Allergic reactions, whether to food, insects or other types of allergens, can happen to anyone, at any age, at any time. An allergic reaction occurs when your immune system overreacts to a typically harmless substance like food, pollen, pet dander, dust or insect venom. The body releases histamine and other chemicals which cause various symptoms like watery eyes, hives, runny nose, swelling, itching, nausea, vomiting or even breathing problems.

Most allergic reactions cause mild discomfort and can be dealt with by taking over-the-counter antihistamines like Zyrtec or Claritin or just by waiting them out. But some allergic reactions turn into a life-threatening situation known as anaphylaxis and require immediate medical intervention. 

Many of us know someone who has had an anaphylactic reaction. It can be a scary experience for all concerned. Because it can happen suddenly with no warning, knowing what to look for and what to do could save someone’s life. To reiterate, anaphylaxis is a severe allergic reaction that can be life threatening if you don’t get treatment right away.

Common symptoms of anaphylaxis include shortness of breath; difficulty breathing; rapid swelling of the throat, tongue or lips; being unable to swallow; severe skin reactions including widespread redness, hives or itchy rash; swelling; stomach cramps; nausea or vomiting, diarrhea;  sudden drop in blood pressure; an increased heart rate; weak pulse; and a feeling of faintness or passing out.

It is important to recognize the stages of an allergic reaction so you can react quickly in an emergency. In stage one, you may notice redness, itching or hives or your nose becomes runny. Whatever allergen you have come into contact with has triggered the release of histamine. 

In stage two, the symptoms worsen and spread. Your face, lips or tongue may swell. You may have trouble swallowing or breathing as inflammation causes your airway to narrow. You might also have digestive issues like stomach pain or diarrhea. Other inflammatory responses may cause a drop in blood pressure.

By stage three, breathing is difficult and dizziness sets in as the low blood pressure and narrowed airway severely limit oxygen delivery to the body. This causes metabolic acidosis, a condition where excessive acid accumulates in the body leading to rapid breathing, confusion or an accelerated heart rate.

By stage four, the situation is life threatening. The heart and lungs may stop working, followed by multi-organ failure, unless there is immediate medical intervention. 

Act immediately in cases of anaphylactic reactions. Administer epinephrine if you have an EPI pen, then call 911. To use an EpiPen, hold the EpiPen upright with the blue cover pointing up. Pull to remove the blue cap. Place the orange tip against the outer thigh at a 90-degree angle, then swing the EpiPen up and bring it down and push it into the thigh until you hear a click. Hold in place and slowly count to three. Remove the EpiPen and gently massage the area for 10 seconds. The EpiPen can be administered through clothes, even thicker material like jeans.  

     Now there is also a needle-free option for epinephrine called neffy, which is a nasal spray. Neffy is just as effective or, in some cases, more effective than the traditional injectable. Neffy also has a longer shelf life and is small and easy to carry. To use neffy, remove device from the package. Hold the device with your thumb on the bottom of the plunger and a finger on either side of the nozzle sticking up. Do not pull or push on the plunger at this time, or try a test spray as each device has only one dose. Insert the nozzle into a nostril until your fingers touch the nose. Keep the nozzle pointed straight into the nose toward the forehead, not angled out or inwards. Press the plunger up firmly until it snaps and sprays liquid into the nostril. If the patient is conscious, tell them to avoid sniffing during or after the dose. If they do sniff, monitor their symptoms for five minutes and if they continue to get worse, give a second dose of neffy in the same nostril. Call 911. 

An EpiPen can be very expensive at $500 to $700 for an EpiPen 2-Pak, but generic epinephrine auto injector two packs run $100 to $300. Insurance may cover some or all of the cost. Depending on your insurance, neffy costs anywhere from no cost up to $400 for uninsured patients. EpiPens expire about 18 months after manufacture though they can remain potent far longer. Neffy lasts up to 2.5 years for the 2 mg dose and two years for the 1 mg dose and can withstand temperature fluctuations. EpiPens should be stored at a temperature from 68 to 77 degrees and shielded from light.

Common triggers for anaphylaxis include foods, especially peanuts, tree nuts, cow’s milk, eggs, shellfish and other fish, soy, sesame seeds; medications including antibiotics such as penicillin and amoxicillin, NSAIDS like aspirin and ibuprofen and anesthetics; insect stings from bees, fire ants or wasps; and latex from gloves, balloons or medical devices. In some cases, no specific cause is found. 

After an anaphylactic reaction, hospitals will monitor the patient for a few hours to overnight to make sure symptoms don’t reoccur. There is a risk for another wave of symptoms, though rare, known as biphasic anaphylaxis, which can occur several hours later. Patients may experience extreme fatigue, anxiety, emotional distress, dizziness or lingering allergic symptoms such as hives following an episode of anaphylaxis. The doctor may prescribe corticosteroids or antihistamines to manage these symptoms. 

A history of allergies significantly predisposes you to anaphylaxis, especially those who have asthma, food allergies or have had severe allergic reactions in the past. Other key risk factors include: a prior anaphylactic episode; asthma, particularly those with uncontrolled or severe asthma; specific triggers such as a known allergy to foods like peanuts, medications like penicillin or insect stings; or a family history. In addition, cardiovascular disease can make anaphylaxis more severe. Exercise, alcohol, infections, stress or taking NSAIDs can contribute to an anaphylactic reaction.