medication works quickly to counteract the life-threatening effects of a severe allergic reaction.

How does epinephrine work?

  • It constricts blood vessels, helping to increase blood pressure
  • It relaxes smooth muscles in the lungs, which improves breathing
  • It reduces swelling in the throat and other affected areas
  • It suppresses the release of additional inflammatory chemicals from the immune system

Epinephrine is typically administered via an auto-injector, a device designed for easy use during emergencies. Common brands include EpiPen, Auvi-Q, and generic versions.

Is it possible to use too much epinephrine during an anaphylactic reaction? While epinephrine can have side effects, in the context of anaphylaxis, the benefits far outweigh the risks. Medical professionals often say, “If in doubt, give epinephrine.” It’s safer to administer epinephrine unnecessarily than to withhold it when it’s needed.

Creating an Anaphylaxis Action Plan

For individuals at risk of anaphylaxis, having a clear, written action plan is crucial. This plan should outline steps to take in case of an allergic reaction and be shared with family, friends, teachers, and coaches.

Key components of an anaphylaxis action plan:

  1. List of known allergens to avoid
  2. Description of potential symptoms
  3. Instructions for using epinephrine auto-injector
  4. Emergency contact information
  5. When to call 911 or seek immediate medical attention

How often should an anaphylaxis action plan be updated? It’s recommended to review and update the plan at least annually or whenever there are changes in allergies, medications, or emergency contacts.

Living with the Risk of Anaphylaxis: Tips for Teens

For teenagers managing severe allergies, balancing normal activities with the need for constant vigilance can be challenging. However, with proper preparation and education, it’s possible to lead a full and active life while minimizing risks.

Strategies for managing anaphylaxis risk:

  • Always carry two epinephrine auto-injectors
  • Wear medical alert jewelry indicating your allergies
  • Read food labels carefully and ask about ingredients when eating out
  • Inform friends about your allergies and how to use your auto-injector
  • Avoid sharing food, drinks, or personal items that may contain allergens
  • Be cautious at parties or events where allergen exposure might be more likely
  • Plan ahead for school trips, sports events, or other activities away from home

How can teens effectively communicate their allergy needs to others? Practice clear, assertive communication about your allergies. Don’t be afraid to speak up, ask questions, or decline food or activities that might put you at risk. Remember, your health and safety come first.

The Role of Antihistamines in Anaphylaxis Management

While epinephrine is the primary treatment for anaphylaxis, antihistamines can play a supportive role in managing allergic reactions. However, it’s crucial to understand their limitations and proper use.

Key points about antihistamines and anaphylaxis:

  • Antihistamines can help relieve mild allergy symptoms like itching or hives
  • They do not stop or reverse the life-threatening symptoms of anaphylaxis
  • Antihistamines should never be used as a substitute for epinephrine in severe reactions
  • Some doctors may recommend taking an antihistamine after using epinephrine, but this should be discussed with your healthcare provider

Can antihistamines prevent anaphylaxis if taken before exposure to an allergen? No, antihistamines cannot prevent anaphylaxis. While they may reduce the severity of some symptoms, they do not prevent the systemic reaction that occurs during anaphylaxis. Always rely on avoiding allergens and having epinephrine available as your primary prevention strategies.

Understanding Biphasic Reactions and the Importance of Medical Observation

After an initial anaphylactic reaction, there’s a risk of a secondary reaction occurring hours later, even without re-exposure to the allergen. This is known as a biphasic reaction.

Facts about biphasic reactions:

  • They can occur up to 72 hours after the initial reaction, but most happen within 8-10 hours
  • The severity can range from mild to life-threatening
  • It’s difficult to predict who will experience a biphasic reaction
  • The risk is higher in severe initial reactions or those requiring multiple doses of epinephrine

Why is medical observation necessary after anaphylaxis? Due to the risk of biphasic reactions, it’s crucial to seek medical care and remain under observation for several hours after using epinephrine, even if symptoms improve. Healthcare providers can monitor for signs of a secondary reaction and provide prompt treatment if needed.

In conclusion, understanding anaphylaxis, its causes, symptoms, and proper management is crucial for anyone at risk of severe allergic reactions. By staying informed, prepared, and vigilant, individuals with allergies can effectively navigate daily life while minimizing the risks associated with anaphylaxis. Remember, prompt recognition of symptoms and immediate use of epinephrine are key to preventing potentially life-threatening complications.

Serious Allergic Reactions (Anaphylaxis) (for Teens)


en español: Reacciones alérgicas graves (anafilaxia)


Reviewed by: Hillary B. Gordon, MD


Allergy & Immunology at Nemours Children’s Health

What Is Anaphylaxis?

Anaphylaxis is a severe allergic reaction that can be life-threatening. Things that can cause allergic reactions are called allergens.

Anaphylaxis (pronounced: an-eh-fih-LAK-siss) most often happens during allergic reactions to:

  • foods
  • insect stings
  • medicines
  • latex

Anaphylaxis can be scary. But being prepared will help you treat a reaction quickly.

What Are the Signs & Symptoms of Anaphylaxis?

Severe allergic reactions can cause:

  • trouble breathing
  • throat tightness or feeling like the throat or airways are closing
  • hoarseness or trouble speaking
  • wheezing or cough
  • nasal stuffiness
  • nausea, belly pain, vomiting, and/or diarrhea
  • trouble swallowing or drooling
  • low blood pressure
  • skin itching, redness, or swelling
  • hives
  • a feeling like something bad is about to happen
  • passing out

Anaphylaxis can cause different symptoms at different times.  An allergic reaction is considered anaphylaxis if someone has:

  • any severe symptoms, such as trouble breathing, repeated vomiting, passing out, or throat tightness
    or
  • two or more mild symptoms, such as hives and vomiting or coughing and swelling

A person with symptoms of anaphylaxis needs treatment right away.

How Is Anaphylaxis Treated?

Someone with anaphylaxis needs help right away. The reaction can get worse very quickly. So doctors usually want people with allergies to carry injectable medicine called epinephrine. Epinephrine enters the bloodstream and works quickly against serious allergy symptoms.

Doctors prescribe
epinephrineauto injectors. These should always be with the person with allergies, including at school, sports, jobs, and other activities. The auto injector is small and easy to use.

If you’re prescribed epinephrine auto injectors, the doctor will show you how to use them. Always have two auto injectors with you in case one doesn’t work or you need a second dose.

Your doctor also might instruct you to take antihistamines in some cases. But always treat a serious reaction with epinephrine. Never use antihistamines instead of epinephrine in serious reactions.

What to Do if You Have Anaphylaxis

Give yourself epinephrine right away if you start to:

  • have trouble breathing
  • feel tightness in your throat
  • feel faint
  • have two or more milder allergic symptoms together (like hives with coughing)

Don’t try to use an inhaler or antihistamine and wait to see what happens. Go straight for the epinephrine! Time matters during anaphylaxis.

If you have signs of a serious allergic reaction:

  1. Use the epinephrine auto-injector right away. Then call 911.
  2. Lay down with your legs raised while you wait for the ambulance.
  3. Go to the emergency room, even if symptoms improve after epinephrine. You must be under medical supervision for several hours. This is because a second wave of serious symptoms (called a biphasic reaction) can happen. You can get more treatment at the emergency room, if you need it.

What Else Should I Know?

Being prepared can help you stay safe:

  • Carry two epinephrine auto injectors with you at all times. Epinephrine can be a lifesaver.
  • Avoid the things you are allergic to.
  • Let friends, teachers, and coaches know about your allergies and how they can help you if you have a reaction.

Reviewed by: Hillary B. Gordon, MD

Date reviewed: January 2022






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Understanding Hives (Urticaria) | Saint Luke’s Health System

Hives (urticaria) are red, itchy, and
swollen areas (welts) on the skin. Sometimes hives are caused by an allergic reaction
from
eating a food or taking a medicine. Other times, hives can be caused by illnesses
like the
common cold. But sometimes the cause may not be known. A single hive can vary in size
from
a half inch to several inches. Hives can appear all over the body. Or they may appear
on
only one part of the body.

What causes hives?

Hives can be caused by allergies to
food and drinks such as:

  • Tree nuts (almonds, walnuts,
    hazelnuts)

  • Peanuts

  • Eggs

  • Shellfish

  • Milk

  • Wheat

  • Soy

  • Colorings, preservatives, and spices used in foods

Hives can also be caused by
medicines such as:

  • Antibiotics, especially
    penicillin and sulfa-based medicines 

  • Anticonvulsant or antiseizure
    medicines 

  • Chemotherapy medicines 

Other causes of hives include:

  • Infection or virus

  • Heat

  • Cold air or cold water

  • Exercise

  • Scratching or rubbing your
    skin, or wearing tight-fitting clothes that rub your skin

  • Being exposed to sunlight or
    light from a light bulb, in rare cases

  • Inhaled chemicals in the
    environment from foods and medicines, insects, plants, or other sources

  • Latex allergy. If you already have a latex allergy, foods such
    as bananas, chestnuts, kiwis, or mangos can trigger hives.

In some cases, hives may occur
again and again with no specific cause (idiopathic urticaria).

If you have hives

  • Stay away from the food,
    drink, medicine, or other thing that may be causing the hives.

  • Ask your healthcare provider
    how to control itchy or irritated skin.

  • Talk with your provider right
    away if you think a medicine or food gave you hives.

Watch for anaphylaxis

If you have hives, watch for
symptoms of a severe reaction that can affect your entire body. This is
called anaphylaxis. Symptoms can include swollen areas of the body, wheezing, trouble
breathing or swallowing, and a hoarse voice. This reaction may happen right away,
or it
may happen in an hour or more. In extreme cases, the airways from mouth to lungs may
swell and make breathing difficult. This is a medical emergency. Use an epinephrine
autoinjector if you have it, and call
911
or go to the emergency room.

When to call your healthcare provider

Call your healthcare provider right
away if:

  • Your hives feel
    uncomfortable

  • You have never had hives
    before

  • Your symptoms don’t go away
    or come back

  • Your symptoms get worse or
    you have new symptoms, such as: 

    • Sneezing, coughing,
      runny or stuffy nose

    • Itching of the eyes,
      nose, or roof of the mouth

    • Itching, burning,
      stinging, or pain

    • Dry, flaky, cracking,
      or scaly skin

    • Red or purple spots

Call
911

Call
911 right
away if you have:

  • Swelling in your lips,
    tongue, or throat

  • Drooling

  • Trouble breathing, talking,
    or swallowing

  • Cool, moist, or pale (blue in
    color) skin

  • Fast and weak heartbeat

  • Wheezing or shortness of
    breath

  • Feeling lightheaded or
    confused

  • Diarrhea

  • Belly (abdominal) pain, cramps, or bloating

  • Severe nausea or vomiting

  • Seizure

  • Feeling dizzy or weak, or a
    sudden drop in blood pressure

  • Chest tightness

types, causes, symptoms, signs, diagnosis, first aid, treatment

Classification

Causes and risk factors

Symptoms

Complications

Diagnosis

Treatment

Prevention teak

Urticaria is a common allergic disease characterized by the formation of a rash in the form of blisters or urticaria. Rashes with urticaria are localized mainly on the skin of the neck, face, body and hands. But there are cases when blisters appeared on the mucous membranes.

The disease affects 25% of the world’s population. Urticaria can appear in both children and adults. Signs are noted more often by women than men. The onset of the disease falls on middle age, namely about 35–40 years. 5% of cases are pediatric patients.

Classification

Depending on the duration of the course of the disease, modern medicine distinguishes the following types of urticaria:

  1. Acute urticaria is a condition that is characterized by the manifestation of symptoms for at least 6 weeks. Patients also report headache and fever.
  2. Acute recurrent – a type of disease with an exacerbation duration of up to 6 weeks. The difference is the duration of remission for 6 weeks.
  3. Chronic urticaria is a disease that lasts longer than 6 weeks. This type can be viral, allergic or autoimmune in nature.

According to the rate of development of the disease, the following degrees are distinguished:

  1. Mild degree, which is characterized by the appearance of rashes in the amount of less than 20 pieces during the day. In this case, patients note a slight itching, which does not bring much discomfort.
  2. The average degree of urticaria, characterized by noticeable itching of the skin and increased formation of urticaria (approximately 30-50 pieces per day).
  3. Intensive degree. Itchy sensations disrupt daily life, and the number of rashes exceeds 50 pieces.

Depending on the mechanism of development of pathology, such types of diseases are distinguished as:

  • allergic urticaria, which is provoked by immune processes. For example, the secretion of pathogen-specific immunoglobulins or the production of cytokine proteins that enhance the inflammatory response;
  • non-allergic, in the development of which immune mechanisms are not involved;
  • food, the provoking factor of which are certain foods;
  • viral;
  • solar, the cause of which is direct contact with the sun’s rays. This type of disease is mainly affected by women with liver pathologies and impaired pigment metabolism;
  • contact, which occurs when the skin comes into contact with chemical materials, such as latex or silicone;
  • aquagenic – an autoimmune form of the disease associated with interaction with water;
  • cold. Occurs when the skin is exposed to low temperature;
  • viral, caused by a viral infection;
  • idiopathic urticaria is a disease whose cause remains unclear.

Causes and risk factors

The manifestation of an allergic disease can have a different etiology. For example, a clear provocateur of the disease is an insect bite or the use of certain drugs, including antibiotics. Blood transfusion, vaccination, and direct interaction with the allergen through food can also provoke the condition.

Other causes of hives include:

  • contact with chemicals such as powders, lotions, home cleaning solutions;
  • increased sensitivity of the skin to mechanical stress;
  • allergies to cold, sun and heat;
  • the use of cosmetics, including shampoos, eyelash and eyebrow dyes, as well as components of formulations used in nail extensions;
  • exposure to pollen from flowers and plants, which can provoke an allergic reaction, including rhinitis or hay fever.

Despite the fact that many factors provoking the disease are known, the cause of about 30% of cases of the disease cannot be established.

In addition, many chronic non-allergic diseases can cause urticaria. These include lymphoma, thyroid pathologies, diabetes mellitus, and diseases of the gastrointestinal tract.

Symptoms

The main symptom of urticaria is the appearance on the mucous membranes and skin of rashes in the form of blisters. Urticaria are purplish, pinkish or pale pink in color. As a rule, formations rise above the surface of the skin. The condition is often accompanied by unbearable itching. In exceptional cases, soreness appears in the places of localization of the rash.

Some patients also report symptoms of urticaria such as:

  • fever;
  • general weakness;
  • body aches;
  • lowering blood pressure;
  • tearing and redness of the eyes;
  • severe swelling of the eyelids;
  • loss of appetite.

In the case of an allergic type of urticaria, patients develop nasal discharge and nasal congestion, the sense of smell decreases and breathing through the nose is disturbed. These changes often lead to a change in hearing.

The severity of cold symptoms varies from patient to patient and may include skin redness, swelling and itching.

To understand what urticaria looks like in children, just look at the skin. In pediatric patients, the symptoms are similar to the manifestations of the disease in adults: itching, blisters up to 3 mm in size, redness. But, in addition to general signs, digestive disorders appear in the form of vomiting, diarrhea and abdominal pain.

When sick, blisters disappear without a trace 1–2 days after they appear. This is a feature of the disease that distinguishes it from other allergic pathologies.

Complications

Like any allergic disease, hives can lead to complications. Rashes in children often turn into ulcers. This is due to the constant scratching of blisters and infection.

Quincke’s edema is the most serious complication of the pathology. At the same time, patients have swelling of the larynx and face, which as a result can lead to respiratory failure. This is a critical situation that requires immediate medical attention.

Anaphylactic shock, which is often accompanied by a decrease in pressure, clouding in the eyes and heart rhythm disturbance, is another possible complication of the pathology.

Diagnosis

Diagnosis and treatment of urticaria is carried out by a group of doctors, depending on the cause of the disease. A physical examination for visible symptoms is done by a therapist. At the initial examination of the patient, the doctor measures blood pressure, body temperature, heart rate and feels the abdomen and lymph nodes. In the case of an allergic type of disease, an allergist-immunologist and a dermatologist are involved in the treatment.

Depending on the severity of the signs and characteristics of the course of the disease in the patient, the doctor may prescribe one or more diagnostic tests:

  1. Complete blood count.
  2. Immunoglobulin lgE general.
  3. Allergotest.
  4. Fecal analysis.
  5. Gastroscopy.
  6. Ultrasound of the abdominal organs.
  7. Ultrasound of the pancreas.
  8. Ultrasound of the thyroid gland.
  9. Chest x-ray.
  10. X-ray of the stomach.

In most cases, the disease stops within the first 14 days, so a special study is not required. After the provoking factor is established, laboratory diagnostics is prescribed.

Treatment

If signs of urticaria appear, it is important for the patient to provide first aid before contacting a doctor. To do this, calm the victim, unbutton the top button of the clothing and give a glass of mineral water to drink.

Symptoms of the disease can appear at any time when interacting with the allergen. Therefore, it is good to have anti-allergic drugs in the form of tablets and drops in the first-aid kit, which must be given to the patient. A cold compress should be applied to the swelling site.

Treatment of urticaria consists of several stages:

  1. Exclusion of the allergen – the causative agent of the disease. To do this, you must stop taking medications that could cause pathology. You should also avoid hypothermia and overheating of the body.
  2. Detection of foci of infection and their elimination.
  3. Compliance with the diet for urticaria. It is important to exclude from the diet foods that can cause allergies: nuts, coffee, chocolate, honey, citrus fruits. The food plate should be filled with hypoallergenic foods, such as vegetable soups, low-fat broth, cereals from cereals, low-fat cottage cheese and yogurt, apples.
  4. Use of medications, including antihistamines, immunosuppressants, and antidepressants. It should be remembered that medicines for the treatment of urticaria should be taken only as directed by a doctor.

With the onset of asphyxia against the background of Quincke’s edema, the patient is urgently prescribed a tracheostomy.

Topical ointments and creams for urticaria have not been shown to be effective. Therefore, the use of only these funds will not lead to a complete recovery.

Prophylaxis

In order to prevent urticaria, doctors advise to adhere to the following recommendations:

  • in case of a tendency to develop allergies, contact with possible allergens should be avoided;
  • it is important to treat diseases in a timely manner in order to avoid complications;
  • a balanced diet is recommended;
  • It is worth minimizing the physical and chemical effects on the skin.

The rate of recovery of a patient with urticaria is affected by age, cause of the disease, gender and individual characteristics of the body. With timely access to a doctor, serious consequences can be avoided.

The author of the article:

Ivanova Natalya Vladimirovna

therapist

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