Learn How EMTs & Paramedics Identify, Treat and Care for Patients with Allergic Reactions
EMTs and Paramedics frequently encounter allergic emergencies. More than 50 million people in the US experience some type of allergic reaction each year, and it’s one of the most common 911 emergencies for EMTs and Paramedics. Although allergies and allergic reactions are common, they are rarely fatal. The PMC estimates fatal allergic reactions from venom, drugs, and food are as likely as death from lightning strikes. This impressively low mortality rate is partly due to the wealth of knowledge and treatments available to EMTs to prevent fatal allergic reactions.
To prepare you to treat allergic reactions, we will review what an allergic reaction is, when allergic reactions occur, symptoms of allergic reactions, when to call 911, basic treatment for allergic reactions, and how an EMT should treat allergic reactions.
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Allergic Reaction Definition
What Is Allergic Reaction?
An allergic reaction is an overreaction of the immune system to a substance that is usually harmless to most people. This substance is known as an allergen. When an individual is exposed to an allergen, their immune system mistakenly identifies it as a harmful substance and launches an attack against it. This response may cause the skin to become inflamed, congested sinuses, and blocked airways.
When the body is allergic to foreign substances, its reaction can be categorized into four distinct reaction types. These reaction types are as follows:
- TYPE I: Type one reactions are classified as anaphylactic reactions. These are the most common allergic reaction. During an anaphylactic reaction, the body releases histamines that cause inflammation and swelling. This can induce mild complications such as a runny nose or itchy skin but can progress into much more severe complications such as anaphylactic shock and blocked airways.
- TYPE II: Type two reactions are classified as cytotoxic reactions. These occur when antibodies bind with antigens on the cell surfaces. This begins a chain reaction resulting in cell death. Cytotoxic reactions lead to conditions like autoimmune hemolytic anemia, immune e thrombocytopenia, autoimmune neutropenia, Goodpasture syndrome, Graves’ disease, and myasthenia gravis.
- TYPE III: Type three reactions are classified as immunocomplex reactions. Like type two reactions, type three reactions are caused by antibodies. These immunocomplexes settle on tissues and organs, and the body’s attempt to remove them leads to damage in the underlying tissue. Type three reactions lead to conditions like rheumatoid arthritis, lupus, serum sickness, and Arthus reaction.
- TYPE IV: Type four reactions are classified as cell-mediated allergic reactions. This type of allergic reaction is unique in the time between the reaction and the inciting contact with the allergen. The reaction typically occurs 48 hours after exposure. Type four reactions lead to conditions such as tuberculin reactions, chronic asthma, contact dermatitis, and fungal infections.
In severe cases, anaphylaxis can occur, a life-threatening reaction that can cause difficulty breathing, swelling of the face, mouth, and throat, and a sudden drop in blood pressure. Anaphylaxis requires immediate medical attention.
Allergic Reaction Symptoms
What Are The Causes and Symptoms of Allergic Reaction?
An anaphylactic reaction or anaphylaxis is EMTs’ most common allergic condition. These reactions occur five to 30 minutes after contact with the allergen. They are classified by inflamed skin and often progress quickly, making it more difficult for the patient to breathe. In severe cases, the patient may experience anaphylactic shock. The most common cause of anaphylaxis is food, insect stings, medications, and latex.
The symptoms of allergic reactions are numerous and varied. The symptoms are often different depending on the allergen that caused the reaction. Below are some common allergens and their related symptoms.
- Hay fever is an allergic reaction caused by pollen. Common hay fever symptoms are sneezing, itchy nose, runny nose, and watery swollen eyes.
- Food allergies come in various forms, but the most common ones include allergies to milk, eggs, fish, shellfish, nuts, wheat, and soybeans. Food allergies induce symptoms such as hives, flushed skin or rash, tingling in the mouth, face, tongue and lip swelling, vomiting, diarrhea, stomach cramps, coughing, wheezing, dizziness, difficulty breathing, and loss of consciousness.
- Insect stings are a common cause of allergic reactions. Venomous insects such as bees, wasps, hornets, yellow jackets, and fire ants are common causes of allergic reactions. Symptoms of venomous stings include swollen skin near the sting site, itching or hives across the body, coughing, chest tightness, shortness of breath, and anaphylaxis.
- Drugs can cause allergic reactions as well. The most common medications to cause allergic reactions are penicillin, antibiotics containing sulfonamides, anticonvulsants, aspirin and other nonsteroidal anti-inflammatory drugs, and chemotherapy drugs. Common symptoms from allergic drug reactions include hives, itchy skin, rash, facial swelling, wheezing, and anaphylaxis.
- Reactions to latex are caused by specific proteins found in rubber latex. Symptoms of a reaction caused by latex include hives, itchy skin, difficulty breathing, and anaphylaxis.
Symptoms of anaphylaxis and anaphylactic shock include loss of consciousness, blood pressure drops, severe shortness of breath, skin rash, lightheadedness, a weak pulse, nausea, and vomiting. These symptoms are cause for concern, and if they present themselves, you should seek medical attention.
When to Call 911
If symptoms occur for the first time, for an unknown reason, or any anaphylactic reaction, it could be caused to call 911 or seek medical attention. When a response develops for the first time, the severity of the reaction and how far it will progress are unknown. For this reason, precaution is advised.
For reactions that have been observed before, monitoring the response is advisable. However, even a history of mild reactions does not exclude the possibility of a severe reaction, and medical attention should be available at the first signs of anaphylaxis. With a history of severe reactions, contact with the allergen can be enough reason to seek medical attention.
How to Treat Allergic Reactions
For mild reactions such as hay fever, over-the-counter antihistamines, decongestants, and corticosteroids are effective treatments. These treatments are either introduced orally or as a nasal spray, and they help reduce the inflammation and stuffiness caused by the body’s release of histamines upon contact with an allergen. The best treatment for mild allergic reactions is avoiding the allergen and hydrating. If discomfort is persistent over-the-counter treatments can help.
For extreme allergic reactions caused by food, drugs, or insect venom, epinephrine is the most common treatment. Epinephrine is a lifesaving emergency medication that can immediately reverse symptoms of anaphylaxis. When appropriately administered, epinephrine relaxes the muscles in the airways and tightens blood vessels to allow for easier breathing. After epinephrine is administered, emergency services should be alerted if they are not already en route. People with a history of allergic reactions should carry epinephrine and be well-educated on how to administer it effectively.
How Do EMTs and Paramedics Treat Allergic Reactions?
EMTs and paramedics treat allergic reactions by providing supportive care and, if necessary, administering medication to manage symptoms and prevent progression to a life-threatening reaction. The specific steps they take may include:
- Assessing the patient: EMTs and paramedics will check the patient’s vital signs and symptoms to determine the severity of the reaction.
- Administering medication: If the patient has a history of severe allergic reactions, they may have an epinephrine auto-injector (such as an EpiPen®) on hand. EMTs and paramedics may administer this medication, which helps to constrict blood vessels, open airways, and increase heart rate. They may also administer antihistamines, such as diphenhydramine (Benadryl®), to relieve itching and hives.
- Monitoring the patient: EMTs and paramedics will closely monitor the patient’s vital signs and symptoms to ensure the reaction is not progressing.
- Transporting the patient: If the patient’s symptoms are severe or have a history of severe reactions, EMTs and paramedics will transport the patient to the hospital for further evaluation and treatment.
It is essential for people with a history of allergies to carry an epinephrine auto-injector and to know how to use it in case of a severe reaction. They should also inform EMTs and paramedics of their allergy history and any medications they are taking.
Necessary EMS Medical Equipment
What Are Some of The Necessary Tools That EMTs & Paramedics Require to Diagnose and Treat Allergic Reactions
EMTs and paramedics require several tools to diagnose and treat allergic reactions, including:
- Epinephrine auto-injector (such as an EpiPen): This can provide immediate relief for severe allergic reactions, such as anaphylaxis.
- Antihistamines: These medications can help relieve itching, hives, and other symptoms of an allergic reaction.
- Oxygen saturation monitor: EMTs and Paramedics use an oxygen saturation monitor, like a pulse oximeter, to help monitor the patient’s oxygen saturation levels, which can drop due to anaphylaxis.
- Blood pressure cuff: Used to monitor the patient’s blood pressure, which can drop during a severe allergic reaction.
- Stethoscope: Used to monitor a patient’s breathing and assess for wheezing or other signs of respiratory distress.
- Airway management equipment: Helps patient’s airway open during cases of severe respiratory distress. Usually, an oxygen mask and a beta-agonist (Albuterol®) are used to help keep their airway open.
- IV supplies: To administer medications and fluids, if necessary.
- Glucagon: To treat low blood sugar, which can occur due to anaphylaxis.
One of the most important single items when treating allergic reactions is the epinephrine auto-injector.
EMT Response Training for Allergic Reactions
A well-trained EMT knows it’s essential to administer treatment quickly when treating allergic reactions. Because anaphylaxis can occur rapidly and affects the airways, it is important to begin the epinephrine ejection as early as possible to reduce the symptoms and reopen the airways. After the injection, a good EMT stays attentive, monitoring the patient’s condition and facilitating proper breathing. After you’ve treated the person’s allergic reaction, making sure they understand what caused their reaction in the first place is one of the best ways to prevent a future episode. Educating them on their condition allows them to avoid another attack or be prepared if one occurs again.
How to Avoid/Prevent Allergic Reactions
Education and awareness are two of the most effective ways to prevent an allergic reaction. Below are some tips and strategies to help prevent or avoid allergic reactions:
- Identify allergens: Determine what substances trigger your allergic reactions and take steps to avoid them.
- Read labels: Carefully read food and product labels to identify allergens and avoid those that contain them.
- Carry an epinephrine auto-injector: If you have a history of severe allergic reactions, carry an epinephrine auto-injector (such as an EpiPen) at all times and know how to use it.
- Wear medical alert jewelry: Consider wearing medical alert jewelry to inform others of your allergies in case of an emergency.
- Educate others: Inform your family, friends, and coworkers about your allergies and how to help in case of a reaction.
- Be prepared when eating out: When dining out, inform your server about your allergies and ask about ingredients and preparation methods.
- Avoid cross-contamination: Avoid cross-contamination, such as using separate utensils and cutting boards for allergens.
- Consider allergy shots: Talk to your doctor about allergy shots (immunotherapy), which can help reduce your sensitivity to allergens over time.
It’s also critical to seek prompt medical attention if you experience symptoms of an allergic reaction, even if they are mild. With appropriate precautions and treatment, most individuals with allergies can successfully manage their condition.
Allergic reactions come in various manners from various sources. However, preparing for the treatment for the most common allergic reaction (anaphylaxis) can be vital. A good EMT has quick, handy access to epinephrine and is well-prepared to administer it to the patient. After administering epinephrine, a good EMT can ease the patient’s trouble by facilitating breathing and keeping the patient calm. With this knowledge, most allergic reactions can be treated with ease. Being aware and prepared to deal with allergic reactions is vital for any good EMT.
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