Anaphylaxis, Redefined

I was raised to think of anaphylaxis as one thing: throat closing/shock. As someone with asthma, that was also part of my anaphylaxis equation i.e. anything with a side of asthma is bad news and warrants serious attention. I was reminded of this last week whilst attending Dr. Paul Ehrlich’s monthly support group as a guest. I stopped in with Brooklyn Allergy Mom and met up with author Henry Ehrlich.

(The Ehrlich cousins have an asthma book out: Asthma, Allergies, Children: A Parent’s Guide By Paul Ehrlich, M.D., Larry Chiaramonte, M.D. with Henry Ehrlich. Here’s Paul’s post on that meeting about training yourself to use the Epi. And Zum Family Blog Janeen’s guest post about how to call 911.)

I realized, in my 20/20 hindsight, that the reaction I had from kissing that dude back in 2009 i.e. wheezing + hives = anaphylaxis. What I learned as a child, well, the definitions have been refined. The newest definition according to the NIH panel is that anaphylaxis affects two or more bodily systems:

Here are the parts specifically that may be affected:

• Skin—itching, hives, redness, swelling
• Nose—sneezing, stuffy nose, runny nose
• Mouth—itching, swelling of lips or tongue
• Throat—itching, tightness, difficulty swallowing, hoarseness
• Chest—shortness of breath, cough, wheeze, chest pain, tightness
• Heart—weak pulse, passing out, shock
• Gastrointestinal (GI) tract—vomiting, diarrhea, cramps
• Nervous system—dizziness or fainting


I went over my emergency plan (find them here) with my pulmonologist the next day and had a check up and feel very lucky that my symptoms hadn't progressed.

Have you read the guidelines yet? Have you gone over your emergency plan plan with your doctor? Practice using an Epi or have isntructions for a 911 call? Do it now, whilst you are well.


Unknown said…
This is very helpful. Thank you for the information. I particularly like the way you set out the organ systems and symptoms.
AllergyMentor said…
This is such a great post, because so many people DO think it is just airway restriction. I know I did when my daughter was first diagnosed with allergies. Her first anaphylactic reaction did not involve her airways, but was still very frightening. Thanks for shedding light on what can be a very confusing topic. Also- under nervous system a common symptom is an overwhelming feeling of impending disaster or unease.
Our allergist always said that anaphylaxis was when more than one body system was affected. But so many people disagree and think that it's only when airway is affected. Thanks for this post (and the shout out). I'm going to tweet it and Facebook it so that everyone can read it.
Henry Ehrlich said…
Thanks, Sloane, for adding your own experience to what we did last week at
Jenny said…
Thanks a lot for this update. I will share it as well. Really important info!
Cybele Pascal said…
Several years ago I had a very extreme reaction to walnuts, that I have always described as "it was almost anaphylaxis" because my throat was closing, and I was wheezing and my tongue and mouth swelled, and I had total body hives, eyes swelled almost shut and everything. The only thing that didn't happen was going into shock. At that time, I didn't have an epi pen for me, just jr's for my kids. In retrospect, I don't think it was "almost anaphylaxis", it was anaphylaxis. It took a week of steroids to knock it down, the hives kept cycling. For me, the lesson learned from that was that one never knows when mild allergy can tip over into something out of control. I'm not an alarmist. I don't live in a state of fear, for either my kids or myself. We have food allergies, that I know are unpredictable, so I'm just cautious. And of course, I have my own epi pen now!
Willow said…
I used to have a more limited definition of ana shock, too. I didn't carry an epipen, and when I had my first full blown ana reaction, I didn't go to the hospital until I started having severe breathing difficulties. By that time, it was almost too late. So understanding of the medical definition of ana. yes, definitely important!

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