Anaphylaxis- a parent’s perspective

Response to a social media post

A mother describes (on social media) in vivid detail her observations as her young daughter develops anaphylaxis and proceeds to go into anaphylactic shock during a controlled tree nut challenge under the care of her allergy doctor and staff.

She makes a few important points worth highlighting and sharing.

1. Anaphylaxis and anaphylactic shock are not the same thing.

It is important to be able to make a diagnosis of anaphylaxis so that it can be treated before it progresses to anaphylactic shock.

Anaphylaxis has many possible clinical presentations and may creep up stealthily. Awareness of the potential symptoms and symptom complexes is essential if the condition is to be recognised and timely treatment instituted.

In the case described, once her little girl had developed symptoms in two organ systems (itchy skin and abdominal pain) she was treated with adrenaline, even though she was still playing happily and showing no signs of distress. The diagnosis was made early and treatment commenced immediately; this was possibly life saving.

The systems that may be involved in anaphylaxis include the skin and mucous membranes, the upper and lower respiratory tracts, the gastrointestinal tract, the cardiovascular system and the central nervous system.

Typically, in anaphylaxis, symptoms occur in more than 1 body system- indicating that the condition is no longer occurring locally but has become systemic.

Sometimes, however, anaphylaxis can develop so suddenly that collapse occurs prior to the presence of any other signs.

Anaphylactic shock describes the end result of anaphylaxis with a profound drop in blood pressure, difficulty breathing, collapse and loss of consciousness. It is difficult to resuscitate a patient once they are in shock.

2. Mild allergic reactions (such as itchy rashes and swelling) and anaphylaxis are not the same thing

Allergy is treated with antihistamines and steroids. Anaphylaxis is treated with adrenaline. If you fail to treat anaphylaxis with adrenaline you will be unlikely to reverse the blood vessel dilatation and airway constriction that is central to the development of anaphylactic shock.

3. Anaphylactic shock tends to develop very quickly, within minutes. It may be too late to reverse the blood vessel dilatation and airway constriction that results in collapse if adrenaline is not given early. Do not wait for anaphylaxis to become anaphylactic shock before giving adrenaline. If you are unsure if you should or shouldn’t give adrenaline, give it. If you give adrenaline to a person who has allergy, but has not developed anaphylaxis you will cause no harm. Err on the side of caution. Give adrenaline early.
4. Even after a person has recovered from anaphylaxis, the allergic reaction may still be ongoing or cause another later anaphylactic reaction (termed prolonged or biphasic anaphylaxis). It is essential that the person be closely observed (in a place where there are resuscitation facilities like a hospital) for several hours following recovery.
5. Anaphylaxis is poorly understood in the community. This causes acute anxiety for parents and caregivers of youngsters with severe allergies. The desperate plea expressed by the parent in this post exposes her fear that one day her child may experience anaphylaxis and her care giver will not be able to recognize it, will not know what to do about it, or will be too afraid or unconfident to react early enough to treat her. Her fear is well founded. There are not many people in the community who have the knowledge and skills required to recognise and manage anaphylaxis. Anaphylaxis seldom occurs conveniently in hospital- it typically occurs in the community, often at children’s parties, when travelling, or at big events when people are outside of their controlled home environments. Broad based education is required.

The ability to recognize and treat anaphylaxis confidently should be part of our core community knowledge. The Allergy Society of South Africa and The Allergy Foundation of South Africa makes anaphylaxis training possible all around the country, please email training@allergyfoundation.co.za for more information.

Reference

World Allergy Organ J. 2011 Feb; 4(2): 13–37.

Published online 2011 Feb 23. doi: 10.1097/WOX.0b013e318211496c

World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis

1. Estelle R. Simons, MD, FRCPC,1 Ledit R. F. Ardusso, MD,2 M. Beatrice Bilò, MD,3 Yehia M. El-Gamal, MD, PhD,4 Dennis K. Ledford, MD,5 Johannes Ring, MD, PhD,6 Mario Sanchez-Borges, MD,7 Gian Enrico Senna, MD,8 Aziz Sheikh, MD, FRCGP, FRCP,9 Bernard Y. Thong, MD,10 and for the World Allergy Organization