Anaphylaxis

A Anaphylaxis is a suddenly occurring pathological, i.e. pathological, immediate reaction of the immune system to certain antigens that are normally not dangerous for the human body.

What is anaphylaxis?

Anaphylaxis is an allergic reaction of the so-called type I (immediate type). An allergy is a hypersensitivity to normally completely harmless environmental substances (allergens).

The allergy is acquired through initial contact with the antigens, small molecules that are on the surface of the allergen. Bacteria also have antigens on their surface. Put simply, these antigens trigger a defense reaction in the immune system. In the case of bacteria, this is a completely physiological, i.e. healthy, reaction. In the case of an allergy, however, the immune system overreacts and forms antibodies against the actually harmless antigens of the allergy-causing substance.

causes

At the first contact with the allergen nothing happens apart from this antibody formation. If there is renewed contact with the allergen, an allergic reaction is triggered. It is not possible to predict when hypersensitivity will appear. It often occurs years after the first allergen contact.

In principle, almost all environmental substances can become allergens. Common allergens are pollen, house dust, nuts and penicillin. A specific cause for allergies has not yet been identified. However, both genetic and environmental factors seem to play a role.

In the case of allergic reactions of the immediate type, the organism reacts to the first contact with the allergen with a very strong formation of antibodies that attach to the surface of the so-called mast cells. Upon renewed contact, these antibodies react with the allergen.

The mast cells on which the antibodies are located release their ingredients, especially histamine, within a very short time. Histamine is a tissue hormone that causes inflammation in the body.

Symptoms, ailments & signs

The symptoms of anaphylaxis are very unpleasant and significantly reduce the quality of life of the person affected, but do not have a direct negative effect on the person's health and are therefore usually harmless. The patients suffer primarily from severe itching and therefore also from reddening of the skin. Scratching usually only increases the itching.

Vomiting, diarrhea or severe nausea can also occur. People also have hives and, in some cases, may have asthma. In serious cases, breathing difficulties can lead to a loss of consciousness, which can injure the person concerned. There is also permanent tiredness and exhaustion due to breathing difficulties.

There is also swelling in various parts of the body and thus possibly restricted movement. Most of the time, the affected person is no longer able to carry out his normal activity due to the anaphylaxis and is therefore significantly restricted in his everyday life. Anaphylaxis can also lead to feelings of fear or dizziness. The symptoms are usually accompanied by severe headaches, and the person's blood pressure also drops sharply.

Diagnosis & course

An anaphylactic reaction can be divided into five stages. The severity of this reaction depends on the effects of the allergen on the organism. External contacts e.g. via the skin usually lead to localized reactions. When the allergen is absorbed via the bloodstream, the body reacts in a generalized manner.

In general, anaphylaxis can be divided into five stages. Each stage requires a specific action. Since anaphylaxis can be life-threatening, acting quickly is essential.

In stage 0, local reactions at the site of allergy contact occur within seconds of contact with the allergen. This can lead to swelling, redness and itching. Treatment is usually not necessary at this stage. However, renewed contact with the allergen should be avoided.

In the first stage, these local reactions spread. This means that e.g. the redness or rash no longer only occurs at the place of contact with the allergy, but also preferably on the face, hands and upper body. In addition, there are other general symptoms such as fear, dizziness, headache. If the throat swells, the person affected also complains of shortness of breath.

At this stage, the emergency doctor must be notified as soon as possible. The victim should be reassured and pulse and breathing should be checked. In stage II, the organs also react to allergen contact. Asthmatic symptoms, abdominal or abdominal cramps, a rise in pulse rate and a fall in blood pressure occur. If the emergency doctor has not yet been called, it is imperative that you hurry. The affected person's legs should be kept high.

Stage III corresponds to anaphylactic shock. The pulse accelerates to more than 100 beats per minute and the blood pressure drops. The victim loses consciousness. Unconscious victims should be brought into the stable side position. If possible, the legs should be slightly elevated.

At the end of anaphylaxis (stage IV) there is a cardiovascular and respiratory arrest. If there is no resuscitation or if it remains unsuccessful, the person concerned dies.

Complications

Anaphylaxis occurs as part of an allergic reaction and has various complications. An allergy in general severely limits the quality of life, as the triggering substance has to be bypassed in order to avoid a reaction. In the most harmless case, contact with the allergen can lead to severe reddening of the skin and itching, and wheals are not uncommon.

A swelling of the airways is also often added and leads to massive breathing problems for those affected, so that they have to resort to an antiallergic agent as soon as possible. In addition to shortness of breath, there are also difficulty swallowing. Quincke's edema leads to increased swelling of the airways, and deeper layers of the skin also swell, making it more difficult to treat.

In the course of the allergy, so-called cross allergies can also occur. The allergen has a molecular structure that can look similar to other substances. This means that other substances can also trigger anaphylaxis. Anaphylaxis can also end in anaphylactic shock, as the blood vessels are opened wide and important organs such as the kidneys and lungs are no longer properly supplied with blood.

This can result in kidney or lung failure. A heart attack is also a possible complication of anaphylactic shock. Anaphylaxis is fatal in one percent of cases.

When should you go to the doctor?

In the case of anaphylaxis, an emergency doctor must be called immediately. First aid measures must be provided at the first signs of an allergic shock reaction. Depending on the symptoms, it may be necessary, for example, to perform chest compressions (in the case of cardiac arrest) or mouth-to-mouth resuscitation (in the case of shortness of breath). When vomiting, the body must be brought into a stable side position. If a circulatory collapse or a heart attack occurs in connection with an insect bite or the consumption of certain foods, anaphylaxis is likely.

Previously, cramps, palpitations or intense pain indicate an allergic reaction that needs to be treated immediately. In addition, it should be checked whether the person concerned has an anaphylaxis passport with them. If this is not the case, the document should be requested at the next doctor's visit. Medical treatment is required in any case of anaphylaxis. After recovery, the person concerned should take further counseling appointments and find out about avoidance strategies and aids. Good preparation can greatly reduce the risks associated with anaphylactic shock.

Doctors & therapists in your area

Treatment & Therapy

Therapy of the allergy and thus a reliable prevention of an anaphylactic reaction is not possible. Only careful avoidance of the anaphylaxis trigger offers protection. If you have a known strong allergy to food or insect venom, your doctor may prescribe an emergency kit.

This contains medication that can guarantee quick help until the emergency doctor arrives. People with severe allergies should always have an anaphylaxis passport with them. This can save lives in an emergency.

Outlook & forecast

The extent and treatment of the anaphylactic reaction are critical to the prognosis. The quicker action is taken in the case of a stronger reaction, the more likely it is that the reaction will subside and that the affected person will improve. This applies up to the point where the anaphylactic reaction has such a strong impact on the organism that it is permanently damaged by an anaphylactic shock.

Mild reactions caused by the initial phase of an anaphylactic reaction are to be considered harmless if they go away on their own within a few hours. Consequential damage is not to be expected. On the other hand, if the patient's condition worsens, the reaction can often no longer subside without administering medication. A rapidly treated anaphylactic reaction usually has no sequelae.

If left untreated, an anaphylactic reaction that goes beyond the stage of transient minimal symptoms often leads to life-threatening shock, which, without appropriate measures, leads to the death of the person concerned.

For many people, the allergic reaction will repeat itself whenever they are exposed to the relevant allergen. Anaphylactic shock that is treated quickly is followed by monitoring in the hospital to determine any damage to the organism. The mortality rate in the event of a severe shock is around one percent. In the case of mild anaphylactic reactions, it is significantly lower.

prevention

An important measure for allergy prevention is a low-allergen environment in childhood, this includes avoiding care products with many additives. Building an intact immune system should also be an important goal.

The following applies here: Too much cleanliness does more harm than good. The way for an allergy can also be paved in the womb. Studies show that children whose mothers smoked during pregnancy are more likely to be exposed to allergies. If an allergy develops despite all prevention, anaphylaxis can almost exclusively be prevented by avoiding the allergen.

Aftercare

Once diagnosed with anaphylaxis, it is the patient's responsibility to avoid an allergic reaction. The attending physician provides information about dangerous substances and substances after the first illness. A new diagnosis is only necessary in rare cases. Doctors diagnose a disease with blood and skin tests. Anaphylaxis lasts a lifetime.

Affected people do not acquire immunity to certain substances after a reaction. Unlike other diseases, follow-up care cannot aim to ensure early detection. In order to avoid life-threatening complications, those affected must avoid allergens in everyday life. These occur in different areas of life.

Food can cause a reaction just like clothing. Some patients also get sick from insect bites. It is advisable to take necessary medication with you, especially when traveling. This enables immediate life-saving measures to be initiated. An allergy pass and special necklaces and bracelets inform first aiders about the underlying disease.

They should always be carried with you in severe forms of anaphylaxis. Allergy sufferers should always inform their immediate environment about the disease and have instructions ready for emergencies. If breathing is affected, the emergency doctor must be informed immediately. The actual aftercare falls to the patient.

You can do that yourself

The best way to prevent anaphylactic shock or anaphylaxis is to avoid the allergen in question. When buying food, especially processed food, the person concerned should always check the ingredients. In the event of strong reactions to specific insects, certain areas in which these are often found should be avoided if possible.

An important course of action to prevent allergies is a low-allergen environment in childhood. The use of care products with many additives should also be avoided. Building an intact immune system can also help prevent anaphylaxis. Too much cleanliness can even prove to be harmful.

It is imperative that expectant mothers refrain from smoking. Various studies have shown that the way for a later allergy can be paved in the womb. Once an allergy develops, the only effective prevention is the consistent avoidance of the specific allergen.

Severe allergy sufferers can, however, wear special hand straps or collars in order to give other people the right information in an extreme emergency and thus receive help more quickly. In addition, it is advisable for those affected to carry an emergency kit with appropriate medication at all times in order to be prepared in an emergency.