Earlier this year, an ostensibly humorous scene in the film version of the children’s tale “Peter Rabbit” stirred up controversy instead of comedy when Peter and his bunny friends tried to trigger an allergic reaction in their nemesis by attacking him with blackberries.
But as anyone who has a severe allergy to food or animals can tell you, the issue isn’t a laughing matter. In fact, the extreme allergic reaction called anaphylaxis can have a life-threatening effect on the heart and lungs, says Paul Skomra, MD, a family practitioner with Swedish Mill Creek Primary Care in Everett, WA.
“Basically, anaphylaxis can cause death from respiratory distress and cardiovascular collapse,” Dr. Skomra says. “You can have bronchial spasms, which can cause wheezing, coughing and chest tightness, and eventually cause what we call respiratory arrest, where you’re not breathing. With the cardiovascular system, you can get a very fast heart rate, which leads to shortness of breath and very low blood pressure and that can progress to cardiac arrest.”
Anaphylaxis is typically caused by allergies to animals or foods, Dr. Skomra says, adding that it’s not completely understood why some people have very little reaction to something like a bee sting or peanuts, while others experience serious, potentially fatal complications. Because anaphylaxis can grow worse very quickly, it’s important to know the signs of an anaphylactic reaction and how to act fast.
What to look for in an anaphylactic reaction
While anaphylaxis can have the most serious effect on the heart and lungs, it can actually trigger symptoms throughout the body, Dr. Skomra says.
“There can be swelling, redness and tears in the eyes,” he says. “Symptoms in the mouth can be some of the most ominous because there can be angioedema, or swelling, in the airway and esophagus and the tongue and the lips. For skin, rashes or swelling can show up, and the hair follicles can stand up. In the gastrointestinal system, there can be some nausea, vomiting, diarrhea and abdominal cramps. It can even affect people neurologically, with headaches, dizziness or lightheadedness. So anaphylaxis can affect almost every body system. If it’s a localized reaction—the site where you got stung by a bee or your tongue gets a little itchy when you swallow something you’re allergic to—that’s not as indicative of an anaphylactic reaction.”
Precautions to take against anaphylaxis
The first step, of course, is to avoid allergens at all costs whenever possible. “Patients with food-induced anaphylaxis should use high scrutiny and be very careful when reading ingredient lists, and shouldn’t be afraid to ask what’s in food prepared for them,” Dr. Skomra says.
If medications are the trigger for anaphylaxis, those should also be avoided. In these cases, it can be helpful for people to wear a medical alert bracelet that lists the medications a person is allergic to, Dr. Skomra says.
If someone has had a system-wide, rather than a localized, response to an allergy, that’s a good indicator that they need an EpiPen, which is used to inject the medicine ephinephrine. “Those people should really see an allergist, who can evaluate the reaction and the symptoms, and can get the patient’s pertinent health history and physical exam, then recommend testing if that’s indicated,” Dr. Skomra says. And of course, that EpiPen should be accessible at all times.
People with severe allergies that can cause anaphylaxis should notify loved ones and the people who are around them on a daily basis, such as co-workers, about their condition. Parents with children who have allergies should contact their schools to see how they handle epinephrine. This knowledge can be important if any anaphylactic reaction ever occurs, because fast action is crucial in those situations.
What to do in case of an emergency
If people witness a severe allergic reaction, they should call 911 and try to get information from the person with the allergy. “I would first try to find out what they ingested and if they have a history of anaphylaxis, and then ask if they have their EpiPen, which is by far the most important tool if someone is having an anaphylactic reaction.”
Another thing to do is have the patient lie down with their legs raised. “Then it’s monitoring and supporting the airway, the breathing and the circulation—we call them the ABCs,” Dr. Skomra says. “After the patient is in that appropriate position, that’s when intramuscular epinephrine can be administered every five to 15 minutes.”
Find a local Swedish physician to discuss any concerns about allergies or any other health care questions you may have. Swedish Express Care clinics offer urgent care, same-day appointments and extended hours every day of the week.
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.