Fear Not! Anaphylaxis Facts and Epinephrine Tips to Build Confidence

When people imagine a severe allergic reaction to food, many think of a face ballooning and splotchy hives covering the body as clear signs of an emergency. Pop culture has taught us in movies and shows to watch for these visual signs of anaphylaxis. In reality, anaphylaxis can look different for each person. For up to 20% of cases, symptoms may not affect the skin at all.

Learning the symptoms of anaphylaxis in a non-urgent situation could save a life. Even if you don't have food allergies yourself, chances are you know 1 in 10 adults who do live with food allergies. Or consider this - a classroom in school has approximately 2 kids with food allergies.

Notice I didn't say 'severe' food allergies? It is important to know the differences between mild and severe symptoms and the variety of ways they can present themselves.

You cannot have a mild or severe food allergy.

You can have mild or severe symptoms.

Food allergies involve the immune system going into overdrive. They are an overreaction of a person’s immune system when the body incorrectly perceives food as a threat.

The job of our immune system is to protect us from germs and diseases. When a perceived threat is ingested (for example a peanut), the immune system sees the peanut as a threat and sounds the alarms to prepare for the attack.

The immune system will trigger cells to release an antibody (which fights foreign intruders) called immunoglobulin E (IgE). IgE is trying to bring the body back under control. The immune system makes IgE antibodies and IgE attaches to mast cells or basophils.

The body has a memory and if these food allergens are ingested again, the IgE antibodies will act as guards to signal a histamine response. The body releases chemicals (e.g. histamine), resulting in mild to severe symptoms.

Reactions to food can take place within minutes or even a few hours after initial ingestion.

The reactions may be mild or severe but the food allergy incidence is unique for each exposure. In other words, past incidences cannot and will not predict future symptoms. The amount of food consumed, current state of the body (does the person have illness? did they just exercise?) and other dynamic factors at play make it hard to predict how a person will react.

So how can you help a person in an urgent situation?

Recognizing symptoms is key and becoming familiar with the protocol is a great first step. Keeping an emergency care plan at your fingertips is a great best practice.

For mild symptoms, if a person experiences one symptom only, then an antihistamine is the route a doctor may suggest:

• Itchy or runny nose

• Itchy mouth

• Mild itching or a few hives on skin

• Nausea or gut discomfort

Severe symptoms are unique to each person and are a sign of anaphylaxis. If any of these occur, give epinephrine immediately:

• LUNG: shortness of breath, wheezing, repetitive coughing

• HEART: pale or bluish skin, faintness, unusual sleepiness, weak pulse, dizziness

• THROAT: tight, itchy or hoarse throat, trouble breathing or swallowing

• MOUTH: significant swelling of tongue or lips with itchiness

• SKIN: many hives over body, widespread redness

• GUT: repetitive vomiting, diarrhea or cramps

Epinephrine stops anaphylaxis.

Antihistamines don't stop anaphylaxis.

Doctors should provide you with a food allergy action plan (aka emergency care plan). This document can act as a reference guide to help you clearly decide which medicine to use in a time of need.

Pro tips:

• Have printed copies hung on each floor of your home and provide one to secondary caregivers that spend time with the food-allergic individual.

• Save a copy to your phone for access at a moment's notice.

Remember, only your doctor can prescribe an epinephrine auto-injector and give you an allergy action plan to follow. You may fill out one of these below plans as well to provide a visual aide. Two samples are below.

Download FARE's emergency care plan here or download AAAAI's emergency action plan here. Both are great examples of visual aides for anyone to follow.

If you are like me, you might struggle with seeing epinephrine as scary at first. After all it has a needle in it and is a potent drug that can literally save a life within minutes. Aren't food allergies scary enough?

I'll admit that I used to hide the Epi auto-injector in our allergy bag from our young kids. I felt safe bringing it but didn't want to freak them out with the 'needle in my pocket'.

I used to be afraid of using epinephrine and often thought of it as a last resort. Don’t make this same mistake! Once a severe reaction starts (even if it seems mild in the beginning), the ONLY way to stop it is to use epinephrine. Antihistamines will not reverse symptoms and may only mask what you see as relief temporarily.

We used to be afraid of the Epi. That changed in December 2020.

We were having hamburger sliders for dinner. Hawaiian sweet rolls were a crowd-pleaser in our house and our kids gobbled them up. Sheltering-in-place during the Covid years meant that sometimes we had groceries delivered from Instacart. Little did we know that the Hawaiian sweet rolls we purchased contained egg.

We had purchased the same brand in the past that didn't have egg in them. The packaging was identical except for one difference - Costco bulk size this time instead of regular 12-pack of sweet rolls.

I was used to reading and re-reading labels at the store and I felt confident that this meal would be safe. I didn't remember to check before serving dinner that night. We were moving quickly and it never crossed my mind to look because we'd eaten this brand in the past. Big mistake on my part.

Fifteen minutes after eating the rolls, our son vomited repeatedly over 10 times, started looking pale and complained that his throat felt itchy. My husband and I glanced at each other and decided it was time for epinephrine.

We told our 9-year-old son the plan and his fingers curled over the counter as he backed into the bathroom corner. He thrashed, pushed us away and screamed so loudly that his sisters burst into tears as they watched through the doorway. He saw it as poison. The needle terrified him. We were all traumatized.

Seconds after the medicine kicked in, he was relaxing again and said he immediately was feeling better. The color started to come back to his face, he calmed down and we stood there stunned watching and waiting. It was a powerful lesson for all 5 of us and one that changed how we viewed epinephrine. Food allergies are definitely scary but we learned that the needle doesn't have to be!

We had to flip the script and start seeing the Epi auto-injector differently.

It was the hero in our story!

We decided to take the trainers out of the box and leave them out. We started socializing the trainers as part of the playroom experience. We let our kids play with them, try them, and even taught friends how to use them. Our kids recorded a 'kid to kid perspective' video demonstrating how to use one to reduce fears.

Once we knew how epinephrine worked to reverse symptoms of anaphylaxis, we started to see it as a helpful tool in our bag or backpack - like a pen in our pocket.

Epinephrine is the medication form of adrenaline, a hormone that your body already produces. It makes the fight or flight reaction occur, constricting blood vessels and increasing blood pressure to ensure support to the most vital organs.

Epinephrine relaxes the muscles around your lungs and also expands the tubes that bring air to the lungs. The heart beats faster and it feels like an adrenaline rush. You can think of epinephrine as an ambulance for your body - your body’s emergency responder.

For added assurance, the Food and Drug Administration (FDA) in the US has approved lower dose epinephrine that is safe for emergency treatment of food allergic reactions in infants and toddlers.

Whether you fear epinephrine or not, or just need an occasional reminder of its incredible life-saving power, I hope you found this article both educational and encouraging.

We can all use these reminders from time to time. Knowledge is power and it can ultimately bring us peace of mind. When we know better, we can prepare better.

Sources: American College of Allergy, Asthma and Immunology [ACAAI], Food Allergy Research and Education [FARE], National Institute of Health NIH and American Academy of Allergy, Asthma and Immunology [AAAAI].

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