Anaphylaxis

Anaphylaxis

This month, we thought that we would take a look at anaphylaxis.

Anaphylaxis is a severe reaction to a range of allergens and is a life-threatening illness that can kill very quickly if the casualty is not treated in a timely manner. The reaction in the body affects more than one system of the body for example, the circulatory system, respiratory system and the digestive system as well as organs not included in these like the skin. An anaphylactic reaction usually occurs within minutes of an exposure but in some cases can take hours to portray itself and affect the casualty.

What is the Circulatory System?

The circulatory system is an organ system that allows blood to travel around the body, as well as transporting vital nutrients, oxygen, carbon dioxide, hormones and blood cells to and from the various cells of the body, providing nourishment, helping to stabilise temperature and PH levels, fighting diseases and maintaining homeostasis (the equilibrium of an organism’s state and internal environment).

What is the Respiratory System?

The respiratory system is a biological system that consists of specific organs and structures used for gas exchange in animals and plants.

What is the Digestion System?

The digestion system consists of the gastrointestinal tract, along with the organs of digestion:

  • Tongue,
  • Salivary glands,
  • Pancreas,
  • Liver,
  • Gallbladder.

The process of digestion takes many stages and starts in the mouth with chewing, working its way down the gastrointestinal tract.

What happens in an Anaphylactic shock?

In an anaphylactic shock reaction, the immune cells of the body release a massive quantity of a chemical known as histamine to try to deal with the body’s overreaction to the allergen. The release of the chemical causes a rash on the skin and causes some itching for the casualty. In severe cases where the body has released extreme quantities of histamine the casualty can suffer from extreme life-threatening Airway, Breathing and Circulation issues.

Airway Problems:

Anaphylaxis can make the blood capillaries leak causing swelling which can cause the airway to swell, therefore affecting the casualty’s breathing as the airway is swelling and blocking the air route.

Breathing Problems:

Just like an asthma attack, anaphylactic shock can constrict the alveoli in the lungs causing difficulty with breathing.

Circulation Problems:

Anaphylaxis can result in a life-threatening blood pressure fall because of the blood vessels dilating to 3 times their normal size, any fluid loss from the leaking capillaries will make the fall of blood pressure even worse. Should this event happen the casualty must lie down. If the casualty is in any other position, this situation can result in a lack of blood to the heart that will stop it instantly.

What triggers an allergic reaction?

There are many triggers of an allergy which include:

Food

In December 2014, the Food Information Regulations came into force which list the 14 major allergens which must be listed on pre-prepared food items and menus when they are used as ingredients in food. The Food Standards Agency published guidelines on these 14 allergens.

So, what are the 14 allergens?

1 – Celery

Celery or Apium graveolens is a marshland plant in the Apiaceace family that has been cultivated since antiquity. Celery has a long fibrous stalk which tapers out into leaves. Celery seed is used in herbal medicine.

Celery includes celery stalks, leaves, seeds and the root called celeriac. Celery is found in a lot of foods some of which include celery salt, salads, some meat products, soups and stock cubes.

2 – Cereals containing gluten

Gluten is a composite of storage proteins termed prolamins and glutelins and stored together with starch in the endosperm of various cereal grains.

The allergen here includes:

  • Wheat,
  • Spelt,
  • Rye,
  • Barley,
  • Oats.

These allergens are usually found in things like baking powder, flour, batter, breadcrumbs, bread, cakes, couscous, meat products, pasta, pastry, sauces, soups, fried foods which are dusted with flour.

3 – Crustaceans

Crustaceans form a large diverse anthropod taxon which includes such familiar animals such as crabs, lobster, prawns, scampi, krill, woodlice (not normally food!), and barnacles. Other sources of this allergen will include shrimp paste, Thai and South-East Asian curries and salads.

4 – Eggs

Eggs are laid by female animals of species, including birds and fish and have been eaten by humans for thousands of years.

Eggs are found in many products for example, cakes, mayonnaise, mousses, pasta, quiche, sauces, pastries or foods brushed or glazed with egg and some meat products.

5 – Fish

Fish are gill-bearing aquatic craniate animals that lack limbs with digits.

Fish are found in various obvious places like fish dishes and fish sauces, but can also be found in pizzas, relishes, salad dressings, stock cubes, and Worcestershire sauce.

6 – Lupin

Lupin more commonly known as Lupinus is from the Legume family of flowering plants and is also used in food. Lupin beans are the yellow legume seeds and are often used as a pickled snack or ground into flour which can enhance the flavour and leads to a rich creamy colour to resulting foods.

Lupin can be found in certain breads, pastries and even flour.

7 – Milk

Milk is a white liquid produced by the mammary glands of mammals.

Milk is a very common ingredient in cuisine including in butter, cheese, cream, milk powders, and yoghurts, as well as being found in food that has been brushed with milk or when powdered milk has been used in soups and sauces.

8 – Molluscs

Mollusca is a large phylum (a classification level) of invertebrate animals whose members are known as molluscs or mollusks, around 85,000 extant species are recognised with the fossil species taking that number up to between 60,000 to 100,000 species.

In food, molluscs include mussels, land snails, squid and whelks, but can also commonly be found in oysters or as an ingredient for fish soups and stews.

9 – Mustard

Mustard is a condiment that is made from the seeds of the mustard plant.

This category, as defined by the Food Standards Agency, includes liquid mustard, mustard seeds and mustard powder. You are likely to find this allergen in foods like breads, curries, marinades, salad dressings, sauces, soups and meat products.

10 – Nuts

A nut is a fruit that consists of a hard-inedible shell, with an edible inner seed, and is not to be confused with peanuts which are actually a legume and grow underground. In this category we are discussing nuts which grow on trees for example,

  • Cashew nuts,
  • Almonds,
  • Hazelnuts.

Nuts are used widely across cuisine, but most commonly found in breads, biscuits, crackers, desserts, nut powders, stir-fried dishes, ice-cream, marzipan, nut oils and various sauces.

11 – Peanuts

As mentioned above in allergen 10, the peanut is a legume and is grown underground, which is why it is often referred to as ground nut or goober. The peanut is a part of the Fabaceae family.

You are most likely to find peanuts in things such as biscuits, cakes, curries, desserts, sauces most noticeably satay sauce, and in groundnut oil and peanut flour.

12 – Sesame Seeds

Sesame is a flowering plant in the Sesamum genus.

Sesame seeds are likely to be seen in bread or commonly on top of sesame seed buns, breadsticks, houmous, sesame oil and tahini. They are often toasted and tossed into salads as well.

13 – Soya

Glycine max is more commonly known as soybean in North America or soya bean and is native to East Asia and part of the legume family.

Soya is often found in bean curd, edamame beans, miso paste, soya flour, textured soya protein, or tofu. Soya is a staple ingredient of oriental food. Soya can also be found in desserts, ice-cream, meat products, sauces and vegetarian products.

14 – Sulphur Dioxide or Sulphates

Sulphur dioxide is a chemical compound with the chemical formula SO2, it is a toxic gas with a pungent, irritating smell. If you have asthma you have a higher risk of developing a reaction to sulphur dioxide.

You can find sulphur dioxide in dried fruits, meat products, soft drinks, vegetables, as well as in wine and beer.

We used the Food Safety Agency guidelines as guidance for this list.

There are many more food-related allergens, which can be very individual to each anaphylactic sufferer, including:

  • Coconut,
  • Kiwi fruit,
  • Strawberry, and
  • Bananas etc.

Insect Stings

Bee Stings

A bee sting is acidic and can cause anaphylactic issues in a casualty. Even if it doesn’t cause a reaction, the bee can leave their sting in the casualty’s body where they have been stung; this can be removed by scraping a blunt straight edge over the affected area, elevating the injury if possible and using ice in a tea towel can help to reduce the swelling and pain on the casualty.

Wasp Sting

The wasp sting is the opposite to the bee and is therefore an alkali. The wasp rarely leaves its stinger in its victim, therefore, elevating the injured part of the body and applying ice in a tea-towel on the affected part of the body can help to reduce the swelling and pain.

With both a bee and wasp sting it is important that you keep a close eye on the casualty in case they should have a reaction to it.

Medication

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Non-Steroidal Anti-Inflammatory Drugs are a drug class that are designed to reduce pain, decrease fever, prevent blood clots, and in higher dosages can reduce inflammation.

They include:

Aspirin,
Celecoxib,
Diclofenac,
Ibuprofen,
Indomethacin,
Naproxen,
Oxaprozin,
Piroxicam.

Penicillin

Penicillin is a group of antibodies that includes Penicillin G, Penicillin V, Procaine Penicillin, and Benzathine penicillin. The chemical formula is C9H11N2O4S.

Perfumes

Perfume is a mixture of fragrant essential oils and/aroma compounds designed to give the human body, environment, food, objects and living spaces an agreeable scent.

How can I recognise an Anaphylactic Shock?

There are 3 main characteristics of an anaphylactic shock.

  1. A rapid onset, as discussed earlier onset can in rare cases be hours rather than minutes,
  2. Life-Threatening:
    • Airway complications:
      • Swelling of the tongue, lips, or throat,
      • Casualty may feel the throat closing up,
      • A hoarse voice,
      • Loud pitched, noisy breathing.
    • Breathing complications:
      • Difficult, wheezy breathing,
      • Tight chest.
    • Circulation complications:
      • Dizziness,
      • Feeling faint or passing out, (if sat upright),
      • Pale, cold, clammy skin,
      • Fast pulse,
      • Nausea,
      • Vomiting (capillaries leaking in the gut),
      • Stomach cramps (capillaries leaking in the gut),
      • Diarrhoea (capillaries leaking in the gut).
  3. A skin rash, flushing and/or swelling, which may disappear and come back, not all casualties will have this.

Other signs and symptoms of anaphylactic shock include:

  • Anxiety,
  • A ‘Sense of impending Doom’.

Not all casualties will have all the airway, breathing and circulation complications but casualties can also have all three.

How do I treat Anaphylactic Shock?

The correct order of treatment for a casualty who is in anaphylactic shock is as follows:

  1. Call 999/112 for emergency help.
  2. Lay the casualty down in a comfortable position
    • If the casualty feels light-headed, lie them down immediately and raise their legs, DO NOT sit them or stand them up as this can be fatal.
    • If you find that the casualty ONLY has airway and breathing complications, they can be sat up, they may even prefer this and it can make breathing easier, however, if they begin to feel light-headed, then you must lie them with their legs elevated.
  3. If the casualty carries an Adrenaline Autoinjector, it can help to save their life. Ideally, they should administer this on their own however, should they need assistance, you can assist them. Prompt use saves lives.
  4. If the casualty becomes unconscious, follow the basic life support skills you are taught on one of our courses, check airway and breathing and then if necessary start Cardio-Pulmonary Resuscitation.
  5. If the casualty has a second Adrenaline Autoinjector, this can be administered after 5 to 15 minutes if there is no improvement or symptoms return.

What is an Adrenaline Autoinjector?

An Adrenaline Autoinjector, or an epinephrine autoinjector to use its real name, is a medical device for injecting a measured dose of epinephrine (adrenaline) by means of auto-injection technology. They were first brought to the market in the 1980s.

Epinephrine (adrenaline)’s chemical formula is C9H13NO3.

There are 3 main makes of Adrenaline Autoinjectors these are:

  • EpiPen,
  • Jext, and
  • Emerade.

EpiPen

The EpiPen like the other 2 adrenaline autoinjectors has similarities and differences. The EpiPen has an 18-month shelf life and is administered to the casualty for a duration of 10 seconds. The dosage inside the autoinjector depends on the size of the casualty:

15 to 30 kg patients = 150mcg
>30kg patients         = 300mcg.

The EpiPen is the most commonly used autoinjector on the market, and comes complete with visual instructions on the pen, making it easy to follow in an emergency. There is also a viewing window, which means you can check whether the epinephrine is good or bad. If the fluid is clear it is good to use, cloudy would indicate that it is past its best and shouldn’t be used. The EpiPen also comes complete with a rhyme:

‘Blue to the sky,
Orange to the thigh.’

This relates to the blue safety cap and the orange thigh that needs to be used to inject the medication in to the casualty’s thigh.

Emerade

The Emerade pen is the one which is mostly aligned to the Resuscitation Council of the United Kingdom (RC(UK)), with a slightly larger needle than the other 2 autoinjectors. The pen has a shelf life of 30 months and is administered to the casualty for a duration of 5 seconds. Like, the EpiPen, the Emerade pen dosage depends on the size of the casualty:

15 to 30 kg patients = 150mcg
>30kg patients         = 300mcg.

The safety cap of the Emerade pen is at the needle end, and like the EpiPen this pen has visual instructions on the barrel to aid easy administration.

Jext

The Jext pen, like the EpiPen, has a shelf life of 18 months and takes a duration of 10 seconds into the casualty’s body. Like the other 2 pens the dosage inside the autoinjector depends on the size of the casualty:

15 to 30 kg patients = 150mcg
>30kg patients         = 300mcg.

The Jext pen like the EpiPen has a viewing window and, as with the other 2 pens, has got visual instructions on the barrel in order to assist in easy administration of the pen.

All of the 3 pens must be injected into the thigh muscle, as this is the biggest muscle of the body and therefore the quickest route of the epinephrine into the body.

If this article has caught your interest or you want to know more about Anaphylaxis there are several ways that you can learn more on our courses, we cover Anaphylaxis in brief in most of our First Aid courses, as well as having a specific course that focuses wholly on Anaphylaxis. Why not visit our First Aid courses page on our website to see what we can offer?

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