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Anaphylaxis is terrifying. You try to breathe but instead you wheeze and gasp for air. You’re sweating and itching, and hives have erupted across your body. Fear of your impending doom takes hold, but you’re at the mercy of swelling that’s squeezing the life out of your heart, lungs, and throat. Your only hope is epinephrine and you need it immediately. The good news? Advancements in immunotherapy could soon prevent multiple allergic reactions from turning into anaphylaxis.
What Is Anaphylaxis?
Before discussing what immunotherapy is and how it works, we need to understand anaphylaxis. This serious, potentially fatal condition affects the entire body within minutes after contact with a life-threatening allergen (e.g. an insect sting, food, medication, or latex). Anaphylaxis can cause shock, an extreme drop in blood pressure, and breathing difficulties, among other serious symptoms.
During anaphylaxis, the body views the allergen as an invader, causing the immune system to go on full alert, overreacting by releasing chemicals which cause allergy symptoms (e.g. nasal congestion, sneezing, itching, hives, and swelling). Instead of attacking one area of the body (i.e. the face, if you’re allergic to an ingredient in mascara), an anaphylactic reaction attacks multiple parts (e.g. the heart, lungs, and throat) simultaneously.
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Can Anaphylaxis Be Cured?
Anaphylaxis is not curable, says Dr. Bukstein. “Curable means that you treat it and it goes away and stays away forever. This is just the opposite. If you have asthma, or if you don’t have asthma but you’ve had an anaphylactic episode in the past, then you’re at the highest risk of having one in the future,” he explains. “The epinephrine just reverses the symptoms, so you don’t die or have a very severe reaction. It reverses the symptoms, but you still are anaphylactic.”
Dr. Andrew Murphy, Chief Medical Officer of the Asthma Allergy and Sinus Center in West Chester, PA agrees. “Anaphylaxis as a pathophysiology phenomenon cannot be cured, meaning there is no pill or injection that I could give to a patient that would forever prevent them from ever having anaphylaxis,” he says.
Immunotherapy Could Reduce the Risk of Anaphylaxis
A person can train his or her body to become less allergic through immunotherapy, according to the American College of Allergy, Asthma, & Immunology (ACAAI). This treatment helps prevent an allergic reaction by gradually increasing a person’s contact with a specific allergen. It’s been successful on allergens such as grass, pollen, dust mites, and bee venom. Here’s how it works: an allergist gives an allergic person gradually increasing doses of the allergen he or she is allergic to.
“Let’s say you have a reaction to venom from an insect sting, You’re allergic to yellow jacket venom. Well, we can desensitize people, so it will lower their risk to very low, just like the general population’s risk by giving them sequential injections of that allergen,
Over time, the person becomes less sensitive to the allergen. This works, “probably by causing production of a “blocking” antibody, which reduces the symptoms of allergy when the substance is encountered in the future. Immunotherapy also reduces the inflammation that characterizes rhinitis and asthma,” claims the ACAAI.
CAN YOU PREVENT A PEANUT ALLERGY?
According to Dr. Andrew Murphy, Chief Medical Office of the Asthma Allergy and Sinus Center in West Chester, PA, a peanut allergy can be preventable. “We now know that early introduction of peanut to babies will prevent the development of peanut allergy and thus prevent peanut anaphylaxis from developing,” he says.
Once you have the allergy, however, preventing anaphylaxis upon contact with a peanut is unlikely. “There are ongoing trials of oral food immunotherapy, in patients with known food allergy (e.g peanut) that have shown promise in reducing one’s risk to reacting to a peanut exposure,” he says. “But [there has been] very very limited success in long term elimination of the risk of anaphylaxis to peanut.”
Currently, immunotherapy is best used for the environmental allergens listed earlier. According to Dr. Bukstein, though, a better solution for food allergies is near. “We’re right on the verge—in the next year probably—where we’ll have ways of [using immunotherapy] with food allergy,” he says. At that point, Bukstein explains, those with allergies will be able to be treated with oral or skin desensitization, allowing them to tolerate small amounts of the food (e.g. peanut). They won’t likely be able to consume peanut butter on toast, but these people may be better protected from anaphylaxis if they accidentally ingest the allergen.
Note: Not everyone is a candidate for immunology, so it’s important to talk to your allergist before undergoing treatment.
Signs of Anaphylaxis
According to Dr. Bukstein, the following signs of anaphylaxis should be taken seriously:
- A skin reaction (e.g. itching, hives, welts, and flushed skin)
- Feeling hot
- Swelling on the face, eyes, lips, or throat
- Difficulty breathing due to constricted airways
- Nausea, vomiting and/or diarrhea
- A weak, rapid pulse
- Dizziness, fainting or unconsciousness
What Are the Most Common Triggers of Anaphylaxis?
“Anaphylaxis is a lot more common in people who have asthma, and people who are allergic to food or drugs,” says Dr. Bukstein. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), these allergens are the most common causes of an anaphylactic reaction:
- Foods (e.g. peanuts, tree nuts, fish, and shellfish)
- Insect stings (e.g. from wasps, hornets, yellow jackets, bees, and fire ants)
How Long Does It Take to Go Into Anaphylactic Shock?
While an allergic reaction differs for everyone, “anaphylaxis typically occurs within minutes of exposure to an allergen,” says Dr. Murphy. “There are some very unique allergens, however, that the reaction may not occur until several hours after exposure.”
According to Dr. Bukstein, anaphylaxis usually occurs within the first 30 minutes, but in very rare cases, it could take 72 hours for the ill effects to take hold.
When to See an Allergist for Anaphylaxis
“Any anaphylactic reaction seen in a doctor’s office, an emergency room, a hospital, urgent care, needs to be seen by an allergist. One-hundred percent of them, not 99, not 98, these are life threatening reactions,” says Dr. Bukstein.
How to Treat Anaphylaxis
The best way to treat anaphylaxis is to prevent it from happening in the first place. Know your allergens and steer clear of them. If you’ve had an allergic reaction (anaphylactic or not) for the first time, see an allergist or immunologist for thorough allergy testing. “There are going to be ways of desensitizing patients and hopefully preventing it, but the best prevention is just avoiding the allergen. Almost all of these allergens have to be ingested or injected. If you can define them and know what they are, then you can avoid them,” says Dr. Bukstein.
The best and only successful treatment for anaphylaxis is epinephrine. As stated by the AAAAI, “anaphylaxis requires immediate medical treatment, including a prompt injection of epinephrine and a trip to a hospital emergency room. If it isn’t treated properly, anaphylaxis can be fatal.” Dr. Bukstein agrees, adding that people must be vigilant about understanding the symptoms of anaphylaxis since they may differ for everyone. “Recognizing anaphylaxis can be a little tricky,” he says. “I’ve been doing it for many years, thousands of episodes I’ve seen, and I can tell you, no two are exactly alike. Some of the symptoms can come with other problems, so, you have to be astute and you really have to recognize it.”
According to the Food and Drug Administration (FDA), “people who have had an anaphylaxis episode always face the risk of another one. Because of this risk, they must carry an emergency dose of epinephrine at all times.” To learn more about life-saving auto-injectable epinephrine devices such as EpiPen, read our post: “Are EpiPens too Expensive?”
Looking for a specialist? Use the Find an Allergist/Immunologist tool on the American Academy of Allergy Asthma & Immunology’s Website.
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