Anaphylaxis Recognition

Look for these symptoms in athletes when anaphylaxis is suspected:

Anaphylaxis should be suspected when any of these three criteria are fulfilled:

1.     Quick onset of illness which involves changes to the skin, mucosal tissue (such as the eyes/mouth etc) or both with at least one of the following:

a.     Breathing difficulty or breathing complications

b.     Reduced blood pressure

2.     Two or more of the following occurs rapidly after an exposure to a suspected allergen:

a.     Any of the items listed in point 1

b.     Persistent gastrointestinal symptoms

3.     Reduced blood pressure after exposure to a known allergen for that person

 

Other signs and symptoms include:

  • Sudden and rapid onset of signs and symptoms
  • Breathing complications: wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, trouble swallowing, itchy mouth/throat, nasal stuffiness/congestion
  • Circulation compromise: pale/blue color, low pulse, dizziness, lightheadedness/passing out, low blood pressure, shock, loss of consciousness, chest pain, fast beating heart
  • Skin reaction (present in 80-90% of all cases): hives, pain/cramps, vomiting, diarrhea
  • Other: anxiety, feeling of impending doom, itchy/red/watery eyes, headache

 

Special populations

There are some special populations or phases that may put certain individuals more at risk for anaphylaxis.  These include but are not limited to:

  • Pregnancy (specifically during labor and delivery)
  • Teens (due to potential for risk-taking behaviors)
  • Middle aged and elderly populations with known or subclinical cardiovascular disease (largely due to the medications used to treat these diseases)

 

How do you know if this is anaphylaxis?

In the hospital, anaphylaxis is diagnosed using the three qualifying criteria options listed above.  Laboratory tests may also examine total tryptase levels as well as histamine levels to confirm diagnosis.  Depending on the cause of the anaphylactic reaction, times from exposure to cardiac arrest were: 5 minutes for a diagnostic or therapeutic intervention, 15 minutes after an insect sting, and 30 minutes after food ingestion.

On the field, anaphylaxis is recognized as a disruption in breathing directly caused by a trigger or allergen.  Field recognition hinges on knowing that the athlete has an allergy before the reaction ever happens.  In some cases, anaphylaxis may mimic an asthma attack, which highlights the importance of having important patient information available at all times.

What else could this be?

  • Asthma attack (life threatening)
  • Septic shock
  • Anxiety attack
  • Fainting episode
  • Unknown cause for skin irritation/reaction