Anaphylactic shock is potentially fatal. Treatment needs to begin immediately.
Anaphylactic shock occurs quickly and can be fatal. It is a severe allergic or hypersensitivity reaction to something a person has been exposed to in the past, as opposed to an anaphylactoid reaction which requires no prior exposure. The reactions are the same. I mention this because some people think that if they have had a food, like shrimp for example, in the past without any problem, it could not be the source of a reaction.
- Food: This is the most frequent trigger. It includes shellfish, nuts, dairy products, soy, and much more.
- Drugs: Including antibiotics and dyes used in x-ray, CT scan, MRI, and etc. Read the label on any drug and there are allergy warnings. Interestingly enough, some medications used to treat anaphylaxis, like prednisone, can cause an anaphylactic reaction.
- Proteins: In immunizations, blood transfusions, etc.
- Venom: Snake, bee, wasp, lizard, jelly fish, and more.
- Exercise: Usually after eating something that a person is allergic to.
Warning: Anaphylactic shock can occur within minutes of the onset of signs and symptoms. Evaluation and urgent treatment are of upmost importance.
- The diagnosis is based on symptoms and the history of exposure. Also, a history of numerous allergies can intensify a response. Symptoms (subjective, non-measurable changes) and signs (measurable changes) include:
- Skin: Swelling, flushing, itching, dermatography (One of my favorite tests. Because of the increase in histamine with allergic responses, you can take a fingernail and make an “x” on the chest. Within minutes the mark will be a raised red or white “x“.)
- Airway: Difficulty breathing, swelling of the upper airway and sinuses, nasal stuffiness, and wheezing.
- Heart: Rapid heartbeat or missing beats, low blood pressure, loss of consciousness.
- Abdomen: Nausea, vomiting, diarrhea
- Other: Persistent erection (priapism). Not the first thing you normally check.
Epinephrine (adrenaline) 0.3-0.5 cc (ml) of 1:1000 strength. Given under the skin (SQ or sub-cutaneous) or in a major muscle (IM or intra-muscular). Children (generally considered <12 y.o.) 0.1 cc/kg. These doses are repeated every 10-30 mins. as needed. Administer even if you are only moderately convinced of an anaphylactic reaction, especially with airway involvement.
Always maintain the airway by tilting the head back if there are no neck injuries. If breathing is severely compromised, a tracheostomy may be necessary. See tracheostomy.
Benadryl (diphenhydramine) 50-100mg. I.V. (intravenous) recommended, but if unable to access veins you may give I.M. every 6 hours.
Cimetidine 300 mg I.V. if available.
Note: Your physician can prescribe the above and give you instructions on the routes of injection. Epi pens are available containing a prescribed one time dosage. I would suggest having at least 3 for extended excursions. Printed prescriptions should be kept together with the name and address of your physician and the purpose of each medication.
For more see: My World-Anaphylaxis…in Bahia Honda
Note: All of the recommendations on this site are aimed at the immediate treatment of potentially life threatening events in the field in order to get the victim to an appropriate medical facility. Always carry a list in your aid kit stating what your allergies and medical conditions are.