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FEATURE ARTICLE: What is anaphylaxis?
Anaphylaxis is the word used for serious and rapid allergic reactions usually involving more than one part of the body which, if severe enough, can kill.
The word anaphylaxis was coined when scientists tried to protect dogs against a poison by immunising them with small doses. Far from being protected, the dogs died suddenly when they got the poison again. The word used for protection by immunisation is 'prophylaxis', so the scientists coined the word 'anaphylaxis' to mean the opposite of protection. What the scientists saw in the dogs helped them to understand that the same can happen in humans. This helped us to understand asthma and other allergies too, because they work in a similar way.
Scientists now use the word 'anaphylaxis' to mean any immune reaction of this type, even if it is not serious. But most doctors use it to mean a life-threatening rapid allergic reaction.
Unfortunately this kind of 'harmful immunisation' happens to a few of us not just from injections but from ordinary foods such as nuts. Quite literally, "one man's meat is another man's poison". Our immune system, which is there to protect us from infection, goes wrong and harms or even kills us.
Injections of many kinds occasionally cause anaphylaxis. Penicillin, injected clot-busting drugs used after heart attacks, and a host of other kinds of injection can occasionally do to human beings what the experiments did to dogs. Thank goodness we now understand vastly more about anaphylaxis, though we still need research to answer important questions.
There are yet other causes of anaphylaxis. You will see more about some of those below. Anaphylaxis has become an important issue in medicine and for the increased numbers of people who have had an attack of anaphylaxis.
Why the increase? When medicines are the cause, the explanation is likely to be that we are simply using more medicines, and that newer medicines which are proteins are more likely to cause anaphylaxis. But this does not explain why foods should be causing anaphylaxis more often. For some reason all the common allergies such as hayfever, allergic asthma and food allergy have become more common. Researchers have definite ideas about why this might be so.
The doctor said it was not anaphylaxis but an 'anaphylactoid reaction'. What's the difference?
There is not much difference to you as the sufferer. There is not much difference to the doctor who is treating you when it happens. It's serious. There is a tendency for these reactions to be less dangerous than anaphylaxis, but don't count on it.
There is a definite difference in the way it comes about. Anaphylaxis is caused by antibodies called 'immunoglobulin E', abbreviated as 'IgE'. But exactly the same end results can happen in various ways without IgE. That is called an 'anaphylactoid' reaction.
Anaphylaxis and anaphylactoid reactions differ in the things which cause them. For example nuts, fish and latex cause anaphylaxis because of IgE. Injections given before some X-rays, morphine-like drugs and some intravenous liquids given to replace blood or fluid loss cause anaphylactoid reactions without IgE.
From here on we are going to use the words anaphylactic and anaphylaxis to cover both types of reaction, since the immediate practical consequences and the immediate treatment are similar.
What are the common causes of anaphylaxis?
Amongst the commoner causes of anaphylaxis are:
- Foods: especially nuts, some kinds of fruit, fish and less commonly spices
- Drugs: Especially penicillins, anaesthetic drugs, some intravenous infusion liquids, and things injected during x-rays. Aspirin and other painkillers (called NSAIDs) can produce very similar reactions.
- Latex: mainly in rubber latex gloves, catheters, other medical products, but also in many things encountered in daily life. Sufferers are nearly always health care workers, mainly nurses, or have other occupational contact with latex. They may get anaphylaxis from bananas, avocados, kiwi fruit, figs, or other fruits and vegetables including even potatoes and tomatoes.
- Bee or wasp (yellow jacket) stings when these cause faintness, difficulty in breathing, or rash or swelling of a part of the body which has not been stung. If you just get a very large swelling of the part of your body which was stung, you are probably not going to have anaphylaxis if stung again.
- Unknown: A substantial proportion of sufferers have no cause found despite all efforts, even in the most expert clinics. Doctors call such unexplained attacks 'idiopathic anaphylaxis'. The word 'idiopathic' in practice means we don't know the cause. Worrying as it is, death from this is very rare indeed. However, there must be a cause or causes. Some cases are bound to be simple failure to find a cause and I always regard this diagnosis as provisional, but if a recognised allergy specialist has given you this label it is unlikely that another specialist will do any better. The explanation is NOT psychological in the vast majority. So in most cases this is a disease for which medical science has not yet discovered the cause. Some top experts who have studied hundreds of patients with idiopathic anaphylaxis believe that it is a disorder of mast cells, causing them to release histamine and chemicals with similar actions too easily. There is an excellent book on this condition, quite short, and intended for doctors and patients. Title: 'Idiopathic Anaphylaxis', edited by Roy Patterson, Published by OceanSide Publications Inc, Providence, Rhode Island, 1997, ISBN 0-936587-10-5.
- Exercise may precipitate such reactions in some ('exercise-induced anaphylaxis'), and so may exercise after food, sometimes apparently irrespective of what the food is, but in other people after specific foods. This is called 'exercise-induced food-dependent anaphylaxis'.
- Medicines called beta blockers used for heart disease or high blood pressure can change mild reactions from another cause into severe anaphylaxis because they block the body's main defence against anaphylaxis.
- Wrong diagnosis of anaphylaxis: a proportion (about 10%) of people sent to specialists with a diagnosis of anaphylaxis have a mistaken diagnosis and have not had anaphylaxis. If this might be true in your case, it is well worth finding this out as you may be spared unnecessary fear and wrong treatment.
How can you tell if someone is having anaphylaxis?
Anaphylaxis usually happens quickly.
Anaphylaxis can produce:
- An itchy nettlerash (urticaria, hives)
- Faintness and unconsciousness due to very low blood pressure. Unlike an ordinary fainting attack, this does not improve so dramatically on lying down.
- Swelling (angioedema)
- Swelling in the throat, causing difficulty in swallowing or breathing
- Asthma symptoms
- Vomiting
- Cramping tummy pains
- Diarrhoea
- A tingling feeling in the lips or mouth if the cause was a food such as nuts
- Death due to obstruction to breathing or extreme low blood pressure (anaphylactic shock)
Faintness with a nettlerash or swelling coming on quickly is probably anaphylaxis, and if there is also difficulty in breathing the danger is greater. Faintness with difficulty in breathing alone will sometimes be due to a panic attack, but can also be due to anaphylaxis.
In the early stages it may be difficult, even for a doctor, to be sure whether the cause of symptoms is anaphylaxis or fainting or a panic attack. If there is doubt, it is sometimes best to use the treatment for anaphylaxis, but the treatment should then be reviewed with a doctor because unnecessary treatment for anaphylaxis is a bad idea. Learn the rules for knowing when to treat, to minimise the chance that you will use the treatment when you should not.
People who are allergic to foods often notice the effect in seconds, and their life may be in jeopardy within a few minutes. Sometimes a reaction takes much longer to start, an hour or so, but can still be extremely serious. Improvement can also happen quickly, especially with the right treatment. A few people then have a second wave of anaphylaxis, so people who have had a serious anaphylactic reaction to nuts should be observed medically for about six hours or overnight.
Fortunately there is a highly effective treatment: adrenaline (epinephrine). But adrenaline (epinephrine) needs to be given as an injection, and is dangerous if used incorrectly. If you need to have adrenaline (epinephrine) available for yourself or someone in your family, it is important that you and anyone else who may have to give the adrenaline (epinephrine) should be properly trained.
It is possible for anaphylaxis to be mild and to need little or no treatment. You would not think so from most of the information you read. Of course a life-threatening attack of anaphylaxis may look mild in its early stages, so you need to go for medical help just in case, and need to have the emergency treatment immediately available in case things start to go more badly wrong. In most cases it is better to err on the side of treating anaphylaxis early rather than to leave treatment rather late. But the fact is that many people get over anaphylaxis even without treatment.
The fact that previous anaphylaxis has been mild does not guarantee that it will not be dangerous in future. Most sufferers with mild attacks do seem to have relatively mild ones if they occur again. But deaths have occurred in people who had only mild attacks before. The answer is to be prepared.
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