We've all seen the movies where someone has an allergic reaction to something and the next minute their face resembles an itchy overblown pizza. (Will Smith in 'Hitch', we're looking at you.)
While for some this may be comedy gold, allergic reactions such as these are actually on the less serious side of the allergy spectrum (though that's not saying they aren't worth medical attention.) For those with anaphylaxis, however, symptoms can be far, far worse than an unbecoming blotchy face. It could mean death.
So here's the million dollar question. If you were in a situation where someone went into anaphylactic shock -- would you a) recognise it for what it was and, b) actually know what to do? (First clue: CALL THE AMBULANCE.)
"There are definitely signs and symptoms that will alert you to something severe happening, as opposed to just, say, typical reaction to too much orange juice," Maria Said, President of Allergy & Anaphylaxis Australia, told The Huffington Post Australia.
"What you're looking for is signs of breathing difficulty, if they start coughing persistently or wheeze, if their voice sounds different, or they complain that they can’t breathe.
"Another sign is swelling of the throat or tongue. It can be sometimes be visible, sometimes not, but they might complain their throat feels really tight or that they can’t breathe.
"You might see that their tongue is swelling, or they are drooling because they can’t swallow their saliva. Basically any sign or symptom to do with respiratory system, or anything to do with heart or blood pressure is a major red flag.
"Of course, you can't really look at someone and say 'gee he has really low blood pressure,' but look for signs that they are pale or look as if they are about to faint. That could indicate something is not right with someone's cardiovascular system."
Said notes while hives or breaking out into a rash might be unpleasant to look at, this doesn't necessarily indicate the person is going into anaphylactic shock.
"We've all seen the graphics of children covered in hives or with really swollen lips," Said said. "At the end of the day, if they don’t have any breathing difficulty or don’t feel faint, dizzy or are showing any signs of collapsing -- basically any signs of the heart or respiratory systems being involved -- it's not classified as a severe allergic reaction. It's actually classified as mild to moderate.
"If, however, they have a swollen tongue, that’s anaphylaxis. Even if it's the only thing they exhibit."
Assuming the worst happens and someone has indeed gone into anaphylactic shock, what can you do to help?
"The first step is to lie the person down. Don’t let them stand up or walk," Said said.
"If they are having difficulty breathing, let them sit on the ground with their legs out in front of them.
"If they are carrying an EpiPen or you have access to one, administer it following the instructions on the plan, then immediately call an ambulance.
"Try to keep the person calm. If after five minutes, their condition hasn’t improved or continues to worsen, give a second dose of the EpiPen if available."
Said also suggests if lying the person on the ground, to put their feet up on a box or chair. If they are vomiting, allow them to lie on their side. Those with breathing difficulties should not lie down at all, but sit on the ground.
For those who are completely freaked out by the thought of administering an EpiPen, don't go all 'Pulp Fiction' and start stabbing anyone in the heart.
"Try not to make it too dramatic," Said said. "An EpiPen should always should be given to the outer mid-thigh. With the EpiPen, there's a blue end and an orange end, and there's a simple rhyme to help you remember which way to hold it: 'blue to the sky, orange to the thigh.'
"Keep your fist around the device and keep fingers away from either end, then place it to the mid-outer aspect of the thigh and push.
"The important thing is for people [who know they have severe allergies] to practice using a training device. You can purchase one for a low price and while they contain no needle and no medication, if they practice three times a year in line with the steps on the device itself, they are going to be better prepared in an emergency situation."
While there is no surefire way to test whether you are susceptible to anaphylaxis or not (Said notes unfortunately, skin-prick tests can come back with false positive results, causing a person to avoid a certain food for no good reason) there is a familial tendency to pass down the allergic gene.
This isn't to say the 'allergic gene' means anapyhlaxis -- it could be passed down in the form of hay fever or eczema, for example -- but it could increase your likelihood of developing allergies in general.
In terms of what factors are most likely to cause an anaphylatic episode, the most common triggers are listed below.
- Peanuts and tree nuts (particularly almond, walnut, hazel, Brazil, and cashew nuts)
- Fish and shellfish, especially shrimp and lobster
- Dairy products
- Insect bites and stings, mainly those from wasps, bees, and ants