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“There is no cure for anaphylaxis, so strict avoidance of triggers is the only way to keep a severe reaction from occurring,” said Anne Muñoz-Furlong, Founder & CEO of FAAN. “For children with severe allergies, even a small exposure can lead to anaphylaxis.” The most common triggers for anaphylaxis are:

* Foods - Any food can trigger an allergic reaction, but the most common are: peanuts, nuts from trees (e.g., walnut, cashew, and Brazil nut), shellfish, fish, milk and eggs. It is important to talk to cafeteria staff and your child about what foods to avoid and not to trade food with other children.
* Stinging Insects - Venom of stinging insects such as yellow jackets, honeybees, paper wasps, hornets and fire ants can cause severe and deadly reactions. Recess exposes children to stinging insects. Teach your child where they are commonly located and how to avoid them.
* Medications - Any medication can trigger a reaction, but the most common drugs that cause anaphylaxis are antibiotics and anti-seizure medications. The school nurse should be aware of what medications your child is allergic to and should have epinephrine available in case of a severe reaction.
* Latex - Products made from natural latex (from the rubber tree) contain allergens that can trigger reactions in sensitive individuals. Inspect the toys in your child’s classroom and inform their teacher about this allergy.
* Exercise - Although rare, exercise can trigger anaphylaxis after eating certain foods before beginning the activity. Inform your child’s physical education teacher of this allergy, and check to see if your child can participate in physical activity before the lunch hour.

“For students, studies show that the most severe allergic reactions, especially to food, occur in the classroom,” said Munoz-Furlong. “Parents, school administrators, teachers, and the school nurse need to develop an action plan before the school year begins to keep these students with allergies safe.”

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AAAAI and FAAN educate about dangers of anaphylaxis

With the upcoming school year approaching, the American Academy of Allergy, Asthma and Immunology (AAAAI) and the Food Allergy & Anaphylaxis Network (FAAN) are asking every parent of a child with food allergies or a known insect sting allergy to alert their child’s school to the condition and have an action plan ready.

A potentially life-threatening allergic reaction, called anaphylaxis, can be triggered by exposure to one or more allergens, including foods, insect stings, drugs, and latex products. Anaphylaxis can affect multiple areas of the body (such as skin, respiratory tract, gastrointestinal tract and the cardiovascular system). Symptoms can include severe headache, nausea and vomiting, sneezing and coughing, hives, swelling of the lips, tongue and throat, itching all over the body, and anxiety. The most dangerous symptoms include difficulty breathing, a drop in blood pressure, and shock - all of which can be fatal.

“All school staff must be made aware of the potentially severe nature of an anaphylactic reaction,” said S. Allan Bock , MD , FAAAAI, and Chair of the AAAAI’s Anaphylaxis Committee. “Parents need to work together with teachers, coaches and school nurses to avoid triggers and act quickly if a reaction occurs.”

To protect your child, and prevent anaphylaxis, the AAAAI and FAAN encourage parents to take the following steps before the school year begins:

* Work with an allergist/immunologist to identify your child’s triggers and reinforce these to your child. If possible, provide your child with a medical bracelet or necklace that identifies his or her specific allergy.
* Tour your child’s school or childcare facility before school starts, and meet with the staff to inquire about policies regarding foods and other potential triggers brought into the classroom.
* Provide staff with information and resources to educate them about your child’s allergy. Have your child’s allergist/immunologist provide clear, written instructions on recognizing a reaction early and administering medication in case of a reaction. Inform staff to call 911 immediately if a reaction occurs.
* Teach staff when and how to properly administer medications such as injectable epinephrine, encouraging them to handle the medication and ask questions. Explain to them that they cannot delay in administering medication to your child, and that they are obligated to assist your child and to include him or her in normal school activities. Children with a history of anaphylaxis should carry epinephrine with them at all times.

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The existence of IgE antibodies is common to all forms of allergic disease. But the physical symptoms differ depending on the type of mediator released and where they act. When a person with allergies begins to experience symptoms, key questions are: What allergens am I reacting to? When, and how much, am I exposed to these substances?

Major allergic diseases include:

* Allergic rhinitis, or “hay fever”
* Allergic conjunctivitis (an eye reaction)
* Asthma
* Atopic dermatitis, or allergic skin reactions
* Urticaria, also known as hives
* Severe allergic reactions to substances such as food, latex, medications, and insect stings
* Problems commonly resulting from allergic rhinitis—sinusitis and otitis media (ear infections)

Symptoms of allergic rhinitis, commonly referred to as “hay fever,” occur when allergens touch the lining of the nose—called the mucus membranes—of a person who is sensitive to that particular allergen. Allergic rhinitis is characterized by congestion, itching and dripping of the nose and itchy, watery eyes. If the person continues to have daily, ongoing exposure to the responsible allergen(s), the symptoms will continue. Similar to allergic rhinitis, allergic conjunctivitis occurs when the eyes react to allergens with symptoms of reddening, itching and swelling.

Symptoms of atopic dermatitis, also called eczema, often result from allergen exposure to the skin. Dermatitis symptoms include itching, reddening, and flaking or peeling of the skin. Symptoms begin in childhood for 80% of those with atopic dermatitis. Dermatitis often precedes other allergic disorders; over 50% of those with atopic dermatitis also develop asthma.

Urticaria, or hives, another allergic skin reaction, is characterized by itchy red bumps that can occur in clumps and be either large or small. Hives are often triggered by infection, certain foods or medications. Foods commonly associated with hives include nuts, tomatoes, shellfish and berries. Medications include penicillin, sulfa, anti-seizure medications, phenobarbital and aspirin.

Asthma is a chronic lung disease that affects more than 17 million Americans and is characterized by coughing, chest tightness, shortness of breath and wheezing. Allergic rhinitis is considered a risk factor in developing asthma: up to 78% of those with asthma also have allergic rhinitis.

When an individual experiences asthma symptoms, the inflamed airways become constricted so it becomes more difficult to breathe through the narrowed air passages. For people with allergies, inhaling allergens may produce increased inflammation of the airway lining and further narrowing of the air passages. Asthma may also occur as a result of other stimuli, such as respiratory tract infections or exposure to irritants.

Individuals who have allergies to specific foods may have severe and possibly life-threatening reactions if they eat them. The most common food allergy triggers are the proteins in cow’s milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts. Food allergy occurs more frequently in children than adults. Many of these children may lose their sensitivity to particular foods over time.

Foods and other allergens, including penicillin, insect stings and latex, can trigger a severe, systemic allergic reaction called anaphylaxis. Anaphylaxis is caused by swelling throughout the body, and can involve several organ systems. Symptoms of anaphylaxis include a feeling of warmth, flushing, tingling in the mouth or a red, itchy rash. Other symptoms may include feelings of light-headedness, shortness of breath, severe sneezing, anxiety, stomach or uterine cramps, and/or vomiting and diarrhea. In severe cases, patients may experience a drop in blood pressure that results in a loss of consciousness and shock. Without immediate treatment with an injection of epinephrine (adrenalin), anaphylaxis may be fatal.

Sinusitis and otitis media are other common allergic diseases that often are triggered by allergic rhinitis. Sinusitis is an acute or chronic inflammation of the nasal sinuses, which are hollow cavities within the cheek bones found around the eyes and behind the nose. This condition affects over 15% of the U.S. population. Otitis media—or ear infections—is the most common childhood disease requiring physician care. If not properly treated, it can affect a child’s speech and language development.

You can learn more about various allergic diseases by reading the appropriate Tips brochures in this series.

Diagnosing and treating allergic reactions

An allergist is best qualified to treat allergic diseases. To determine if you have an allergy, your allergist will take a thorough medical history and perform an exam. If indicated, he or she will then perform allergy skin testing, or sometimes blood testing, to determine precisely which substance is causing your allergy. Once your allergy triggers are identified, your physician can help you establish a treatment program. The first step is to minimize your exposure to your particular allergens to whatever extent possible. Your physician may also prescribe medications to reduce allergic symptoms as well as inflammation.

Immunotherapy, also known as allergy shots, may also be recommended to modify your immune response. For many patients, immunotherapy can help diminish their reactions to allergens. Please see the Tip brochure in this series for more information on allergy shots.

In summary, an allergic reaction is a complex chain of events that involves many cells, chemicals and tissues throughout the body. While there is not yet a cure for allergic disease, there are many treatments available to lessen symptoms. See your allergist to determine the best course of treatment.

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