Anaphylaxis is a sudden, potentially life-threatening allergic reaction. The
symptoms may begin mildly but quickly become severe, often in a matter of
seconds to minutes; occasionally, though, the symptoms develop gradually over a
24-hour period. The more rapidly the symptoms begin, the more severe they
generally are. Anaphylaxis may occur again the next time a person is exposed to
an allergen (allergy trigger). The first exposure to a trigger generally lays
the groundwork for anaphylaxis by creating hypersensitivity. Anaphylaxis should
always be considered a medical emergency, and you should seek help right away.
It is estimated to be responsible for 500 deaths each year.
Signs and Symptoms
Itching (often the first symptom), redness, hives, swelling,
Swelling in the nose or throat, hoarseness, wheezing, difficulty
speaking, trouble breathing, chest tightness
Abnormal heart rate or rhythm, shock, heart attack
Stomach cramps, nausea, vomiting, diarrhea
Loss of bladder or bowel control, an urgent feeling of needing to go
to the bathroom
Tingling, headache, light-headedness, feeling disoriented or feeling a
sense of doom, fainting, seizures
What Causes It?
Anaphylaxis occurs when the immune system overreacts to an allergen that you
have encountered at least once before. Occasionally, through a different
mechanism, an anaphylactic-like reaction (called anaphylactoid reaction) occurs
with the very first exposure to the allergen. Symptoms are the same for both
anaphylaxis and anaphylactoid reactions. Symptoms develop when cells release
substances that are meant to protect you against the allergen.
Examples of anaphylaxis triggers include:
Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as
ibuprofen), and prescription opiate pain medications (such as codeine); people
with asthma and nasal polyps tend to be at greater risk for an anaphylactoid
reaction to these drugs
Foods, such as nuts, shellfish, egg whites, and berries; those who
react to ragweed may also react to chamomile tea
Insect bites or stings
Ingredients in some allergy skin tests, allergy shots, and
Latex (as in condoms, rubber gloves)
Food coloring and preservatives (such as tartrazine, also known as FDC
yellow dye No. 5)
Although rare, athletes may have an anaphylactoid reaction to exercise
after eating certain foods, such as celery, shrimp, apples, squid, wheat,
hazelnut, or chicken; this reaction is thought to be related to
Who's Most At Risk?
The following factors may increase your risk for anaphylaxis:
Initial exposure to the allergen by injection (intravenous
Frequent exposure to the allergen, particularly if frequent exposure
is followed by a long delay and then a reexposure
Taking beta-blockers, angiotensin-converting enzyme (ACE) inhibitors,
or angiotensin II receptor blockers (ARBs)—medications
used to treat heart disease or high blood
What to Expect at Your Provider's Office
Your healthcare provider will perform an exam, ask about any contact you may
have had with possible allergens, and conduct blood or urine tests, a chest X
ray, allergy tests, or other tests.
To help prevent anaphylaxis: Avoid anything known or suspected to have
triggered a previous allergic response.
See an allergist for testing and treatment if any allergies are known
Take medicines by mouth instead of by injection whenever
If you have a history of anaphylaxis, carry a syringe loaded with
epinephrine to inject immediately after exposure to a known allergen or at the
first sign of a reaction. Healthcare providers can suggest a kit and provide
instruction. Close family, friends, and caregivers should be taught to use the
kit, too. Also, wear a Medic Alert bracelet to alert others that you have a
history of this condition.
Get emergency medical care right away to maintain breathing, blood pressure,
and heart function and to reverse the reaction.
Epinephrine is the drug of choice and should be given right away. Once at the
hospital, additional drugs, including antihistamines and corticosteroids, may be
used to control symptoms and prevent delayed relapse.
Surgical and Other Procedures
For breathing trouble, healthcare providers may need to open the airway with
an endotracheal tube and possibly connect a ventilator. Other procedures may be
necessary as well to stabilize blood pressure.
Complementary and Alternative Therapies
Anaphylaxis always requires standard emergency medical care. For the most
part CAM therapies are inappropriate for treating an anaphylactic reaction. That
said, they may help prevent allergic responses, including anaphylaxis.
Some CAM approaches may also lessen the severity of any allergic reaction and
may improve non-life-threatening symptoms of anaphylaxis. Specific nutrients,
herbs, and acupuncture show promise. Be aware, however, that like prescription
drugs, some nutraceuticals and botanicals can cause allergic reactions,
Omega-3 Essential Fatty Acids
Omega-3 essential fatty acids have anti-inflammatory properties that may help
protect against the extreme reaction of anaphylaxis. There was a lower death
rate from anaphylactic shock in animals on a high omega-3 fatty acid diet
compared to those on a high omega-6 diet. How this translates to humans is not
known at this time.
Quercetin & Other Flavonoids
Naturopathic doctors have recommended that people with known allergies take
quercetin (a naturally occurring flavonoid) before being exposed to allergens.
This should lessen the severity of the allergic response. If you are susceptible
to allergies you might want to consider taking quercetin supplements or eating
foods high in flavonoids (such as fruits and vegetables) on a regular basis.
Animal studies appear to support this traditional use of quercetin.
Vitamin C is thought to enhance the activity of quercetin.
Animal studies suggest that zinc may help protect against gastrointestinal
symptoms (stomach cramps, nausea, vomiting, or diarrhea) that sometimes
Several studies have investigated the effects of medicinal plants
traditionally used in Asia to prevent or treat allergic reactions. Results from
animal studies on the effects of medicinal plants traditionally used in South
Korea suggest that the plants may help prevent anaphylaxis and other allergic
responses in susceptible individuals. These herbal remedies include:
Sweet chestnut tree (Castanea
crenata)—used in Asian countries to treat whooping
cough and lacquer poisoning; inhibited skin and blood vessels reactions related
to anaphylaxis in animal studies. Quercetin is the active component.
minima)—used in Traditional Chinese Medicine for
anti-inflammatory and anti-allergy purposes; appears to inhibit the release of
histamine, a substance that causes many common allergy symptoms. Contains
flavonoids as one of the active components.
Danshen root (Salviae
miltiorrhiza)—used traditionally for treatment of
allergies; inhibited skin related allergic reactions in rats.
Asian rose spp. (Rosa
davurica)—traditionally used to regulate immune
response; inhibited anaphylaxis in an animal study.
Hardy orange (Poncirus
trifoliata)—used traditionally for treatment of
allergies; animal studies have shown inhibition of anaphylaxis.
Skullcap root (Scutellaria
baicalensis)—thought to have anti-allergy
Licorice root (Glycyrrhiza glabra or G.
uralensis)—thought to have anti-allergy
Reishi mushroom (Ganoderma
lucidum)—thought to have anti-allergy
Combination herbal remedies have also been tested in animals with varying
degrees of success in preventing anaphylaxis or other allergic reactions. Use of
herbal medicines for prevention of such responses is best directed by a
licensed, certified specialist.
Consumer Alert: Although this happens much less frequently with
plant-based substances than with pharmaceutical preparations, there are certain
herbs for which there have been rare reports of allergic reactions, including:
Arnica flower (Arnica montana)
Artichoke leaf (Cynara scolymus)—in
those with an allergy to artichokes
Blessed thistle herb(Cnicus
Cayenne pepper (Capsicum spp.)
Cinnamon bark (Cinnamomum verum)
Dandelion root or herb (Taraxacum
officinale)—may trigger a reaction in those with
Echinacea (Echinacea purpurea)
Fennel oil and fennel seed (Foeniculum vulgare)
Ginkgo biloba leaf extract
Poplar bud (Populus spp.)—may trigger
a reaction in those with salicylate sensitivity
Psyllium seed (Plantago spp.)—allergic
response more common with powder or liquid form
Anaphylaxis requires immediate emergency medical attention. While the
following homeopathic remedies have been used for allergic reactions including
symptoms of anaphylaxis, they should be administered only under the guidance of
a certified, trained homeopath in the appropriate circumstances. Before
prescribing a remedy, homeopaths take into account a person's constitutional
type. A constitutional type is defined as a person's physical, emotional, and
psychological makeup. An experienced homeopath assesses all of these factors
when determining the most appropriate treatment for each
Aconitum -- helps alleviate the tremendous anxiety and fear of
dying that may occur during or immediately following an anaphylactic
Arnica Montana -- may be used in the case of shock or following
a traumatic experience
Apis Mellifica -- for puffy, rapidly swelling skin following an
insect bite or sting.
An animal study comparing electroacupuncture (applying an electrical charge
to acupuncture needles) to no treatment in cases of allergic shock demonstrated
promising results. Sixty percent of the untreated animals died from their
allergic reaction, compared to only 20% of the animals treated with
electroacupuncture. While conventional treatment of anaphylaxis should never be
delayed, this study suggests acupuncture may prove to be a useful adjunct. More
research is needed before conclusions can be drawn.
Without proper treatment, anaphylaxis can be deadly. Most people who receive
proper treatment do well, however. Once you have anaphylaxis, you will not
necessarily have it again even with exposure to the same allergen. But the risk
is high, so do your best to avoid the inciting substance. Drugs classified as
beta-blockers, monoamine oxidase inhibitors, ACE inhibitors, and ARBs may worsen
anaphylaxis or interfere with treatment; if you have a history of anaphylaxis,
you may want to check with your physician or pharmacist to find out if you are
on one of these medications.
Symptoms that started early may continue or new symptoms may set in later.
Therefore, hospitalization may be needed for at least 24 hours. For a severe
reaction, providers may monitor heart function or admit patients to the
intensive care unit.
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Review Date: December 2000
Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD,
Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University
and Senior Medical Editor Integrative Medicine, Boston, MA; Scott Shannon, MD,
Integrative Psychiatry, Medical Director, McKee Hospital Center for Holistic
Medicine, Fort Collins, CO; David Winston, Herbalist, Herbalist and Alchemist,
Inc., Washington, NJ.
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