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Anaphylaxis: Causes, Symptoms and Treatment

Anaphylaxis is a severe, life-threatening allergic reaction affecting the whole body that requires immediate medical treatment.

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Anaphylaxis is a severe, life-threatening allergic reaction affecting the whole body that requires immediate medical treatment.

What is Anaphylaxis?

Anaphylaxis is a severe, acute, and potentially life-threatening hypersensitivity reaction of the immune system. It affects multiple organ systems simultaneously and can develop within minutes of exposure to a trigger. Anaphylaxis is a medical emergency and must be treated immediately. Without prompt medical care, it can progress to anaphylactic shock and prove fatal.

Causes and Triggers

Anaphylaxis is triggered by an excessive immune response to certain substances known as allergens. The most common triggers include:

Foods: Peanuts, tree nuts, shellfish, fish, milk, eggs, and wheat
Insect stings: Bees, wasps, and hornets
Medications: Antibiotics (especially penicillin), non-steroidal anti-inflammatory drugs (NSAIDs), and radiocontrast media
Latex: Found in rubber gloves and various medical products made from natural latex
Physical exercise: Rarely, often in combination with specific foods (exercise-induced anaphylaxis)

In some cases, no clear trigger can be identified. This is referred to as idiopathic anaphylaxis.

Mechanism of Action

During anaphylaxis, the immune system reacts to a harmless allergen as if it were a serious threat. On previous exposure to the allergen, antibodies of the type Immunoglobulin E (IgE) were produced and bound to mast cells and basophils. Upon re-exposure to the allergen, these IgE antibodies activate the mast cells, which then release large amounts of chemical mediators such as histamine, tryptase, and leukotrienes. These mediators cause vasodilation, increased vascular permeability, bronchospasm, and other systemic effects throughout the body.

Symptoms

Symptoms of anaphylaxis can vary but typically develop very rapidly. Common signs include:

Skin and Mucous Membranes

Itching, skin redness, hives (urticaria)
Swelling, especially of the face, lips, and throat (angioedema)

Respiratory System

Shortness of breath, wheezing (bronchospasm)
Hoarseness, difficulty swallowing
Risk of suffocation due to laryngeal swelling (laryngeal edema)

Cardiovascular System

Drop in blood pressure, dizziness, fainting
Rapid heartbeat (tachycardia)
Anaphylactic shock with loss of consciousness

Gastrointestinal Tract

Nausea, vomiting, abdominal cramps, diarrhea

Diagnosis

Anaphylaxis is primarily diagnosed clinically, based on symptoms and medical history. In an acute situation, immediate treatment takes priority. Subsequent diagnostic measures may include:

Serum tryptase: An elevated tryptase level in the blood, measured within 1-3 hours after the event, confirms mast cell activation.
Allergy tests: Skin tests (prick test, intradermal test) or blood tests for specific IgE antibodies to identify the trigger.
Provocation tests: Possible in specialized centers under medical supervision.

Treatment

Emergency Measures

When anaphylaxis is suspected, immediate action is critical. The key steps are:

Call emergency services (911 or local equivalent) and do not leave the person alone
Administer adrenaline (epinephrine) intramuscularly into the outer thigh – this is the first-line treatment. Many affected individuals carry an adrenaline auto-injector (e.g., EpiPen).
Lay the person flat with legs elevated (except in cases of breathing difficulty: semi-reclined position)
If breathing or circulation stops: begin resuscitation immediately

Additional Medical Treatment

Antihistamines: Relieve skin reactions and itching but do not replace adrenaline
Corticosteroids (e.g., methylprednisolone): Suppress late-phase reactions
Beta-2 agonists (e.g., salbutamol): Used for bronchospasm to open the airways
Intravenous fluids: To stabilize circulation in cases of shock

Long-term Prevention

Strict allergen avoidance
Carrying an emergency kit containing an adrenaline auto-injector, antihistamine, and corticosteroid at all times
Allergy counseling and education of family members and companions
Allergen immunotherapy (desensitization): Possible for insect venom allergy to achieve long-term desensitization
Carrying a medical alert card with information about the allergy and emergency medication

References

Ring J. et al. - Guidelines on anaphylaxis: acute therapy and management. Allergo Journal International, 2014. AWMF registration number 061-025.
Muraro A. et al. - The EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy, 2014; 69(8): 1008-1025.
World Allergy Organization (WAO) - Anaphylaxis Guidance 2020. Available at: www.worldallergy.org

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