Which of the following is the single best answer with regard to anaphylaxis?

Symptoms

The first signs of an anaphylactic reaction may look like typical allergy symptoms: a runny nose or a skin rash. But within about 30 minutes, more serious signs appear.

There is usually more than one of these:

• Coughing; wheezing; and pain, itching, or tightness in your chest
• Fainting, dizziness, confusion, or weakness
• Hives; a rash; and itchy, swollen, or red skin
• Runny or stuffy nose and sneezing
• Shortness of breath or trouble breathing and rapid heartbeat
• Swollen or itchy lips or tongue
• Swollen or itchy throat, hoarse voice, trouble swallowing, tightness in your throat
• Vomiting, diarrhea, or cramps
• Weak pulse, paleness

Some people also remember feeling a "sense of doom” right before the attack.

Symptoms can move to shock and loss of consciousness.

As many as 1 out of every 5 people may have a second anaphylactic reaction within 12 hours of the first. This is called a biphasic anaphylaxis.
 

Treatment

Epinephrine is the most effective treatment for anaphylaxis, and the shot should be given right away (usually in the thigh). If you’ve had an anaphylaxis reaction before, you should carry at least two doses of epinephrine with you at all times.

Epinephrine expires after about a year, so make sure your prescription is up to date. If you have an anaphylactic reaction and the pen has expired, take the shot anyway.

When medical personnel arrive, they may give you more epinephrine. If you’re not able to breathe, they may put a tube down your mouth or nose to help. If this doesn’t work, they might do a kind of surgery called a tracheostomy that puts the tube directly into your windpipe.

Either in the ambulance or at the hospital, you may need fluids and medications to help you breathe. If the symptoms don't go away, doctors may also give you antihistamines and steroids.

You probably will need to stay in the emergency room for several hours to make sure you don't have a second reaction.

After the initial emergency is over, see an allergy specialist, especially if you don't know what caused the reaction.

Causes

Anaphylaxis happens when you have an antibody, something that usually fights infection, that overreacts to something harmless like food. It might not happen the first time you come in contact with the trigger, but it can develop over time.

In children, the most common cause is food. For adults, the main cause is medication.

Typical food triggers for children are:

• Peanuts
• Shellfish
• Fish
• Milk
• Eggs
• Soy
• Wheat

Common food triggers for adults are:

• Shellfish
• Tree nuts (walnuts, hazel nuts, cashews, pistachios, pine nuts, and almonds)
• Peanuts

Some people are so sensitive that even the smell of the food can trigger a reaction. Some are also allergic to certain preservatives in food.

Common medication triggers are:

• Penicillin (more often following a shot rather than a pill)
• Muscle relaxants like the ones used for anesthesia
• Aspirin, ibuprofen, and other NSAIDs (nonsteroidal anti-inflammatory drugs)
• Anti-seizure medications

Anaphylaxis also can be triggered by a few other things. But these aren’t as common:

• Pollen, such as ragweed, grass, and tree pollen
• Stings or bites from bees, wasps, yellow jackets, hornets, and fire ants
• Latex, found in hospital gloves, balloons, and rubber bands

Some people can have an anaphylactic reaction if they breathe in latex.

Some can have a reaction to a combination of things:

• Breathe in birch pollen and eat apple, raw potato, carrots, celery, or hazelnut
• Breathe in mugwort pollen and eat celery, apples, peanuts, or kiwi
• Breathe in ragweed pollen and eat melons or bananas
• Touch latex and eat papaya, chestnuts, or kiwi

In rare cases, it can be triggered by 2 to 4 hours of exercise after eating certain foods or by exercise on its own.

Anaphylactic reactions usually start within minutes of contact with the trigger, but they can also happen an hour or more later.

Some people never figure out what caused their reactions. That’s known as idiopathic anaphylaxis. If you don’t know your triggers, you can’t avoid them. So it’s especially important to carry epinephrine injectors, make sure you and people close to you know how to use them, and wear medical alert jewelry.