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Anaphylaxis is a severe, potentially life threatening allergic reaction, it can develop fairly rapidly and can even result in death. With anaphylaxis the patient can experience difficulty in breathing due to chest tightness (wheezing) or sensation of closing of the throat due to swelling in the throat, or may feel dizzy or collapse due to fall in blood pressure. Other symptoms of allergy may or may not be present at the time of anaphylaxis for instance patients may have rash, swellings or vomiting, abdominal pain or loose motion in addition to the above symptoms of anaphylaxis. Anaphylaxis is often due to exposure to food, latex, drugs or insect bites. As these reactions are quite often due to Specific IgE antibodies against the allergen, these antibodies may be detected by skin prick test or blood tests to establish a definitive diagnosis.

Some cases of anaphylaxis however may have no identifiable trigger hence are called ‘Idiopathic’.

Sometimes for a severe allergic reaction to occur a concomitant trigger is needed for example exercise, drugs or alcohol.

Exercise Induced Anaphylaxis

In some patients exercise on its own may induce symptoms of severe allergy or even anaphylaxis. At times this may be due to exercise alone, at other times it may be due to eating a heavy meal or a drug like aspirin or ibuprofen and then exercising and at still other times it may be triggered by eating a particular food and then exercising within a few hours of eating. These cases are identified by taking a good history. In these patients food or drug on its own does not cause symptoms, but a combination of food or drug prior to exercise can trigger the allergic reaction

Wheat dependent exercise induced anaphylaxis

In some patient eating wheat containing meal within a few hours prior to exercise (walking, jogging, and sports activities) can trigger an allergic reaction. In these patients quite often an antibody against one of the components of wheat (Omega 5 gliadin) can be found on blood tests and this helps in giving appropriate advice to the patient.

Risk factors for anaphylaxis

Allergic patients who also suffer from asthma  are more likely to get a more severe allergic reaction if exposed to the allergen. If patient is hot, exercising or has consumed alcohol they are more likely to absorb the allergen and get a more severe reaction.

Treatment of anaphylaxis

Once a patient has suffered an anaphylaxis episode, a specific allergic trigger is looked for by taking a good history, and doing relevant blood tests or skin prick tests to determine the cause for the reaction. Patients are advised to avoid the particular trigger, be it a food, drug, or insect sting. In case of food allergy patient is advised to be especially careful by looking at food labels to identify the triggering allergen. In case of drug or  venom allergy or severe food allergy the patient may be advised to wear a medic alert device about their allergy. Patients are advised to carry antihistamines, and may be advised to carry two adrenaline auto injectors (if they cannot safely avoid the culprit allergen) and sometimes a short course of steroids on their person at all times. Patients should be trained in how and when to use their adrenaline auto injector. If patients suffer from asthma they should see their GPs regularly to ensure that their asthma is under good control and should always carry their asthma inhalers. Anaphylaxis is a severe life-threatening condition which can progress very rapidly, if ever patients develop symptoms of anaphylaxis despite having taken their antihistamines they should use their adrenaline auto injector and call the emergency services (dial 999) and be taken to their nearest emergency department for further observation and treatment.

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