Anaphylaxis is a serious type of allergic reaction that affects hundreds of thousands of Americans each year. (1)
In a standard allergic reaction, you typically develop symptoms in one area of your body, such as an itchy throat and runny nose, or hives that break out on an area of skin.
Anaphylaxis can affect anyone who has an allergic reaction, even if previous responses to the same allergen were less severe.
But you’re more likely to have an anaphylactic reaction to a given allergen if you’ve done so in the past. The more recently this has happened, the higher your risk of a repeat reaction when you’re exposed to the allergen. (1)
If you know that you’re at risk for anaphylaxis, you’ll need to work with your doctor to be prepared in the event that you’re exposed to an allergen and have an episode.
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This means having an epinephrine auto-injector with you at all times and knowing how, and when, to use it.
Just as importantly, you’ll need to take steps to avoid exposure to the allergen that causes your reaction in the first place.
It may not always be possible to avoid exposure to an allergen that causes an anaphylactic reaction. Medical treatments may be available to reduce your chance of a reaction in these cases, although these treatments carry certain risks along with benefits. (1,2,3)
Avoiding Trigger Exposure
Avoiding allergens that have caused anaphylaxis or a severe reaction in the past is the most important step to prevent anaphylaxis.
When you’re treated for anaphylaxis at the hospital, after your condition has been stabilized, your healthcare team should work with you to discuss and identify the cause of your reaction, as well as future prevention and potential treatments.
This discussion should include an evaluation of whether your exposure was avoidable in the case of known triggers, or what the trigger might have been if it’s not already known.
It may be more difficult to identify the trigger, or combination of triggers, that leads to a reaction in some cases. Sometimes, the trigger may not be identifiable.
One trigger may be an exercise-induced reaction (which is actually what’s known as an anaphylactoid reaction, since it doesn’t involve a specific allergic trigger).
In some people, an exercise-induced reaction is associated with a specific food trigger. In this situation, you won’t have an anaphylactic reaction just by eating this food — only if you exercise soon after eating it. There is some thought that exercising distributes the allergen from your gut blood flow, which is more allergen-tolerant than the rest of your system, where the reaction occurs.
If you suspect that this may be the case, because of a pattern of reactions in the past, your healthcare team can help confirm your suspicions through diagnostic testing and discussing the situations in which you’ve had a reaction.
If a food trigger of an exercise-induced reaction is identified, you’ll need to avoid eating it four to six hours before exercising. Some physicians may also advise avoiding this food for four to six hours after exercising as well.
If no food trigger of an exercise-induced reaction is identified, you’ll be instructed to limit your physical activity to lower-intensity exercises than those that have typically caused a reaction in the past — or at least to stop exercising at the first sign of a reaction. The most common triggers of exercise-induced anaphylaxis include jogging, aerobics, tennis, walking, dancing, and bicycling. The most triggering activities are of moderate intensity.
If you’re prone to an exercise-triggered reaction, you should always:
- Exercise with a partner
- Carry a mobile phone when exercising
- Keep an epinephrine auto-injector with you
Taking an antihistamine before exercise and warming up before engaging in more intense activity are not considered effective at reducing the risk of an exercise-induced reaction, according to the Cleveland Clinic. (1)
Patients with a known history of anaphylaxis should work with their allergist or primary care doctor to develop an anaphylaxis action plan and should be encouraged to wear a medical ID tag. (4)
Tips for Avoiding Anaphylaxis
A number of general strategies and tips may help you or your child avoid anaphylaxis, or improve health outcomes when a reaction happens.
Double-check food ingredients. If you or your child has a severe food allergy, scan food labels carefully for troublesome ingredients, which may be harmful to some people even in trace amounts.
You should also feel free to ask detailed questions about ingredients and food preparation when you’re eating out or at a friend’s home.
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Introduce new foods to children slowly. If your child has had a severe allergic reaction to a food, it’s more likely that another new food will also cause problems once your child becomes sensitized to it.
This means that the first few times you give a new food to your child, you should give it in small amounts with bites that are spaced out.
Wear a medical ID tag. Having a necklace or bracelet that indicates your anaphylaxis risk can help bystanders and first responders identify what’s happening to you in case of a reaction.
Carry all potential treatments with you. These include an epinephrine auto-injector for nearly everyone, and also possibly a chewable antihistamine and a stiff card to scrape out a bee’s stinger.
Don’t share your epinephrine. Unless you know for sure that someone else is having an anaphylactic reaction, you shouldn’t use your auto-injector on anyone else.
Doing so not only may put you at risk for having this treatment unavailable, but it may cause medical problems in someone who isn’t experiencing anaphylaxis, such as someone having a cardiovascular event like a stroke or heart attack. (2)
Long-Term Therapies for Anaphylaxis
Certain medical treatments may help reduce your risk of anaphylaxis, or reduce the severity of a reaction, if you can’t avoid exposure to an allergen.
One such situation is when you haven’t identified the cause of recurrent anaphylaxis. In this case, you may benefit from long-term steroid therapy to stop these reactions from happening.
This therapy should be directed by an allergy specialist, and involves taking the corticosteroid drug prednisone daily, along with other drugs as needed when you have a reaction (including epinephrine).
After one to six weeks of taking prednisone daily, you’ll most likely switch to taking it every other day and gradually reduce your dose until you’ve tapered off the drug completely. (1)
In cases where you may not be able to totally avoid an allergen — such as insect (bee, wasp, or hornet) venom — allergen immunotherapy, also known as desensitization, may be helpful.
For this therapy, you’ll be given a series of allergy shots (injections) that contain increasing doses of the allergen to make your immune system less sensitive to it.
This therapy isn’t always effective, and some people respond better to it than others. It also carries the risk of causing an allergic reaction, including anaphylaxis, if the dose is increased too quickly.
Injections for allergen immunotherapy are usually given once or twice a week until you reach what’s known as a maintenance dose, which must be taken indefinitely every two to four weeks to maintain immunity.
Because of the risk of an allergic reaction, you’ll need to stay at your doctor’s office for monitoring for at least 30 minutes after receiving each allergy shot.
It can take as long as three to four years to build up to a maintenance dose in allergen immunotherapy.
As an alternative to injections, a newer technique for desensitization involves taking sublingual (under-the-tongue) drops of an allergen. You’ll hold the drop under your tongue for a few minutes before swallowing it.
Because sublingual therapy is newer, its dosing schedule is less established. It may range from every day to three times a week. (5)