Causes

Anaphylaxis occurs when the immune system overreacts to normally harmless substances called allergens. Children with asthma and allergies to certain foods, stinging insects, or medicines are at highest risk, though anaphylaxis may occur in anyone.

Common allergens that can trigger anaphylaxis include

• Foods such as peanuts; nuts from trees, like walnuts, pistachios, pecans, and cashews; shellfish like shrimp and lobster; fish like tuna, salmon, and cod; milk; eggs. In rare cases, anaphylaxis may be related to a certain food followed by exercise.

• Insect stings from bees, wasps, hornets, yellow jackets, and fire ants.

• Medicines like antibiotics and antiseizure medicines. However, any medicine, even aspirin and other nonsteroidal anti-inflammatory drugs, have the potential to cause severe reactions.

Signs and Symptoms

Anaphylaxis includes a range of signs and symptoms that often happen quickly and occur at the same time. The most severe symptoms restrict breathing and blood circulation. Signs and symptoms are different for each child and may include

• Skin: itching, hives, redness, swelling

• Nose: sneezing, stuffy nose, runny nose

• Mouth: itching, swelling of lips or tongue

• Throat: itching, tightness, difficulty swallowing, hoarseness

• Gut: vomiting, diarrhea, cramps

• Chest: shortness of breath, cough, wheeze, chest pain, tightness

• Heart: weak pulse, passing out, shock

• Nervous system: dizziness, fainting, feeling that you are about to die

Treatment

For anyone experiencing anaphylaxis, epinephrine should be given right away followed by a call to 911 for further treatment and transfer to a hospital.

Epinephrine is the main medicine to treat anaphylaxis. The medicine comes in auto-injector syringes. It's important to know how to use the medicine. Your child's doctor can go through the medicine directions with you. Ask your child's doctor what to do if the symptoms do not improve very quickly after a single dose.

Epinephrine should be prescribed for anyone who has ever had an anaphylactic attack and for children at high risk for anaphylaxis. Epinephrine is available in 2 different doses based on the weight of the child. Parents and caregivers should always have at least 2 doses with them when with their child. The best place to inject it is in the muscles of the outer part of the thigh.

Children who are old enough can be taught how to give themselves epinephrine if needed. School-aged children also need one at school with instructions from their doctor about how and when to use it. It is important to share this action plan with anyone who cares for your child.

During a reaction, an oral antihistamine may also be given, but not in place of epinephrine. Also helpful in case of an emergency is medical identification jewelry that includes information about your child's allergy. This should be worn at all times.

Prevention

After an anaphylactic attack, your child needs to be seen by a doctor. Even if the cause seems obvious, there may be other causes. An evaluation by an allergist is often needed. An allergist has specialized training in diagnosing the cause of anaphylaxis and providing additional treatment. They will recommend a prevention and treatment plan based on the causes.

In most cases, the only way to prevent an attack from happening again is to avoid the cause. An emergency action plan describing the allergies, symptoms, and treatments is important so that the child and any caregivers knows what do if another attack occurs.

Note: Although children's allergies are often outgrown, anaphylaxis often lasts for many years or even for life. Your child's doctor may recommend regular checkups to see if your child is still allergic and to review how to avoid triggers and treat reactions. In the case of anaphylaxis caused by stinging insects, immunotherapy (also called allergy injections or allergy shots) can help prevent anaphylaxis from future stings, but is currently not available for other types of anaphylactic allergies.

For More Information

American Academy of Pediatrics

www.aap.org and www.HealthyChildren.org

• Download and fill out an Allergy and Anaphylaxis Emergency Plan at www.HealthyChildren.org/AnaphylaxisPlan.

American Academy of Allergy, Asthma & Immunology

www.aaaai.org/tools-for-the-public

American College of Allergy, Asthma & Immunology

www.acaai.org

Food Allergy & Anaphylaxis Network

www.foodallergy.org