Anaphylaxis - Be Prepared

May 24, 2017

By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy

Anaphylaxis is a medical term used to describe a severe allergic reaction. While it is acute it is also potentially fatal. The most common causes of anaphylaxis are foods, insect stings, antibiotic medications, latex, and sometimes even exercise (no, this is not an excuse to stop going to the gym). In Canada about 2% of the population is at risk for a severe food or insect sting allergy.

This is now the season where we have to start being concerned about insect bites. Insect sting anaphylaxis is most common in adults, where around 3% of people will severely react to a yellow jacket wasp, white-faced hornet or honeybee sting.

Food induced reactions account for 30-50% of anaphylaxis cases in North America. It is most common in young children with up to 7% of the population being highly sensitive to a food allergen. Peanut allergies are the most significant. About 20% of those with a peanut allergy will outgrow it. According to the CDC allergies in children increased by 50% from 1997 to 2011 and hospitalization rates also continue to rise. The positive statistics show fatalities from food allergies are decreasing likely attributed to better education and preparedness. Food allergy reactions almost always cause significant breathing problems along with gastrointestinal effects 40% of the time.

Do not be confused with "food allergy" and "food intolerance". Food intolerances do not involve the immune system.

Medication allergy is most common in young and middle aged female adults. Specifically antibiotics, ASA, general anesthetics, NSAIDS and local antibiotics cause most commonly cause anaphylaxis like reactions. The most effective strategy in these types of reaction is to simply avoid the medication.

Anaphylaxis most commonly affects the skin, mucous membrane respiratory system (your breathing), heart function and digestive system. Approximately 80-90% of cases affect the skin or mucous membrane. In children we commonly see respiratory symptoms and then a skin reaction. In adults we most commonly see hives, swelling in the face and tongue, flushing, and significant "reddening" on the skin. Food Allergy Canada (www.foodallergycanada.ca) asks you to think of the acronym FAST to be able to recognize symptoms quickly.

FACE: hives, itching, redness, swelling of face, lips or tongue

AIRWAY: trouble breathing, swallowing or speaking, nasal congestion; sneezing

STOMACH: stomach pain, vomiting, diarrhea

TOTAL BODY: hives, itching, swelling, weakness, dizziness, sense of doom, loss of consciousness

Epinephrine is the first line choice for treating anaphylaxis. It works by causing vasoconstriction in most body organ systems and prevents and relieves airway constriction. It can also prevent hypotension and shock. What you need to know is it can save a life. Epinephrine in the auto-injector format is available in an adult dose and a youth dose for those under 30kg. You should always confirm the dose for a child with advice from a doctor or pharmacist. If required an Epi-Pen is to be injected intramuscularly into the thigh. It can be given straight through thin clothing if required. Additional doses can be used every 5 to 15 minutes depending on the symptoms. A majority of those living in the parkland are more than 10 to 15 minutes away from their nearest emergency room; therefore, they should have more than one dose on hand. The key is you need to get medical attention as soon as possible. It is also crucial to point out that anti histamines are not effective in the treatment of anaphylaxis and are not life-saving. Asthma medications should never be used in place of epinephrine either.

Epinephrine is quite safe. Side effects are mild and are actually important to see because you know the epinephrine is working properly. They include tremor, feelings of anxiety, palpitations, headache and dizziness. A person experiencing anaphylaxis should not be expected to self- administer the EpiPen. So if you are a friend or a family member of someone who has an EpiPen you need to learn how to use it properly. For more information on EpiPens and for some great resources, be sure to visit www.epipen.ca. Your clinic pharmacist will also track the EpiPens expiry date to give you a reminder to replace it before it expires. . EpiPens do not require a prescription, however speak to your clinic pharmacist so you can effectively use one if it is ever needed. With camping and cottage season just warming up, make sure you are properly prepared for a safe summer.

 


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