Going Gluten-FreeApril 13, 2011

Surprising Facts about Anaphylaxis

A recent Medscape article about food allergies caught my eye. According to author Laura Stokowski, RN, there are now over 200,000 visits to the emergency room for food-related acute allergic reactions every year. About 90,000 visits a year are due to food-induced anaphylaxis. That’s 3 times higher than once thought.

And what are now the most common food triggers for anaphylaxis? Peanuts, tree nuts, fish, shellfish, cow’s milk, soy, eggs and sesame seeds. Yes, sesame seeds. Until recently, allergy to sesame was considered rare. And now here it is on the list of most common triggers.

Did you know that anaphylaxis can go unrecognized in hospital emergency rooms? That means this life-threatening condition is undiagnosed and improperly treated!

“The difficulty faced by clinicians lies in determining which patients have anaphylaxis or are progressing toward anaphylaxis,” writes Stokowski. “As many as 1 in 4 patients was not identified as having anaphylaxis, although it was clear from their medical records” that they did.

Why the diagnostic confusion? The reason is that the symptoms of anaphylaxis that many doctors look for—hives, flushing, swelling—actually don’t occur in up to 20 percent of cases. Nor is shock (drop in blood pressure) always present. In actuality, severe anaphylaxis is more likely to involve respiratory distress--wheezing, trouble breathing, coughing--than either of these.

What helps nail the diagnosis, besides astute clinical observation by savvy doctors, is a detailed medical history, particularly of previous episodes, and a history of foods consumed in the previous six hours. 

Several weeks back, The National Institute of Allergy and Infectious Diseases (NIAID) came out with food allergy guidelines that included this simple definition of anaphylaxis: A serious allergic reaction that is rapid in onset and may cause death. The guidelines also spelled out clinical signs that must be present for docs to diagnose anaphylaxis. Click here for the guidelines.

Here are other facts about anaphylaxis that might surprise you. Did you know that:

  • Although anaphylaxis more commonly develops in children, a first episode can occur at any age. Yes, that means first-time anaphylaxis can happen to an adult.
  • 40 percent of anaphylactic reactions include gastrointestinal symptoms—diarrhea, cramping, stomach pain, nausea, vomiting.   
  • Other potential symptoms (unexpected by many) can include anxiety, mental confusion, lethargy, seizure and reduced muscle strength.
  • Asthma is a major risk factor for death from food-induced anaphylaxis.
  • Epinephrine should be administered immediately and, if necessary, it should be repeated every 5 minutes to control symptoms. “A frequent error…is waiting too long to redose… or moving on to adjunctive pharmacologic agents in patients who respond sub-optimally to the first dose…,” writes Stokowski.
  • Patients should carry 2 doses, not 1, of auto-injectable epinephrine at all times. Expiration dates should be regularly checked to avoid outdated medicine.

There are still a lot of questions about allergies—why incidence rates are on the rise, why some of us are more vulnerable than others, why allergies occur at all. But knowing the facts about anaphylaxis is important to living safely with serious food allergies.

Source: Medscape Allergy & Clinical Immunology, “Food Allergy in the Emergency Department: The Patient with Anaphylaxis” by Laura Stokowski, RN.

 

Comments (2)

I had my first anaphylactic reaction at 35 brought on by shrimp, years later by latex, and recently two anaphylactic reactions to sesame seeds. I am also gluten free. Many gluten free foods add sesame seeds, so I am now limited even in my gluten free choices, and cannot rely on the gluten free label for safety since I cannot eat sesame products, and in America it is not required to list sesame as an allergen. I have elevated Tryptase and am not sure what it all means. I am very thankful for Living Without because I am able to read about others experiences and relevant articles addressing this difficult walk.

Posted by: GILLETTE K | April 14, 2011 3:54 PM    Report this comment

We have personally experienced this situation. We had 2 visits to the ER for respiratory distress that were undiagnosed as anaphylaxis. Severe allergy diagnosis came 2 years after recurrent symptoms! I would have to add that in addition to savvy doctors, you need parental input. Parents spend the most time with the patient and have actually quite a bit of information that can help doctors put the pieces together. Find a doctor that will listen to you and work with you to diagnose quickly.

The suggestion about dosing with Epi every 5 minutes is in contradiction to everything I've ever heard (every 10-15 minutes) from Doctors/Pharmacy...so I'll be checking into that one. We always carry 3 Epi's as we live in a more rural area.

Posted by: Doreen G | April 14, 2011 11:00 AM    Report this comment

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