Episode 14: Allergies and Anaphylaxis

This podcast provides general information and guidance on first aid treatment. It is not a substitute for professional medical advice or certified first aid training. Always seek the advice of a qualified health care professional for any medical concerns, or before making any decision related to your health, or treatment. In a medical emergency, always call for immediate medical help.

Introducing the First Aid Unboxed Podcast Episode on Allergies

Mark:
Hello and welcome to, can you believe it, Episode 14 of the First Aid Unboxed podcast. I am Mark Wakeley, but I am purely the facilitator for the expertise that is Louise Madeley. Good afternoon, Louise.
Louise:
Good afternoon.
Mark:
Right. Okay. Thank you to everybody who has been listening to the podcast. We have had thousands and thousands of downloads. Lots of people have been listening. I hope it has been of some help.
One thing we need to remind you is that if you are concerned about your health, you need to go and see a professional. This is purely advisory and for your information.
Right then, Louise, what are we going to be talking about this week?
Louise:
We are talking about allergies and anaphylaxis in particular.

Personal Allergy Stories: Pets, Hay Fever and Everyday Triggers

Mark:
Okay. Allergies are something very close to my heart. I am allergic to most furry animals in one description or another, and I suffer a bit of hay fever as well.
Louise:
I have noticed.
Mark:
Horses are my worst thing. It is the only time I have ever had to have an injection for it, but that is the worst thing. But we have got a dog, and I am allergic to the dog, so I am probably not unusual. I do know a few people who are allergic to their own pets as well. But then, once you have got them, you cannot get rid of them, can you?
Louise:
Well, no. And Sasha is beautiful
Mark:
Anyway, let us start by just doing a round-up of what it is and what it is doing to you.

What Is an Allergy? Immune System Response Explained

Louise:
Well, firstly, you have got an allergy, and from that you have then got anaphylaxis. So you are talking about hay fever and general allergies and other similar things; that is an allergy.
All an allergy is, at the end of the day, is your body’s immune system having an exaggerated response to a substance, which we call an allergen. In other words, it could be any allergen, it could be any substance. It is just that some people have these severe reactions to them, or an exaggerated response; hence you end up with an allergy.
It is your body’s defence mechanism basically fighting against itself, fighting against your body.
Mark:
So it is your antibodies fighting your body?
Louise:
Yes, in a nutshell.
It is a reaction of your body to a foreign body, in a nutshell.

Pet Allergies and Protein Triggers

Mark:
Okay. So with my pet allergy, or the fur allergy, or whatever: apparently it is a protein in the dander of the animal, in the fur, that I am allergic to. So my body thinks that that is attacking me, yes? So it reacts against that.
Louise:
Whereas my body does not. I have two dogs. I know your dog in particular; she is wonderful, and I do not react to her in the least. However, you do.
As we have said many times on different podcasts, everybody’s body is different, and particularly when it comes to allergens. What is an allergen to one person is not to another.
I did not have an allergen until I was in my early twenties, and I was devastated, because it was to shellfish. I used to love eating prawns and shrimps. I could eat a massive bowl of shrimps in one sitting, quite happily. And then we were away somewhere on holiday, and I had a severe reaction due to my liver being affected. So my liver becomes enlarged if I have had any form of shellfish. Again, you are back to proteins. It is a protein binding in shellfish.

Common Allergy Triggers: Shellfish, Nuts and More

Mark:
There do seem to be some things that people are more allergic to. I do not eat shellfish. I do not eat any fish at all or any meat, because I am a vegetarian. So it seems that shellfish is one of the most common things that people are allergic to, along with things like nuts and things like that. So, you know, or maybe they are just the ones that we hear most about, I do not know.
Louise:
Yes, and there are more severe reactions as well when you are talking about anaphylaxis, because that is what people tend to talk about, or what people know through the news.
Mark:
So yes, those all seem to be quite common ones. But I think maybe we just hear more about them.
And things that you ingest, I assume, are more dangerous than things that are external as well.
Louise:
It depends on the person, and it depends on the reaction. On some occasions, somebody has peanuts, for example, and there have just been peanuts in the vicinity, and somehow that has transferred onto the person, and they have had anaphylaxis from it. Whereas others might have eaten an entire dinner and had a mild reaction to it. So it is all down to how severe the reaction is.

Early Signs of an Allergic Reaction: Symptoms to Watch For

Mark:
What do we need to look out for?
Louise:
When we are talking about allergic reactions, and we are talking about the milder version here, it could be anything from skin reactions, so rashes, hives – which are those itchy welts that you can get on your skin – very sore, very painful.
Mark:
I am very familiar with that.
Louise:
Yes, absolutely. Redness, swelling, especially around the face, lips and eyes.
It could be respiratory symptoms, so sneezing, a runny nose, all the things that you have at this moment in time, bless you: itchy or watery eyes, hay fever-type symptoms. Most people are aware of hay fever and the symptoms that you get with that, or a mild cough.
From a gastrointestinal point of view, it could be stomach cramps, nausea, or a feeling of unease, which is quite common as well.
Again, these are not anaphylactic symptoms. These are symptoms of a milder allergic reaction. It is when the body is saying, “There is a foreign body in me, and I need to react to it.”

Managing Mild Allergies: Avoidance and Antihistamines

Mark:
So we have had a reaction. What is the first thing we need to do?
Louise:
For the milder reactions, you can generally manage it by either avoiding the allergen – unlike Sasha, your puppy dog, where you cannot avoid her – I just wash my hands a lot, to be honest.
Mark:
Yes, exactly.
Louise:
Or using over-the-counter antihistamines. Certainly, as first aiders, it is about being vigilant for any escalation. So when you get a mild allergic reaction, you are then looking to see if that person is developing anaphylaxis.
Generally, people who have allergies are aware of them, more often than not, especially the mild ones, and they will be proactive. They will make sure that they have got their antihistamine spray with them, for example.
And I do highly recommend that anybody with hay fever, when we used to prescribe it, it would be prescribed about a month before the season starts. So whether it is grass pollen or tree pollen, whatever the allergen is that you are reacting to, start taking those antihistamines and start taking that medication. Speak to your general practitioner and have them prescribed about a month before the season is due to start. Try and build up an immunity before it all starts.

Antihistamine Safety: Dosage, Drowsiness and Medical Advice

Mark:
And, you know, can you take too many? Is it a dangerous thing to do, to take antihistamines?
Louise:
You absolutely need to take the prescribed amount. There are prescription-only medications, depending on how severe the reaction is. You can get some over the counter, but always, always speak to your pharmacist. Read the label – all of it. Make sure that you do not give certain ones in certain situations. For example, Piriton (chlorphenamine) can cause drowsiness. So if you are driving, for example, and you are not used to the medication, then you would not want to be taking that.
I took that once for the very first time, and I got onto the sofa and slept for seven hours from taking one Piriton.
Mark:
So it just knocked you out, basically.
Louise:
Out cold.
Mark:
Okay, so read the leaflet absolutely, and be aware of what you are going to be doing that day. So you know that if it is going to make you drowsy, you are not doing something like operating heavy machinery, I think is probably what they usually say, is it not?
So we have taken our antihistamine. What if things continue to deteriorate?

When Allergies Escalate: Risk of Developing Anaphylaxis

Louise:
Well, one of two things is going to happen. Either you have a mild reaction, you take your medication and that reaction reduces – great – or it does not, or it develops into anaphylaxis, or you just get anaphylaxis straightaway.
So just because you have mild reactions does not necessarily mean that it can escalate into, or it will escalate into, anaphylaxis – but it can. You are more likely to go straight into anaphylaxis. That is the problem.
The reason that we say stay away from allergens after you do get mild reactions to certain things is because they can get more severe. You can also become allergic to something at any time in your life. For me, it was in my early twenties, no problem before then. I have known some people a lot older who have suddenly had an anaphylactic reaction to something that, as far as they are aware, they have been around for years. Anaphylaxis can occur at any time.
It is recognising that anaphylaxis, that is the key. Regardless of whether somebody is allergic to certain things or not, if you see those reactions – and they are generally immediate, hence it is anaphylaxis – then you need to react immediately.
Mark:
And what do we need to do?

What Is Anaphylaxis? Definition from the Resuscitation Council

Louise:
According to the Resuscitation Council, when you are talking about anaphylaxis, it is a serious, systemic hypersensitivity reaction. It is not a mild allergy at all.
So, to break that down, what they are actually saying is that it affects several different parts of several different systems.
Mark:
So this is not just sneezing and a runny nose. This is far more severe.

Speed of Anaphylaxis: Why Fast Treatment Matters

Louise:
Absolutely. This is very extreme. It happens immediately. It can happen within seconds. And quite often, you will find that paramedics will say, actually, a bit like we say with choking, they do not necessarily go to choking. They end up where they are either fine, or they have gone straight down to needing cardiopulmonary resuscitation.
It is very similar with anaphylaxis. Getting that treatment into that person, getting an adrenaline auto-injector – which is the EpiPen, or Jext, or whichever make you have got – getting it into them as quickly as possible: usually by the time the paramedic gets there, because the reaction is so severe and so fast, you will find that either they have had their anaphylactic pens and they are in a stage of recovery, or they could well be in the stage of cardiopulmonary resuscitation by the time the paramedics get there.
So it is about getting there as fast as humanly possible, getting that medication into them. That is how quickly we are talking.
So it is a severe, rapidly progressing, potentially life-threatening allergic reaction, as opposed to the allergies that we talk about in the milder sense.
It is immediate. Somebody eats a peanut, for example, and within seconds they will suddenly start to swell. Their lips will swell, they will start to perspire, they become bright red, you know, these sorts of symptoms. I will go into them properly in a minute. But it is about speed. It is always about speed when it comes to anaphylaxis.
Mark:
With my sister, it is walnuts. And even if she just touches her lip, straight away she can feel a tingle immediately. I mean, she obviously keeps away from all that sort of stuff, and none of it is in the house. Ironically, she works in the catering business, but it is one of the things she cannot do. But yes, she keeps away from all that sort of stuff. She is very aware of it. But I know that she will have a reaction immediately.
Louise:
Exactly. That is when you are pretty sure that is anaphylaxis – the fact that they have had it as an immediate reaction. It is not every time, but generally it tends to be almost as soon as that allergen has been processed or has been touched.
Mark:
Okay. What does anaphylactic shock look like?

Signs and Symptoms of Anaphylactic Shock

Louise:
Well, as I said a second ago, the difference is the multiple body systems that are affected. Airway, breathing, circulation can be compromised. These are all different systems.
So what it looks like: as I said before, it appears rapidly after exposure to whatever the allergen may be.
Severe skin reactions: widespread hives, intense itching, significant flushing, sudden paleness, swelling that rapidly worsens, particularly around the face, lips, tongue and throat. Again, we are always talking about a life-threatening condition when we are talking about anaphylaxis.
Breathing difficulties: it could be very severe wheezing, persistent coughing, shortness of breath, a tight feeling in the chest, noisy breathing – we call it stridor. I can do an impression of stridor, but I am not going to on air. I do a quite good one when I am doing first aid courses, obviously, because I have seen stridor on thousands of occasions, unfortunately.
A hoarse voice, so they sound very croaky, and it sounds as though their throat is tight, is the way to describe it. Clearly their airway is compromised if they have got any of these, which again is a crucial sign, particularly in first aid.
Circulatory problems: so they could feel dizzy, light-headed, sudden weakness, a sudden drop in blood pressure, in which case they can collapse or faint. A weak and rapid pulse – I always call it very thready; when you feel it on the wrist, it is very thready. They might appear pale and clammy.
Gastrointestinal symptoms could be severe: nausea, vomiting, intense stomach cramps, sudden diarrhoea – as in, it literally just falls away.
Neurological changes: so a sudden feeling of impending doom – you know how we talked about this before with heart attacks and that sudden feeling of impending doom – confusion, disorientation, loss of consciousness.
Again, all of these require an immediate first aid response. It is life-threatening.
Mark:
And is this your body going into overdrive to try and protect itself from a perceived infection or enemy or whatever it feels?

The Body’s Overreaction: Immune System in Anaphylaxis

Louise:
Exactly. It is the body attacking itself at a massive rate. And if anybody has seen somebody have an anaphylactic reaction and go into anaphylactic shock, you are talking about seconds to a very few minutes that this reaction will occur. It really is astounding and terrifying to watch somebody go through it, especially if it is a loved one.
It is knowing how to switch off that nervous system and let your parasympathetic nervous system take over and do the right thing quickly.
Mark:
So if someone in your presence goes into this anaphylactic shock, what is the best course of action for you to take?

First Aid for Anaphylaxis: Using an EpiPen or Adrenaline Auto-Injector

Louise:
Right. Well, the key is that that person has an EpiPen. I say EpiPen; it is an auto-injector, an adrenaline auto-injector. Adrenaline, otherwise known as epinephrine. Most people have probably heard of an EpiPen – it is actually a brand name EpiPen, the same as we call a vacuum cleaner a Hoover. It is the same concept. They are called adrenaline auto-injectors.
There are three different types, two on the market at the moment. One is called EpiPen, and the other is called Jext, which has it written clearly on it, what it is. Emerade, I believe, is not on the market in the United Kingdom now. So there are only the two.
So, administering adrenaline in a first aid situation:
Firstly, assess the situation as always – Danger, Response, Airway, Breathing, Circulation. So make sure that you are safe at all times. Is the environment safe for you and the casualty? If necessary, move the casualty if you have to.
Locate the auto-injector. Now, generally, people will know exactly where their auto-injectors are, and the second they get that sensation that things are starting to swell, and they are getting that feeling that something has happened, they will be hunting for that auto-injector themselves. Ideally, that person has a bracelet or a necklace or something on them.
Mark:
Yes, that was one of my questions. You can get bracelets with details, cannot you?
Louise:
Yes, you can get bracelets with details, and quite often it will say where to locate the adrenaline auto-injector.
For those who are young and in school, for example, there will be a care plan for anybody with an auto-injector. Schools can now have spare auto-injectors in their schools. And, to be fair, most do have that now.
Mark:
Is it the same drug for all allergies?
Louise:
All allergies, yes. All ages, no. So you get, from our point of view, junior ones and adult ones, which are different.
Mark:
I assume that is about dose size and things like that.
Louise:
Yes. So locate the auto-injector, that is the key.
Call for help. You want 999 or 112 immediately. State that you suspect that it is anaphylaxis and that you do have adrenaline on you, if that is what you have got.
So prepare the auto-injector. Remove the safety cap. Usually, when you get an adrenaline auto-injector, when you get one of these pens, it tends to come with a credit card-sized card which tells you what you need to do on it and how to use it.
It is usually blue or yellow, the cap – it depends on the brand. The EpiPens – what we say as we lift them up is, “Blue to the sky, orange to the thigh.” So the cap is blue; the orange bit is underneath. That is the part that has the needle in it. So it is all ready to go. As soon as you take that cap off, if you push it into the thigh, it will deliver that drug.
Mark:
And is the thigh the place where you should put it?
Louise:
Yes. Always put it into the thigh. If you are administering two, then put it into each thigh: one into one, one into the other. It does not matter which way round.
So remove the safety cap. With the EpiPen it is blue, with the Jext it is yellow. To administer the injection, all you do is lift it up and bring it down into the outer mid-thigh. It can be done through clothing; you do not need to take clothes off for it – straight into the thigh.
Depending on the device, you hold it in place for three to ten seconds. Personally, I just go with keeping it in for ten seconds. You may not register which device it is, whether it is an EpiPen or a Jext. It does not matter. Just hold it in there for between three and ten seconds. I would say hold it for ten seconds, and that is the time it takes for the injection to go into the thigh, and that will administer the correct dose and everything.
Absolutely only ever give that person their own injector. Do not take somebody else’s injector. If somebody says, “Oh, I have got adrenaline here, shove this in,” do not. You do not know if it is an adult or a junior dose; it is not prescribed for that person. And you are a first aider, you are not prescribing medication. You are administering something that comes under Schedule 19, which means it can be given to the person by anybody. That is the key.
So hold it in place for ten seconds. Depending on the instructions, remove it. The needle will retract, but it will also have a safety shield on it. So once you have retracted it, the needle will be inside the device itself, so you cannot then jab yourself with it.
If symptoms improve after the injection, then obviously you are seeking medical advice anyway. The paramedics should be on their way before all of this is done, if humanly possible. If you think that they are looking quite well afterwards, then do not cancel the ambulance. There can be a biphasic reaction, where symptoms can return later on. So the adrenaline seems to have worked, and they are looking a lot better, and they go, “Right, I am off to have my day.” No. They need to be seen by a paramedic. End of story. They have had adrenaline into their system.

How Adrenaline Works in Anaphylactic Shock

Mark:
What does the adrenaline actually do?
Louise:
Adrenaline is there to reduce inflammation. So it literally just shrinks all that inflammation. That is all it is there for. We use it for a lot of different things in medicine, but for anaphylactic shock, the whole point of it is to reduce that swelling.
However, somebody has had an allergen. They have had a reaction to it, a very severe one. It does not mean it is going to last permanently. They could well go into a second reaction, hence the biphasic reaction.
If you feel that they have not reacted well enough and they are still struggling, then you can leave it for about five minutes. If they are still struggling, then you can give them a second. They should have two injectors on them. You can give a second one into the other thigh after about five to ten minutes.
While you are waiting for the ambulance, position the casualty. Help them to lie down flat with their legs raised. If the face is pale, raise the tail – if they are conscious and breathing comfortably. Obviously, that just helps the blood flow to the vital organs better.
If they are having breathing difficulties, you can put them in a semi-sitting position that will help; just prop them up against a pillow, a wall, anything that just lifts them up so that they can breathe better.
If they become unconscious but they are still breathing, place them into the recovery position to maintain the open airway. We are back to the basics of Airway, Breathing, Circulation – Danger, Response, Airway, Breathing, Circulation.
If you see any visible stingers – so my mother, for example, is allergic to wasp stings – if you can see that there is a wasp sting in there, use a credit card; it is the best thing just to try and get that sting out. You just brush it against the skin and pull that sting out. You do not want the allergen to remain inside them.
So, any visible stingers that you can see, remove them like that. Never squeeze them. It is instinct for people to want to squeeze when they see blood appear and so on. Do not do that. All it will do is release more venom.
Do not let them stand or walk, even if they are feeling better. That can suddenly reduce their blood pressure and they will end up back where they started, on the floor.
And always be prepared to administer a second dose of adrenaline, if they have a second injector on them – they should do. But give them five or ten minutes; if there is no improvement, then most certainly give them a second dose.
Really, it is about prevention and preparedness. If we know somebody has severe allergies as well – we have somebody at my son’s school who has a peanut allergy – nobody brings nuts into school at all. It is as simple as that. There is just a blanket rule: do not bring peanuts or anything associated with peanuts into school. And everybody adheres to it.
Mark:
Yes, when you read often on food ingredients, and it says, “This was prepared in a factory where there are nuts,”
Louise:
That can be enough for somebody to have an anaphylaxis reaction and go into anaphylactic shock – just the fact that peanuts have been in the surrounding area while something else has been made. That can be enough.
Mark:
I do not think I could cope if I was allergic to peanuts.
Louise:
Me either. I love peanuts.
Mark:
Exactly.

Preventing Anaphylaxis: Preparedness, Pens and Medical Alert Jewellery

Louise:
Yes, prevention and preparedness is what it is about really. Make sure that that person carries their prescribed adrenaline auto-injectors at all times. Regularly check the expiry dates as well. Replace them promptly. Make sure that before they are due to expire you have gone to the general practitioner and got a new one.
Encouraging – we were saying before about jewellery – medical alert jewellery, so that people know what you are allergic to and where you keep your pen, in particular. And familiarise yourself with the emergency action plan.
So if you know that somebody is coming to your house and they have these severe reactions and anaphylaxis and they have adrenaline auto-injectors, ask them if you can just have a look at their emergency action plan, just in case anything does happen, especially for children when it comes to schools or carers, caregivers, nurseries and so on.
And avoiding known triggers: you can always mitigate – we have talked about this a lot. You can mitigate as much as you like, but things happen and the risk is there.
It is important to differentiate as well: not all rashes or breathing difficulties are anaphylaxis. However, if you are in any doubt whatsoever, or symptoms are worsening rapidly, always treat it as a medical emergency. Call 999. Always be safe rather than sorry, every time. If in doubt, you are phoning 999 for further advice.
Mark:
And I will say that about all the things we talk about on these podcasts. You know, we are having a discussion about this. Louise is a trained professional and has been most of her life, but this is not a substitute for your doctor’s appointment or calling 999, so please keep that in mind when listening to the podcasts – and getting certified by doing a proper first aid qualification as well.

First Aid Training: Learning to Use Auto-Injectors Safely

Louise:
This needs to be done properly, face to face, and you must be shown how to use an auto-injector correctly.
Mark:
And is this something you teach in your first aid courses?
Louise:
It is not necessarily in every first aid course as part of the syllabus. I teach it in every single one. It is too important, especially at this time of year, but just in general. The more people who know and are comfortable to hold and play with a trainer…
If anybody has auto-injectors, you can go on to both the EpiPen and the Jext websites and you can have a trainer as well; it is free. So you can get these trainers online through the website for both Jext and EpiPen. They are free of charge. They will send you a trainer, and you can practise with it as many times as you like. It is one of those rechargeable ones without the needle in it. You just press a button and you can use it again and again and again and practise – and show everybody who knows you, anybody that is likely to be in contact with you. Show them how to use these pens.
And if in doubt, call 999.
Mark:
Absolutely. Okay, as usual at the end of these discussions, we will have a few takeaways from this. So what have we got for today then, Louise?

Allergy and Anaphylaxis Do’s and Don’ts: Key Takeaways

Louise:
Okay, very simply, do’s and do not's.
Here are the do’s:
Avoid the food, medicine or thing that you are allergic to. So if you have a food allergy, check food labels carefully. Tell staff at restaurants and cafes about your allergy. Most cafes now, or they certainly should, carry allergen information.
Mark:
I think it is a legal requirement now, is it not?
Louise:
I think so. Yes, I am hoping so, but I think you are right.
So always declare if you have any allergy to anything.
Always carry two adrenaline auto-injectors with you at all times. All times – including, “I am just popping down to the shops.” Always carry them with you.
Check your adrenaline auto-injector for expiry dates regularly. Get new ones before they expire. Put it into your digital diary, or whatever you use. Make sure that you get new ones before they expire.
Practise how to use your auto-injector by using a trainer injector, as I was saying before. It is just an injector that has no needle or medicine in it, and you can reprime it again and again and use it as many times as you like.
Teach your friends, family and colleagues, or carers, whomever, how and when to use your adrenaline auto-injector. Use it if you think that you may have anaphylaxis, even if your symptoms are mild.
Wear medical alert jewellery, such as a bracelet with information about your allergy. This just tells people – and I say the same about anybody who has epilepsy as well. Make sure you have these things on you, because you want people to do the right thing at the right time and quickly.
Do not leave your adrenaline auto-injectors anywhere too hot or cold, such as in the fridge or outside in the sun. It does not belong in hot temperatures and cold temperatures. Otherwise your adrenaline may not work the way you want it to when you need it to.
And obviously, for more information, do speak to your pharmacist, your general practitioner. You may have an allergy specialist nurse and doctor to talk to, but make sure you get the right information.

How to Contact the First Aid Expert and Find Courses

Mark:
Okay. So thank you, Louise, for that information. As I said, I have learned stuff, like I always do in these conversations as well.
If people want to get in contact with you to ask you any more questions, what is the best way to do that?
Louise:
You can go to my website: madeleysfirstaidplus.co.uk, or email me at enquiries@madeleysfirstaidplus.co.uk

Mark: This is a 1386 audio production.
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Connect with Madeley's First Aid Plus:
• Website: www.madeleysfirstaplus.co.uk
• Email: enquiries@madeleysfirstaplus.co.uk
• Phone: 01952 727 007
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Stay Tuned for Episode 15 Next week, we'll delve into Fractures And Broken Bones.

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