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Allergic Rashes, Reactions and Anaphylaxis
Percentagewise, allergic reactions of varying severity account for a significant portion of emergency room visits. Patients can have allergic reactions to a wide variety of substances: foods, cosmetics, lotions, plants, pollens, animal danders, medications, bee stings, ant bites, injectable radiopaque contrast material, and even the fabric softener or detergent used on clothes. It cannot be overstated that we are all exposed to a great number of potential allergens daily. Some individuals will suffer from "hives." This refers to an itchy skin rash, characterized by welt-like eruptions on the skin. Hives can be triggered by exercise, heat, cold, stress, and exposure to any number of potential allergens.
Symptoms of an allergic reaction can range from mild itching, to a full state of shock (low blood pressure), that if left untreated, can result in death. There are a number of clinical manifestations for allergic reactions.
SYMPTOMS AND FINDINGS OF ALLERGIC REACTIONS
1. BODY RASH OR "HIVES" (URTICARIA)
2. FACIAL, LIP, OR EYELID SWELLING
3. TONGUE AND VOCAL CORD SWELLING
4. ASTHMA-LIKE WHEEZING AND SHORTNESS OF BREATH
5. RAPID DROP IN BLOOD PRESSURE AND SHOCK (ANAPHYLAXIS)
Obviously one will not experience every one of these symptoms, but patients tend to fit into one of these 5 categories. Evaluation will include a patient history to determine any potential exposures to unusual foods, exposures to pet or insect bites, or use of any new medication. Skin tests may be helpful later but are not used during the reaction. Breathing problems may warrant a chest x-ray. Treatment is with antihistamines (i.e. Benadryl) and adrenalin shots where appropriate. Steroid medications (methylprednisolone) may be given intravenously to the victim of a more serious allergic reaction. Repeat doses of medications are frequently necessary when dealing with a food allergy. Longer acting antihistamines (Seldane, Hismanal, Atarax) are useful for the longer term management of allergic symptoms. Anaphylaxis, the most severe form of allergic reaction, will require IV antihistamines (and epinephrine) and blood pressure support with IV fluids. Mild urticaria (hives) can be treated safely with an antihistamine (Benadryl) and a skin cream (i.e. Caladryl or Calamine). Any development of tongue swelling, difficulty swallowing, difficulty speaking, or shortness of breath requires EMERGENCY physician evaluation.
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