🚨 Men's Health

Anaphylaxis — Emergency Recognition & Response

A life-threatening allergic reaction — how to recognise and act fast

Anaphylaxis is a severe, potentially life-threatening allergic reaction that can develop within minutes of exposure to a trigger. It is a medical emergency requiring immediate treatment with adrenaline (epinephrine). In Nigeria, triggers include food (crayfish, peanuts, fish, eggs), medications (penicillin, aspirin, NSAIDs, contrast dye), insect stings (bees, wasps), and latex. Anaphylaxis deaths are preventable — the main cause of death is delayed adrenaline administration. Everyone should recognise anaphylaxis and know the immediate first response.

Signs and Symptoms

✓ ANAPHYLAXIS if TWO OR MORE body systems are affected after exposure to a trigger:

✓ SKIN: widespread hives (urticaria), flushing, itching, angioedema (lip/tongue swelling)

✓ RESPIRATORY: throat tightening, hoarse voice, stridor, wheezing, difficulty breathing

✓ CARDIOVASCULAR: sudden drop in blood pressure, rapid weak pulse, collapse, loss of consciousness

✓ GASTROINTESTINAL: sudden severe abdominal cramping, vomiting, diarrhoea

✓ NEUROLOGICAL: confusion, feeling of impending doom, loss of consciousness

✓ BIPHASIC REACTION: symptoms may resolve then return 1–72 hours later — all anaphylaxis needs observation for at least 4 hours

Risk Factors

Known food allergy (especially peanut, shellfish, fish, tree nut)
Previous anaphylaxis (highest risk factor for recurrence)
Penicillin allergy — most common drug cause of anaphylaxis in Nigeria
Use of beta-blockers or ACE inhibitors (worsen severity, reduce adrenaline effectiveness)
Asthma — more severe respiratory compromise during anaphylaxis
Latex allergy (healthcare workers at risk)
Exercise-induced anaphylaxis (rare — triggered by exercise alone or food + exercise)
Contrast media (iodinated dye) used in CT or angiography

When to Seek Help

ANAPHYLAXIS — act within minutesDo not wait for 'all symptoms' — if skin + breathing or skin + cardiovascular signs after an allergen exposure: give adrenaline and call for emergency help IMMEDIATELY

After penicillin injectionStay in the clinic for 15–30 minutes after any injectable antibiotic — anaphylaxis typically occurs within 30 minutes

Any previous anaphylaxis — carry a planPrescription for adrenaline auto-injector, written action plan, MedicAlert bracelet. See allergist for desensitisation options

Post-anaphylaxis dischargeAll patients need at least 4–6 hours observation for biphasic reaction. Most need 12–24 hours if severe

Referral after anaphylaxisAll anaphylaxis episodes need allergist follow-up to identify trigger, confirm diagnosis, and provide prevention plan

Tests & Diagnosis

🧪 Serum tryptase

Blood test within 1–3 hours of anaphylaxis — elevated tryptase confirms mast cell activation. Not widely available in Nigeria but useful in diagnostic uncertainty

🧪 Specific IgE and skin prick testing

Done 4–6 weeks after the episode — identifies the culprit allergen for avoidance advice

🧪 Detailed allergy history

The trigger, timing, symptoms, response to treatment — the most important diagnostic tool

🧪 ECG

After anaphylaxis — cardiac arrhythmias can occur during or after severe anaphylaxis

Treatment Options

STEP 1: Adrenaline (epinephrine) IM — FIRST AND MOST IMPORTANT

Adult: 0.5mg (0.5mL of 1:1000) IM into outer thigh. Child: 0.01mg/kg (maximum 0.5mg). Repeat every 5–10 minutes if no improvement. Adrenaline is the only life-saving treatment — antihistamines and steroids are NOT substitutes for adrenaline

STEP 2: Call for emergency help

Call ambulance or transport to nearest hospital immediately. Do not leave the patient alone

STEP 3: Position

Lie patient flat with legs elevated (unless breathing is difficult — then sit up). Do NOT allow patient to stand — sudden death from positional hypotension can occur

STEP 4: Remove trigger if possible

Stop the infusion/injection, remove bee sting if visible

STEP 5: IV fluids

For hypotension — rapid 0.9% saline infusion in hospital

STEP 6: Antihistamines and steroids

Given AFTER adrenaline — chlorphenamine (piriton) IV, IV hydrocortisone — reduce risk of biphasic reaction. NOT first-line

STEP 7: Inhaled salbutamol (ventolin)

For bronchospasm/wheeze that persists after adrenaline

Frequently Asked Questions

Can I use antihistamine instead of adrenaline?

No. Antihistamines are far too slow — they take 30–60 minutes to work. In anaphylaxis, the airway can close and blood pressure can collapse within minutes. Adrenaline is the only appropriate first-line treatment. Antihistamines are given after adrenaline as secondary treatment.

Where can I get an adrenaline auto-injector (EpiPen) in Nigeria?

Adrenaline auto-injectors are not reliably stocked in Nigerian pharmacies — this is a genuine gap in emergency preparedness. Draw-up adrenaline ampoules (1:1000) are available at hospitals. If you are at anaphylaxis risk, work with your doctor on a plan — some patients carry a 1mL syringe pre-loaded with adrenaline ampoule. Advocacy for auto-injector availability is ongoing.

What if I'm not sure it's anaphylaxis?

If in doubt, give adrenaline. The risk of giving adrenaline when not needed (mild tremor, fast heartbeat) is far lower than the risk of not giving it when it is needed (death). This is a core principle of anaphylaxis management — err on the side of treatment.

My child had a mild allergic reaction — what do I do?

Mild reactions (localised hives only, no breathing or cardiovascular symptoms) can be managed with antihistamine. However, reactions can escalate — observe for 2–4 hours. Any sign of throat involvement, breathing difficulty, or collapse: adrenaline and emergency services immediately. See an allergist for allergy testing and an action plan.