When Is an Allergic Reaction an Emergency?
Recognizing the first signs of a serious, life-threatening allergic reaction (anaphylaxis) and taking immediate action with emergency medication can be the difference between life and death. If you or a loved one, especially a child, has a severe allergic reaction, every second counts.
"The biggest mistake is not treating a severe allergic reaction,” says Scott H. Sicherer, MD, an Elliot and Roslyn Jaffe professor of pediatrics, allergy and immunology and the chief of the division of allergy and immunology in the department of pediatrics at Mount Sinai Hospital in New York City and author ofFood Allergies: A Complete Guide for Eating When Your Life Depends on It. “The people who die from anaphylaxis are those who had a delay in treatment."
That’s why it’s critical for people with severe allergies to know the symptoms of anaphylaxis and be prepared with an emergency action plan.
How to Identify Anaphylaxis
The signs and symptoms of anaphylaxis can vary greatly from person to person as well as from time to time in the same person. Also, they may develop very quickly — within seconds of exposure to an allergen — or evolve over an hour or so.
The most common signs and symptoms of an allergic reaction include:
- Cough, difficulty or irregular breathing, wheezing, itchy throat or mouth, and difficulty swallowing
- Nausea, vomiting, abdominal pain, and diarrhea
- Itchiness, red bumps or welts on the skin (hives), and skin redness
- Dizziness, lightheadedness, heart palpitations, chest discomfort or tightness, mental confusion, weakness, lower blood pressure, rapid pulse, loss of consciousness, and fainting
An allergic reaction becomes more serious and is considered a medical emergency when any of the signs or symptoms are particularly severe, such as loss of consciousness or difficulty breathing, or if different parts or systems of the body are involved, such as having the combination of hives and vomiting, Dr. Sicherer says.
How to Treat Anaphylaxis
As soon as anaphylaxis is detected, call 9-1-1 immediately and administer epinephrine if available. Try to keep the person as calm as possible.
If he or she has been diagnosed with a severe allergy, emergency medicine should be on hand. “The only treatment is injectable epinephrine,” says Robert Wood, MD, a professor of pediatrics and the chief of the division of pediatric allergy and immunology at Johns Hopkins Children’s Center in Baltimore, Md. “The most common misconception is that epinephrine is dangerous, which isn’t the case. Some doctors will often warn people not to give epinephrine until the last resort, but people with a severe allergic reaction need to take it sooner rather than later.”
People who have severe allergies may be told by their doctor to take a dose of epinephrine even before serious symptoms develop. "For example, if someone has a severe peanut allergy and they know they ate peanut, you could reasonably give the epinephrine before symptoms occur or if there were only mild ones,” Sicherer says.
While waiting for medical assistance to arrive, follow these potentially life-saving tips:
- Avoid giving any oral allergy medicine and any liquids if the person is having trouble breathing.
- If the allergic reaction is from a bee sting, scrape the stinger off with a credit card or fingernail. Donotuse tweezers, which will release more venom into the sting site.
- To help prevent shock, have the person lie flat with his or her feet elevated about 12 inches and cover him or her with a blanket or jacket. Do not put the person in this position if it causes discomfort or if a neck, back, or leg injury is suspected.
- Donotput a pillow under the person’s head if he or she is having trouble breathing.
At the Emergency Room
Treating anaphylaxis doesn’t end with injecting epinephrine, even if the person feels better. The next step is seeking medical care at an emergency room (ER).
“The reason you must go to the ER is because you’re having a serious allergic reaction, and even if you feel better after taking epinephrine, the symptoms can still come back," Sicherer says.
In fact, sometimes a person may get better after a severe allergic reaction but then have symptoms come back even stronger several hours later, which is called biphasic anaphylaxis, he adds. “You should go to the ER and stay there for at least four hours to make sure the symptoms are under control," Sicherer says. Medical personnel will monitor you and give additional medications if needed.
Video: When to go to the ER for an allergic reaction
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