How to avoid dangerous mistakes when responding to anaphylaxis

More than four million Australians live with an allergic disease. Anaphylaxis — the most severe and potentially life-threatening form of allergic reaction — causes around 2400 hospital admissions and 20 deaths in Australia each year.

World Allergy Week, running from 13–19 June, is seeking to raise awareness of allergies and anaphylaxis, with leading allergy organisations promoting important resources that could save lives.

“For many people, allergic reactions are uncomfortable and unpleasant, but for others they can be life threatening, culminating in anaphylaxis,” said Dr Preeti Joshi, Co-chair of the National Allergy Strategy (NAS) and paediatric clinical immunology/allergy specialist.

“Most commonly these can be caused by food, insect stings or bites, or certain medications. When a person experiences anaphylaxis, a large amount of histamine and other chemical mediators is released into the body, causing an inflammatory response.

“There are few things more frightening than having or witnessing an anaphylaxis. The symptoms can go from bad to worse very quickly. Your blood pressure can suddenly drop, and your airways narrow, affecting breathing. If anaphylaxis isn’t recognised and treated immediately, it can result in serious complications and can even be fatal,” Dr Joshi explained. “It is important to educate yourself about what to do, or not to do, if someone is having a severe allergic reaction.

“We strongly recommend positioning the patient appropriately, giving adrenaline if it’s available and calling triple zero.”

Three dangerous mistakes people make when responding to anaphylaxis

To increase community awareness this World Allergy Week, allergy experts have highlighted the common mistakes people can make when responding to severe allergic reactions.

1. Assuming it is not a severe allergic reaction because there is no skin rash or facial swelling.

“Many people assume that a person can’t be having a severe allergic reaction if they don’t have a skin rash or swelling, but one in six people will have no skin symptoms at all. In fact, skin symptoms tend to be a mild to moderate allergic symptom,” said Professor Michaela Lucas, President of the Australasian Society of Clinical Immunology and Allergy (ASCIA) and clinical immunology/allergy specialist.

“While it is important to be alert to those symptoms, do not ignore more serious symptoms just because there is no rash, particularly if there has been known exposure to an allergen. Breathing difficulties, tongue or throat swelling, dizziness or collapse are all possible symptoms of anaphylaxis and require immediate attention. ASCIA Action Plans and First Aid Plans for Anaphylaxis provide excellent guidance on what to do in an emergency.”

2. Delaying the administration of adrenaline (epinephrine).

“Many people still believe that taking an antihistamine will prevent a mild to moderate allergic reaction from progressing to anaphylaxis. This is not the case. Antihistamines do not treat the symptoms that affect breathing and blood pressure. Adrenaline is the first-line treatment for anaphylaxis — a delay in giving adrenaline can cost a person’s life,” Co-chair of the National Allergy Strategy and CEO of Allergy & Anaphylaxis Australia (A&AA) Maria Said explained.

“If in doubt, always give an adrenaline autoinjector, such as EpiPen. These are emergency devices that work to reverse a severe allergic reaction. General-use adrenaline autoinjectors can often be found at schools, larger hotels, convention centres or on planes.”

3. Allowing the person to walk (even to or from an ambulance) after having adrenaline.

“Anaphylaxis always requires a trip to an emergency department, even if a person appears to have recovered, as they need to be carefully monitored. A common mistake is allowing a person to walk, even to an ambulance or even worse, drive themselves,” paediatric clinical allergy specialist and Chief Investigator of the Centre for Food & Allergy Research (CFAR) Associate Professor Kirsten Perrett said.

“This is incredibly dangerous because of the impact of anaphylaxis on blood pressure. Walking or standing can take blood away from the heart, which could impede resuscitation if required. That is why it is always important to lay a person flat or allow them to sit with their legs outstretched if they are having trouble breathing, but not to walk or stand — this could save their life.”

Important educational resources

“Currently, the only way to prevent anaphylaxis is to avoid the allergen. Therefore, we are taking the opportunity during World Allergy Week to remind all Australians that the safety of people living with allergy is a shared responsibility. We need to increase allergy awareness, education and training in the Australian community — from people living with allergies to people preparing, packaging and selling food, and people caring for children in schools or patients in hospitals. We would like to encourage everyone to familiarise themselves with the following important resources. While anaphylaxis can be a frightening experience, being prepared and being able to react quickly does save lives,” Said added.

1. ASCIA Action Plans and First Aid Plans for Anaphylaxis outline the signs, symptoms and actions to take if someone is having a severe allergic reaction.
2. Anaphylaxis animation resources provide easy-to-understand and step-by-step instructions on how to:

• recognise the signs and symptoms of an allergic reaction including anaphylaxis;
• position a child or adult having a severe allergic reaction (anaphylaxis); and
• administer an EpiPen adrenaline autoinjector.
   

Dr Katie Allen MP, food allergy expert and Member for Higgins, encourages all Australians to go through the educational resources available.

“Australia has the world’s highest incidence of food allergies. One in 10 infants, and one in 20 children in Australia have food allergies. Sufferers live with the ever-present risk of life-threatening anaphylaxis because there is no cure. That’s why it is so important to raise awareness and constantly educate and re-educate the Australian community,” Dr Allen said.

“Patients and families are always walking the allergy tightrope — that’s why as part of the Standing Committee on Health, Aged Care and Sport we held an inquiry into allergies and anaphylaxis, of which our final report named ‘Walking the allergy tightrope’ listed key recommendations which are now awaiting Ministerial response. These recommendations will change the lives of Australians living with allergies and anaphylaxis.

“I encourage not only foodservice providers but all Australians to go through the educational resources available. Information can be easily accessed for example through the Allergy & Anaphylaxis Australia website or social media channels such as Facebook. By simply educating yourself and raising awareness with others you can save lives,” Dr Allen said.

More to be done

Said commented, “We applaud the 2019 Parliamentary Inquiry into Allergies and Anaphylaxis. The Inquiry was enthusiastically supported by health professionals, researchers and Australians living with allergic disease, as well as those who had lost loved ones to anaphylaxis. Many shared their traumatic experiences with the Committee in the hopes of preventing such losses in the future.

“We all now eagerly await a response to the 24 recommendations in the report. We hope to continue our important work with the Australian Government to assist with implementation of the recommendations, which will have enormous impact on the lives of Australians living with allergic disease.”

Fast facts

• Food allergy-induced anaphylaxis doubled between 2003 and 2013.¹
• Prevalence of food allergy: one in 10 infants; one in 20 children (10–14 years); and 2–4% of adults.^2-4
• Hospital admissions for anaphylaxis have increased five-fold between 1993 and 2013.¹
• Deaths from anaphylaxis in Australia have increased by 7% per year (1997–2013).¹
• Fatalities from food-induced anaphylaxis increase by around 10% each year.¹
   

References

1. Mullins et al. Anaphylaxis Fatalities in Australia 1997 to 2013. JACI. 2016. 137 (2): Suppl AB57. DOI: 10.1016/j.jaci.2015.12.189.
2. Osborne NJ, Koplin JJ, Martin PE, Gurrin LC, Lowe AJ, Matheson MC, et al. Prevalence of challenge proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol. 2011; 127 (3):668-76.
3. Sasaki M, Koplin JJ, Dharmage SC, Field MJ, Sawyer SM, McWilliam V, Peters RL, Gurrin LC, Vuillermin PJ, Douglass J, Pezic A, Brewerton M, Tang MLK, Patton GC, Allen KJ. Prevalence of clinic-defined food allergy in early adolescence: the School Nuts study. J Allergy Clin Immunol 2017;DOI: http://dx.doi.org/10.1016/j.jaci.2017.05.041.
4. Tang MLK, Mullins RJ. Food allergy: is prevalence increasing? IMJ. 2017. doi:10.1111/imj.13362.

Image credit: ©stock.adobe.com/au/annette shaff