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The most dangerous thing about a peanut allergy or any other severe allergy is its potential to cause anaphylaxis, a potentially-life threatening allergic reaction.
In his indispensable how-to guide, The Peanut Allergy Answer Book (3rd Edition), Dr. Michael C. Young does a great job of explaining what anaphylaxis is, the different levels of reaction to look out for, and what foods are most likely to cause it (hint: peanuts are on the list).
Take our quiz to find out how well you know your anaphylaxis facts, and then learn more with an excerpt from Dr. Young’s book.
1. What defines anaphylaxis?
A.) A prolonged fit of coughing and sneezing
B. ) Any severe allergic reaction
C.) An allergic reaction that involves two or more body systems
D.) Total organ failure
2. Which is not a recognized grade of of anaphylaxis reaction?
C. ) Moderate
3.) What symptoms frequently accompany moderate anaphylaxis?
A.) Hives and itching
C.) Tightness of the throat and chest
D.) Wheezing and vomiting
E.) All of the above
4.) Which of the following foods is not a common cause of anaphylaxis?
B.) Tree nuts
C.) Whole wheat bread
Answers: 1.) C– Anaphylaxis is an allergic reaction that involves two or more systems 2.) A — There is no such designation as a benign anaphylaxis reaction 3) E — All of the above 4) D– Whole wheat bread is not a common cause of anaphylaxis
“Anaphylaxis is the systemic manifestation of allergy—when an allergic reaction affects the body as a whole and not just locally.
In other words, some patients have hives just in the area of contact with the food allergen, such as the lips and mouth, while other patients erupt in hives over their entire body, regardless of the route of exposure. It is this latter system total body reaction that is termed anaphylaxis.
A 2006 symposium of experts convened and a consensus was reached on the clinical definition of anaphylaxis. They established three criteria, any one of which was enough to indicate the likelihood of anaphylaxis:
- An acutely occurring (minutes to several hours) illness involving skin, mucous membranes, and at least one of the following: respiratory compromise, reduced blood pressure, OR
- Two or more of the following that occur promptly after exposure to an allergen: skin/mucous membrane involvement, respiratory distress, reduced blood pressure, gastrointestinal symptoms, OR
- Reduced blood pressure after exposure to the allergen
So a person who is having a combination of symptoms, such as hives and vomiting with cramping abdominal pain, is undergoing anaphylaxis because two organ systems (the skin and the GI tract) are involved, even if the symptoms themselves are not severe.
It is the involvement of two organ systems or more, indicating that the reaction is systematic, that defines anaphylaxis.
The severity of anaphylaxis can be graded mild, moderate or severe. The symptoms of mild anaphylaxis can include hives, a sensation of fullness of the mouth and throat, swelling of the eyelids and lips, and nasal congestion.
Moderate anaphylaxis would be accompanied by the additional symptoms of generalized or rapidly worsening hives and itching, swelling, flushing, tightness of the throat and chest, wheezing and vomiting.
The potential worse-case scenario is severe anaphylaxix, which is a life-threatening reaction. This can cause severe swelling of the tissues of the upper airway, resulting in obstruction of breathing through the throat, blocking airflow in and out of the lungs.
When the lower airways of the lungs narrow, shortness of breath, wheezing and asthma can occur, compromising oxygenation.
When the cardiovascular system of the body undergoes anaphylaxis, massive tissue leakage from blood vessels results in decreased blood pressure and shock. Severe anaphylaxis is explosive in onset, usually occurring within minutes after exposure. Patients often have a sense of impending doom in the initial stages of severe anaphylaxis. Seizures can result from lack of oxygen. The combination of obstructed breathing and lack of oxygen with loss of heart function and blood pressure is often fatal.
The common causes of fatal anaphylaxis are bee stings, drug reactions, and food allergies. Annually, there are 300 deaths from penicillin allergy, 150 deaths from food allergy (90 percent of which are from peanuts and nuts) and fifty deaths from insect-sting anaphylaxis.
By comparison, the annual death rate from asthma attacks is approximately 5,000.
Peanuts, tree nuts, and shellfish cause the majority of severe allergic reactions to foods.
There are other conditions that can mimic the symptoms of anaphylaxis. Chest tightness and difficulty breathing can be a symptom of asthma, heartburn or anxiety. A heart attack is sometimes very similar to an anphylactic reaction, so prompt medical attention by a physician is crucial so that proper and appropriate treatment can be given.”
- Promising new treatments, including oral desensitization and Chinese herbal medicines
- The most recent recommendations for feeding at-risk infants and young children
- The latest laboratory tests for determining the risk of life-threatening anaphylaxis
Michael C. Young, M.D., is Associate Clinical Professor of Pediatrics at Harvard Medical School and practices at Children’s Hospital in Boston and South Shore Allergy & Asthma Specialists in South Weymouth, MA. He is a graduate of Harvard University and Yale Medical School. He trained in pediatrics and allergy and clinical immunology at Children’s Hospital. Dr. Young is a past president of the Massachusetts Allergy Society and has been selected for inclusion in The Guide to Top Doctors by the Center for the Study of Services and Boston Magazine’s top doctor. He has received honors from the Allergy & Asthma Foundation of America and the Food Allergy & Anaphylaxis Network. Dr. Young is a member of the Massachusetts Department of Education Task Force on Anaphylaxis, which developed the first guidelines in the United States for the management of food allergies and anaphylaxis in schools. He lives in Massachusetts.