Anaphylaxis Prevention

How Do You Prevent Anaphylaxis?

  • An established anaphylaxis Emergency Action Plan (EAP):
    • Contact information
      • Names and phone numbers, including family members to be contacted in an emergency
    • Details allergies/known trigger factors
    • Generic and proprietary names of drugs and possible cross-sensitivities to drugs, if relevant
    • Recognize the signs and symptoms of mild, moderate and severe allergic reactions
    • Treatment medication prescribed and when it should be used
    • Clear statement of the need to administer adrenaline
    • When to call emergency services
    • Where medication is stored at home, in school, or workplace
    • Review dates for prescribed medication if appropriate, e.g. when child reaches 30 kg in weight or expiration dates
    • Number of injectable adrenaline devices (e.g. Epipens) required
    • Who is trained to administer medication in home, school, workplace
    • Knowledge of the use of epinephrine auto injectors
  • Understand of the importance of epinephrine auto injectors
  • Be aware of which athletes who have allergies and need or use Epi-pens
  • Inform the correct personnel (e.g. coaches, assistants) of athletes with allergies and their triggers
  • Have athletes avoid triggers (e.g. foods, medications, insects, cold air)
  • Epi-pens should be carried at all times by those with a known life-threatening allergy
  • Be aware of athletes that have experienced an anaphylactic reaction in the past
    • Advise them to see an allergist for testing and education if need be
  • Those at risk for anaphylaxis should wear or hold medical identification

Common anaphylaxis mechanisms and triggers include the following categories and examples:

  • Foods (i.e., nuts, shellfish, fish, milk, egg, etc)
  • Venoms (i.e., stinging insects)
  • Medications (i.e., NSAIDs)
  • Rubber latex
  • Radiocontrast media
  • Physical factors (i.e., exercise, cold, heat, sunlight, emotional stress)
  • Ethanol (i.e., wine, beer)
Woman having her legs examined

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:

  • Pregnant women (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 other conditions could this be?

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

Anaphylaxis Treatment

Treatment of Anaphylaxis:

  • Check for ABC’s (airway, breathing, circulation)
  • Activate Emergency Medical Services (EMS)
  • Remove triggers
  • Administer epinephrine if qualified to do so.  (Depending on the severity, a second dose may be needed, and can be repeated every 5-15 minutes, if needed)
  • Place patient in comfortable position [on their back (or a reclined seated position if breathing is labored) , elevate the lower extremities]
  • Monitor vitals until advanced medical personnel arrives
  • Send Epi-pen with EMS

Recommended Equipment List

  • Epi-pen
  • Phone
  • Benadryl
  • Ice
  • Blood pressure cuff and stethoscope
  • Wrist watch to take pulse
  • CPR mask/bag-valve mask
  • Supplemental oxygen
  • Emergency Airway Kit
  • Automated external defibrillator (AED)
  • Emergency contact cards

Anaphylaxis Return-to-play

Individual Return to Activity:

Follow up with primary care physician and seek out clearance prior to return to play

  • Gradual and individualized return to play under the guidance of a physician or medical care provider
  • Make sure an Epi-pen is available on site
  • Ensure athlete has medical identification if new allergy was discovered
  • See allergy specialist about 3-4 weeks after episode to determine specific anaphylaxis triggers (if unknown)

Anaphylaxis Resources


American Academy of Allergy, Asthma and Immunology

American College of Allergy, Asthma and Immunology

Epipen Epinephrine Auto-Injector

Auvi-q Epinephrine Auto-Injector

Food Allergy Research and Education


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