An allergic reaction occurs when the immune system overreacts to a harmless substance, or allergen, releasing a flood of chemicals like histamine into the body. While many reactions are mild, others can quickly escalate to a severe, life-threatening condition known as anaphylaxis. Making a swift decision regarding emergency services is paramount, as untreated anaphylaxis can progress to shock and death in a short period. This article provides guidelines for recognizing when an allergic reaction requires an immediate 911 call.
Symptoms That Require Calling 911
A 911 call is necessary the moment an allergic reaction involves two or more body systems or presents with any single severe symptom of anaphylaxis. Signs involving the airway and breathing are the most immediate cause for alarm. These symptoms include a sudden onset of wheezing, difficulty breathing, or a persistent cough. Swelling of the tongue or throat, a tight feeling in the throat, or a hoarse voice also indicate that the airway is compromised and requires emergency medical intervention.
Any sign of circulatory distress also warrants an immediate emergency call, as this indicates the body is entering anaphylactic shock. Look for signs such as persistent dizziness, fainting, or a sudden loss of consciousness. The patient may also exhibit a weak and rapid pulse, indicating that blood pressure has dropped to dangerously low levels.
Finally, a combination of widespread symptoms signals a systemic emergency. This includes generalized hives or swelling combined with severe gastrointestinal distress, such as uncontrollable vomiting or diarrhea. The patient may express an overwhelming sense of dread or impending doom, which is a recognized symptom of severe reaction.
Recognizing Rapidly Worsening Reactions
Even if initial symptoms appear mild, a reaction that is changing quickly must be treated as an emergency. Allergic reactions often start with minor issues, such as a slight tingling sensation in the mouth or a patch of localized hives. If this mild presentation rapidly progresses to a moderate symptom, such as generalized flushing or throat clearing, the reaction is on an emergency trajectory. The speed of symptom onset is often directly related to the ultimate severity of the reaction.
Many of the most severe reactions develop within minutes of exposure to the allergen. Waiting to see if a mild symptom improves can be dangerous because the transition to full anaphylaxis can be sudden and irreversible without prompt treatment. Therefore, a reaction that is noticeably worsening over a period of mere minutes must prompt an immediate call to 911.
Immediate Steps While Waiting for Help
After dialing 911, the most important immediate action is to administer the prescribed epinephrine auto-injector (AAI), if one is available. Epinephrine, or adrenaline, is the first-line treatment for anaphylaxis and works to reverse the life-threatening symptoms by constricting blood vessels and opening the airways. The device should be administered immediately into the mid-outer thigh, and the time of administration should be noted for the emergency medical services (EMS) team. Even if the patient is hesitant or symptoms seem to improve, the injection should be given without delay.
Proper positioning of the patient while awaiting EMS arrival is also important for managing blood flow and breathing. If the patient is dizzy or showing signs of shock, they should be laid flat on their back with their legs elevated to help return blood to the heart and other vital organs. However, if the patient is experiencing significant difficulty breathing, they should be allowed to sit up, perhaps with their legs outstretched, as this position can ease the strain on their respiratory muscles. The patient should never be allowed to stand or walk, even if they feel momentarily better, as this can cause a sudden, fatal drop in blood pressure.
Continuously monitor the patient’s responsiveness and breathing until help arrives. If the patient becomes unconscious or begins to vomit, they should be carefully turned onto their side into the recovery position to prevent choking. If symptoms do not improve or worsen after the first dose, a second dose of epinephrine can be administered approximately five to ten minutes after the first, provided the patient has a two-dose prescription. Preparation for the paramedics should include gathering known medical information, such as the suspected allergen and a list of current medications.