Guide to Treating an Allergic Reaction

by Dr. Mary Williams, R.N. D.C.

Allergens are a daily part of life. They can be in the air around you, your home, your food, even when you stop smell the roses. What is not as common is how to handle these allergens when they get in proximity to someone sensitive to them. Allergic reactions can range from a runny nose to anaphylaxis, and it is important to know what sort of first aid to do in each situation, especially to prevent exacerbating the situation. Knowing what to look for, or what the common allergens are can help when trying to identify the allergen affecting the person.

There are many different kinds of allergens, and the sensitivities that they cause can happen if they come into contact by swallowing, ingestion or breathing into the lungs, gastrointestinal tract, respiratory tract, skin, nose or eyes. The most common allergens can be any of the following:

• Animal dander
• Foods (particularly nuts, shellfish and fish)
• Bee (or other insect) stings
• Dust Mites
• Insect bites
• Plants
• Molds
• Pollen

There are other allergies, such as to medications and vaccinations that are found less commonly. Most severe reactions happen within seconds to minutes after exposure to the allergen occurs. However, some can happen after hours, most commonly if the allergen is eaten, and in rare occasions, the reaction can happen after 24 hours. Allergies appear more often in families with a history of allergies, but the allergies that are inherited through the family are not always the same.

Reactions

The first time an allergic reaction occurs, the reaction may be very mild. Afterwards, however, repeated exposure can lead to more serious reactions. After the initial exposure and reaction, even the smallest amount of exposure to the allergen can initiate a severe reaction. As mentioned above, reactions can range from mild, which would be a runny nose or watery eyes to severe and life-threatening. Reactions can occur in one section of the human body or they can cover the whole body. Anaphylactic shock, otherwise known as anaphylaxis, is the most severe reaction that can happen as a result of allergies. It is so severe that medical attention is required, and if it is not treated immediately can lead to death within 15 minutes.

Signs of a mild allergic reaction include:

• Hives (particularly the face and neck)
• Itching
• Rashes
• Nasal congestion
• Watery, red eyes

Signs of a moderate allergic reaction include:

• Abdominal pain
• Anxiety
• Abnormal or high-pitched breathing sounds
• Diarrhea
• Coughing
• Flushing or redness of the face
• Swelling of the face, eyes, or tongue
• Chest discomfort or tightness
• Wheezing
• Difficulty breathing or swallowing
• Dizziness
• Unconsciousness
• Palpitations
• Nausea or Vomiting

First Aid

Whenever an allergic reaction occurs, first aid should be applied. When a reaction of mild or moderate nature occurs, similar steps learned during first aid certification can be followed.

1. Calm and reassure the person having the allergic reaction, as anxiety can exacerbate symptoms.
2. Identify the type of allergen and help the person avoid having further contact with it. For example, if the allergen is from a bee sting, scrape the area to remove the stinger instead of using tweezers. Using tweezers would result in squeezing the stinger allowing more venom to leak out.
3. If an itchy rash develops, a cold compress used in combination with an over-the-counter hydrocortisone cream helps.
4. Continue to monitor the person for increasing distress, then get medical help, as mild reactions still may result in the health care provider recommending an over-the-counter antihistamine.

 

Severe reactions follow slightly different, and more imperative guidelines.

1. Check the person's ABC's of basic life support (airway, breathing, and circulation) immediately. A hoarse or whispered voice is a warning sign of a dangerously swelling throat, as well as coarse sounds when the person is breathing in air.
2. If necessary, begin performing CPR.
3. Call 911 immediately
4. Calm and reassure the person having the allergic reaction.
5. Check for the cause of the reaction, if there is a stinger, see above #2.
6. If the person has their prescribed emergency allergy medication available, assist the person in injecting themselves or taking the medication, but avoid oral medication if the person is exhibiting signs of trouble breathing.
7. Begin steps to avoid the onset of shock. Help the person to life flat and raise their feet about 12 inches from the ground. Then cover them with a blanket or coat. Avoid moving the person if a neck, back, head, or leg injury is suspected or if more discomfort is caused.

 

Even if the person having the allergic reaction has their emergency medication, medical attention should still be received, as they do not always cause complete protection. Also, never perform CPR if you are not certified, as you can make the situation worse if not performed correctly. CPR is meant to keep blood flowing throughout the body. If a person has a known allergy, make sure that it is understood. Those who are susceptible to severe reactions are given ID bracelets to wear at all times as warning. Make sure to avoid foods or medications that can trigger an allergic reaction, and be sure to ask detailed questions about ingredients in meals when eating away from home and to check ingredient labels when eating at home. For young children with food allergies, introduce new foods one at a time in small amounts so you can recognize an allergic reaction, as young children may not be able to inform you what is happening. Even schools have forms and parent provided medicine on hand for its students informing of such allergies. The best way to react to a reaction is with speed and calm. Always be aware of the allergies around you and if emergency medication is needed should the situation arise.

For more information, see the links below.

Acute Hypersensitivity Reactions: What Nurses Need to Know
Allergy/Anaphylaxis Action Plan (pdf)
Allergens
Allergen Policy
Allergic Reactions (pdf)
Allergic reactions
Allergic Reactions - UMD
Bee Stings / Safety
Emergency Treatment for Vaccine Reactions (pdf)
Experts Urge Quick Use of Epinephrine for Severe Allergic Reactions
Food Allergies in Schools
Food Allergies: What You Need to Know
Guidelines for Care of Students with Anaphylaxis (pdf)
Latex Allergy - Information for Health Professionals
Pollen and Outdoor Allergies
Preventing Anaphylaxis in School (pdf)
Treatment of Severe Allergic Reaction (pdf)
World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis (pdf)