Common allergens like nuts, shellfish, insect stings, and even penicillin can trigger allergic reactions in some people. When the body reacts too intensely to these external substances, it can lead to a life-threatening condition called anaphylactic shock. This condition affects the blood and respiratory systems, and it’s critical to recognize the symptoms and know how to provide first aid in such an emergency.

What Is Anaphylactic Shock?

Anaphylactic shock is one of the most severe forms of an allergic reaction. So, what exactly is an allergy? Simply put, it’s the body’s over-the-top reaction to substances that are usually harmless, such as pollen, insect venom, certain foods, or latex. These substances are known as allergens. Some common allergens include the protein compounds in penicillin or aspirin.

How Does Anaphylactic Shock Develop?

In short, the faster the reaction occurs after exposure to the allergen, the more severe it tends to be.

Here’s what’s happening inside your body: For some individuals, allergens trigger the production of specific antibodies called immunoglobulin E (IgE). Once IgE attaches to certain white blood cells (mast cells and basophils), it releases a mix of chemicals like histamine, heparin, and leukotrienes. Their job? To find and remove the allergen from the body. This initial reaction, called the early phase, happens within 5-30 minutes of contact with the allergen. It causes blood vessels to become more permeable, leading to swelling and a drop in blood pressure.

Then, a few hours later, other immune cells join the action, leading to typical allergic symptoms like nasal congestion, itchy eyes, or hives. In more serious cases, internal organs like the lungs or digestive system may be affected. If the blood system is involved and oxygen delivery becomes impaired, it can lead to anaphylactic shock, a potentially fatal condition. This can cause the body to collapse entirely.

Who Is at Risk?

Anaphylactic shock typically occurs in people who have been sensitized to an allergen before. This means their immune system has encountered the substance in the past, leading to the production of antibodies. The next time they come into contact with that allergen—even in tiny amounts—their body can go into overdrive, triggering a severe reaction.

What Are the Symptoms of Anaphylactic Shock?

The signs of anaphylaxis can appear within 30 minutes of exposure to the allergen. Along with typical allergy symptoms like a stuffy nose, itchy skin, or hives, you may notice more concerning signs:

• Pale or bluish skin
• Swelling of the face, lips, tongue, or throat
• Hoarseness, wheezing, dry cough, or difficulty breathing

As the allergic reaction worsens, additional symptoms may include:

• Abdominal pain, nausea, vomiting, or diarrhea
• Difficulty speaking or swallowing
• Full-body swelling
• Headaches, dizziness, confusion, or anxiety
• A drop in blood pressure, weak pulse, and rapid heartbeat

First Aid for Anaphylactic Shock

If someone suddenly turns pale, struggles to breathe, experiences swelling in the throat, or loses consciousness, immediate action is required:

1. Position the Person Properly: Lay them on their back and elevate their legs slightly (around 20 cm) to improve circulation. If they’re unconscious or vomiting, place them on their side (left side for pregnant women). If they’re having trouble breathing but are still conscious, help them sit with their legs bent, the so-called “W-position.”
2. Administer Epinephrine (Adrenaline): If the person has an epinephrine autoinjector (like an EpiPen), use it immediately according to the instructions. Usually, the injection goes into the outer thigh.
3. Call Emergency Services: Dial emergency services (e.g., 155) and follow the operator’s instructions. If the person’s heart stops, begin chest compressions.
4. Remove the Allergen (If Possible): If there’s a bee sting or insect venom under the skin, try to remove it using a credit card or flat object. Avoid using tweezers, as it might push venom into the wound.
5. Stay Calm and Reassure: If the person is still conscious, talk to them calmly and reassure them. Anxiety can worsen the situation.

How Long Does Anaphylactic Shock Last?

Anaphylactic reactions can either be monophase (where symptoms appear after allergen exposure) or biphasic (where symptoms recur hours later). If the reaction is biphasic, it can occur anywhere from 1 to 72 hours after the initial episode, typically peaking around 10 hours later. That’s why, even if symptoms seem to subside, the person needs to be monitored in a hospital for at least 24 hours.

Treatment for Anaphylactic Shock

Anaphylactic reactions need to be managed by healthcare professionals. Symptoms may worsen or reappear after the first wave of treatment, so it’s essential to be under medical supervision. The primary treatment involves:

• Epinephrine: This is the go-to solution for anaphylaxis. It constricts blood vessels, helping to stabilize blood pressure, reduces swelling, opens up airways, and eases breathing. For individuals who have experienced severe allergic reactions in the past, a doctor might prescribe an epinephrine autoinjector.
• Oxygen Therapy: This helps ensure that the body gets the oxygen it needs when breathing is compromised.
• Antihistamines and Steroids: These medications can help reduce inflammation and ease breathing difficulties.
• Bronchodilators: Inhalers containing beta-agonists can help open up the airways for easier breathing.

Can Medications Trigger Anaphylactic Shock?

Yes, certain medications can cause an allergic reaction. Antibiotics (especially penicillin), NSAIDs (like aspirin and ibuprofen), anti-seizure drugs, contrast agents used in imaging, and even vaccines can all trigger anaphylaxis. It’s a good idea to stay in a monitored setting for 30 minutes after receiving a vaccine, just in case.

Preventing Anaphylactic Shock

The best way to prevent anaphylactic shock is to avoid known allergens. Always check product labels for ingredients, and ask about ingredients if you’re trying new foods or eating out. If you’re allergic to insect venom, wear long sleeves and pants, avoid strong perfumes, and don’t drink from open containers outdoors.

If you’re allergic and have children, they may also develop allergies. Introduce new foods gradually and keep an eye out for reactions. If you’ve had a severe allergic reaction in the past, always carry an allergy card, an epinephrine autoinjector, or antihistamines. And don’t forget to check expiration dates regularly.

Anaphylactic Shock in Children

Anaphylactic shock can affect children too, often triggered by food allergies like nuts, dairy, eggs, fish, or shellfish. Medication allergies, particularly penicillin, or vaccines can also be culprits. In fact, up to 80-90% of children will show skin reactions like rashes. Some unusual signs in children include:

• Irritability, restlessness, or inconsolable crying
• Sudden drooling
• Unusual drowsiness

For children, the first aid procedures are the same as for adults, and epinephrine is still the best treatment.

Anaphylaxis is scary, but with quick thinking and proper treatment, you can help save a life.