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Allergic Reactions (optional)

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Speaker 1: Shoo bee. Speaker 2: Now let's cover allergic reactions. We've all heard stories of people who have died suddenly from a severe allergic reaction and these stories are frightening. But fortunately events like this are very rare with less than 1,500 different deaths from all different age groups and all types of allergies in the United States. Statistically this is a very small number compared to approximately 50 million Americans that suffer from some form of allergy. But unfortunately resent studies show that allergies of all kinds are increasing in developed countries. Nobody knows why for sure but one prominent theory is that we've developed to sterile a lifestyle. With the constant use of antibacterial soap and this different hand sanitizers and air tight modern homes our bodies immune systems are not developing to fight germs in the same way as they did in the past. Now this can lead to over reactive immune systems. Finding a balance between healthy living and clean living is a must. So other theories include over use of antibiotics, excessive immunizations, highly processed foods, and environmental pollutants that have all lead to the breakdown and confusion of the bodies natural immune system. But whatever the cause the reality is that more people are developing allergies than ever before and we need to be prepared to handle those emergencies from allergic reactions. Now you might find it interesting to know that food and insect allergies are the most common causes of severe reactions that happen outside of the hospital with food allergies being the most prevalent. Children tend to be the most affected and according to the Centers for Disease Control and Prevention between the years of 1997 and 2007 in the United States the number of children that have food allergies rose by 18%. Fortunately, most children outgrow their food related allergies by adulthood. But peanut allergies, they tend to be lifelong. Now you might be thinking to yourself, yeah but what causes an allergy to develop? Well the immune system normally defend the body against things that can be dangerous to your health such as viruses and bacteria. A healthy immune system keeps a person from getting sick when harmful germs find their way into the body by attacking and destroying the germs. An allergy results when the immune system mistakenly targets and over reacts by attacking a normally harmless substance that's been eaten, inhaled, injected or has contacted the skin. This substance that causes an allergy is called an allergen. An allergen may have been introduced to the body many times before without any trouble at all but at some point for some reason the body flags it as an invader and triggers the immune system to attack the allergen. The body will remember that specific allergen by producing antibodies that will be ready to go into action to attack the allergen as soon as it enters the body. This is the reason that an allergic reaction is often more severe the second or even the third time when it happens. Now when the immune system attacks an allergen high quantities of histamine and other chemicals are released into surrounding tissues and depending on the part of the body involved the histamine and chemicals cause itching, hives, rash, sneezing. They can form wheezing. It can make swelling, a runny nose, nausea, and even more symptoms than that. Now, a serious allergic reaction that can be life threatening is called anaphylaxis. This is a severe sudden reaction that affects many parts of the body all at the same time and it typically begins within minutes after an allergen is introduced to the body. This severe allergic reaction can cause the body's vessels all over the body to dilate. In other words, they open all the way up and cause anaphylactic shock. The full opening of the blood vessels causes a sudden drop in the blood pressure and the brain and the other vital organs become oxygen starved. Anaphylactic shock will cause death if it's not treated. Now, the treatment is epinephrine which helps constrict the blood vessels and open the airways. Now, the most common things that cause anaphylaxis are foods such as peanuts, tree nuts, fish, shell fish, eggs, and milk, biting or stinging insects such as bees, latex, and medications. Now, food is generally the most common cause of anaphylaxis with peanuts being the most common cause of fast, severe, and life threatening reactions. Because severe nut allergies tend to affect children a lot of fear is associated with nut allergies. It has become a very popular and emotional topic. This is the reason that many schools, airlines, food manufacturers, and other places have become nut free zones. But more effective than banning nuts completely there are precautions public facilities can and should practice such as having nut free tables at lunch for children to eat. Most importantly children need to be taught what foods to avoid. Children with allergies need to carry an EpiPen. Schools, daycares, camps, and other places that typically serve food to children should have EpiPens for emergencies. Now, preventing an emergency is the best but if an emergency happens you need to know how to recognize it and be prepared to handle it. The following signs and symptoms would indicate a person is going into anaphylactic shock: Trouble breathing. Wheezing. Tightness of the throat. An itchiness on the tongue. Swelling of the face, eyes, lips. Hives. Itching, flushed or pale skin. Rapid heart beat. Low blood pressure. Maybe they have nausea, vomiting or diarrhea. Dizziness, fainting, or eventually unconsciousness. Now, children may describe their symptoms in the following way. They may say things like it feels like something's poking my tongue or my tongue is tingling, my mouth itches, my tongue feels like there's hair on it, my mouth feels funny, there's something stuck in my throat. They might say things like my lips feels tight or my body feels weird all over. And if you recognize any of the signs and symptoms of anaphylaxis, don't wait for signs and symptoms to get worse, call 911 immediately and if it's available assist with or administer an auto injectable epinephrine such as an EpiPen. Keep the person calm. Have them sit down and be in a position of comfort while you're waiting for the ambulance. Let them sit in a position that's easiest for them to breathe. Typically, this is sitting up and leaning forward. And if the person feels faint or is not fully conscious lie them down, elevate their legs, and keep the person warm. Talk to them, reassure them, and keep the person's airway open while monitoring their breathing, and be prepared to start CPR if the person stops breathing and becomes unresponsive. It is possible for a reaction to happen again after the initial reaction so most people should be really cautious and be observed during the following 4 to 6 hours after they had their first initial event. Remember the best way to help somebody in an anaphylactic reaction is to recognize their signs and symptoms early, activate EMS calling 911 or a code, and then assisting them with their EpiPen to reverse their symptoms and help save their life.

While there are only around 1500 deaths each year in the U.S. from severe allergic reactions, it is nonetheless frightening how quickly these allergic reactions can occur.

Around 50 million Americans suffer from an allergy, and this is a number that's apparently on the rise. One theory as to why has to do with our too-sterile modern life. One that includes:

  • Antibacterial soap
  • Hand sanitizer
  • Air-tight homes
  • Antibiotics use
  • Excessive immunization
  • Eating highly processed foods
  • An increase in environmental pollutants

It seems our bodies' immune systems aren't developing as effectively to fight germs and other foreign invaders like they were in the past.

The most common causes of all allergic reactions are from foods (number one) and insects (number two). Children are most affected when it comes to food allergies. And while most kids outgrow their food allergies, according to the CDC, the number of children with food allergies rose by 18 percent in a 10-year span from 1997 to 2007.

Pro Tip #1: While most kids outgrow most food allergies, there is one that cannot be outgrown – the peanut. Sadly, peanut allergies are for life.

What Causes an Allergy?

The job of your immune system is to protect your body from foreign invaders – various bacteria, germs, and viruses. A healthy immune system protects the body even in the presence of these invaders.

However, when there is an allergy present, the immune system will mistakenly target and overreact to a threat that doesn't really exist. This results in your immune system attacking a harmless substance that has recently been eaten, inhaled, injected, or come into contact with the skin. And that substance is called an allergen.

An allergen can be introduced to the body a number of times with no trouble. Then, for seemingly no reason, the body one day decides to flag that allergen as a foreign invader, which triggers the body to attack the allergen. And to further complicate matters, the body will remember the allergen and produce specific antibodies that will attack the allergen even more fiercely next time it's introduced into the body.

Pro Tip #2: This is why allergic reactions are often more severe the second or third time – the build-up of antibodies and larger battles.

When the immune system attacks the allergen, high quantities of histamine and other chemicals are released into the surrounding tissues. Depending on the part of the body affected, symptoms can include:

  • Itching
  • Hives and rash
  • Sneezing
  • Wheezing
  • Swelling of the face
  • Runny nose
  • Nausea

There is one particular kind of allergic reaction that can be especially life-threatening – anaphylaxis.

Anaphylaxis is a severe and sudden allergic reaction that affects many parts of the body at the same time within mere minutes of the allergen coming into contact with the body.

Warning: Anaphylaxis can cause the body's blood vessels to suddenly dilate – as in opening all the way up, which can lead to anaphylactic shock. Anaphylactic shock can cause a sudden drop in blood pressure resulting in organs like the brain quickly becoming oxygen starved. Anaphylactic shock will cause death if not treated.

One common and basic treatment for anaphylactic shock is epinephrine (or an epi pen), as it constricts blood vessels and opens the airway, thereby reducing the effects of the allergen.

The most common causes of anaphylaxis are bees and other stinging insects, latex, medications and the following foods:

  • Nuts
  • Fish
  • Shellfish
  • Eggs
  • Milk

The most common cause of severe, life-threatening allergic reactions is by far the peanut.

How to Treat for Allergic Reactions

As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.

"Hi, my name's _____. I'm a paramedic. I'm going to help you."

The first thing you'll want to look for are the signs and symptoms of allergic reactions and anaphylactic shock:

  • Trouble breathing
  • Wheezing
  • Tightness in the throat
  • Itchiness on the tongue
  • Swelling of the face
  • Hives
  • Pale skin
  • Rapid heart rate
  • Low blood pressure
  • Nausea
  • Vomiting
  • Diarrhea
  • Dizziness

How children typically describe an allergic reaction may better help understand some of the signs:

  • It feels like there's hair on your tongue
  • You experience tingling
  • Your mouth itches
  • It feels like something is stuck in your throat
  • Your lips feel tight
  • Your body feels weird all over

Warning: The key element with allergic reactions is time. Don't wait. Call 911 immediately. If available, use an epi pen. But don't wait for symptoms to get better.

The three steps to providing care for allergic reactions are:

  • Recognize the signs early
  • Call EMS or a code if in a healthcare setting
  • Assist the patient with an epi pen if needed

Pro Tip #3: Keep the patient calm. Sit them down. Make sure they're comfortable. To make breathing easier, have the patient sit straight up and lean forward.

If the patient is feeling faint or is losing consciousness, lie them down, elevate their legs, and keep them warm. Talk to them, reassure them, but be prepared to begin CPR if they suddenly stop breathing or become completely unresponsive.

Warning: There is the possibility of a secondary reaction after the first. Which is why the patient should be monitored for four to six hours after the initial allergic reaction.

A Word About how to Know if it's Anaphylaxis?

Depending on the situation, there may be different things to watch out for as you put the puzzle pieces together. Here's a cheat sheet that may help.

Situation #1: You know that the patient has been exposed to an allergen.

What to Look For:

  • Trouble breathing OR
  • Signs and symptoms of shock

Situation #2: You think the patient may have been exposed to an allergen.

What to Look For: Any TWO of the following:

  • A skin reaction
  • Swelling of the face, neck, tongue, or lips
  • Trouble breathing
  • Signs and symptoms of shock
  • Nausea, vomiting, cramping, or diarrhea

Situation #3: You do not know if the patient has been exposed to an allergen.

What to Look For:

  • A skin reaction (such as hives, itchiness or flushing) OR
  • Swelling of the face, neck, tongue, or lips PLUS
  • Trouble breathing OR
  • Signs and symptoms of shock