Anaphylaxis

Overview

Anaphylaxis (from Greek: ana = against, phylaxis = protection) is a sudden immune system reaction against a foreign substance. Typical symptoms of anaphylaxis include skin reddening (erythema) or itchiness and hives (urticaria). In addition to these milder symptoms, anaphylaxis can also include diarrhoea, shortness of breath and severe respiratory reactions, in rare cases resulting in death. The most severe reactions are referred to as ‘anaphylactic shock’.

Anaphylaxis belongs to the category of immediate allergies, in which reactions occur very quickly, often within seconds or minutes of allergen contact. Class E antibodies (IgE) trigger the release of messenger substances (histamines, leukotrienes, etc.) which cause the reactions mentioned above.

Anaphylactic reactions are divided into various degrees of severity.

  1. Mild general reaction (skin and mucous membrane reactions)
  2. Severe general reaction (including nausea, vomiting)
  3. Life-threatening general reaction (including respiratory difficulty)
  4. Circulatory problems (including heart palpitations, sometimes leading to circulatory collapse).

Causes and triggers

Food allergens are the most common cause of anaphylaxis in children. Common basic food substances such as chicken eggs, cow’s milk, wheat or peanuts can cause some of the most severe reactions. In adults, medications such as pain relievers, antibiotics or x-ray contrast media, and also insect venom from bees or wasps are the most common causes of severe allergic reactions. In terms of food, the consumption of wheat in combination with physical exertion is a common cause of anaphylaxis in adults. But celery, nuts, fish and shellfish can also cause severe reactions in adults.

Another trigger of anaphylactic reactions is latex (such as found in medical latex gloves).

Diagnosis

A detailed record of the patient’s medical history (anamnesis) is an important basis for diagnosis.

In addition, standard allergy diagnostic examinations such as skin tests and blood tests for IgE antibodies can provide information on which substances cause a reaction in the patient. Unfortunately these tests give no indication of whether and how severely you may react to the substance that tested positive in the skin test. The cause of an allergic reaction can only be clearly determined by conducting provocation tests under medical supervision in which potential co-factors are considered.

Prevention

The best way to prevent anaphylactic shock is to avoid contact with the trigger substance.

Patients should always carry an allergy passport that documents trigger substances.

What to do in an emergency?

During an anaphylactic reaction, every second counts. Any patient who has ever experienced a severe allergic reaction should be provided with an emergency kit from his doctor. The patient should have the emergency kit and his allergy passport with him at all times, even while on holiday, at a restaurant or visiting friends.

Family and friends should be informed about the use of emergency medications so that are all able to help in an emergency.

An emergency kit contains:

  • Antihistamines
  • A cortisone preparation
  • Adrenaline (auto-injector)
  • Asthma spray as needed

The correct way to deal with anaphylaxis:

Take the emergency medicine
Call emergency services (112)

The Anaphylaxis Register

A number of clinics in Germany, Austria and Switzerland have been collecting data on anaphylactic reactions since June 2006 via an online survey (www.anaphylaxie.net).  Information is collected regarding triggers, possible co-factors, underlying diseases, emergency care and preventive measures. If you have experienced a severe allergic reaction, inform your doctor and ask for information on how to handle the situation. The goal is to become more knowledgeable about the frequency of anaphylaxis and the treatment of patients who experience a reaction.

Participating centres in Germany, Austria and Switzerland:

Germany:
Aachen, Alzenau, Augsburg, Berlin, Bochum, Bonn, Bremen, Buxtehude, Dresden, Düsseldorf, Eberswalde, Erlangen, Essen, Fehmarn, Freiburg, Freudenberg, Fürth, Göttingen, Greifswald, Halle-Wittenberg, Hamburg, Hanover, Heidelberg, Homburg, Jena, Karlsruhe, Kiel, Cologne, Leipzig, Lippe-Lemgo, Lostau, Lübeck, Munich, Munster, Neumünster, Niederberg, Oldenburg, Osnabruck, Passau, Rheine, Rostock, Schmallenberg, Schwedt, Stade, Treuenbrietzen, Tübingen, Wangen im Allgäu, Wiesbaden, Würzburg

Austria: Graz, Innsbruck, Salzburg, Vienna

Switzerland: Aarau, Basel, Bern, Geneva, Lucerne, Zurich.

Legal notes:

Prof. Dr. med. M. Worm
Last changes made: July 2016