Signs and Symptoms

Question 1

S/S

Answer 1

Changes develop over several minutes and usually involve at least two body systems.

Question 2

S/S

Answer 2

Anaphylaxis occurs as part of a continuum. Even when there are mild symptoms initially, there is the potential for progression to a severe and even irreversible outcome. Fatalities during anaphylaxis usually result from delayed administration of epinephrine and from severe respiratory complications, cardiovascular complications, or both. Unconsciousness is rarely the sole manifestation of anaphylaxis, though this can occur. More commonly, unconsciousness occurs as a late event in severe cases that present with additional anaphylactic symptoms. 4

Features of early or mild anaphylaxis may include swelling and hives at injection site, sneezing, nasal congestion, tearing, coughing, and facial flushing. These symptoms are generally associated with minimal dysfunction.

Features of moderate to severe anaphylaxis include obstructive swelling of the upper airway, hypotension, and marked bronchospasm (constriction of the air passages of the lung by spasmodic contraction of the bronchial muscles)

Question 3

hives/urticaria and welts/Angioedema

Answer 3

Urticaria and angioedema are the most common manifestations of anaphylaxis. Urticaria (hives) are raised, often itchy wheals on the surface of the skin. Angioedema is a swelling similar to urticaria, but the swelling is beneath the skin rather than on the surface. The swellings are called welts. The welts usually occur around the eyes and lips. They may also be found on the hands, feet, neck and in the throat

Question 4

Frequency

Answer 4

Skin*

80% to 90%

Hives, swelling (face, lips, tongue), angio-edema, itching, warmth, redness, drooling in children

Respiratory

Up to 70%

Coughing, wheezing, shortness of breath, chest pain or tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny, itchy nose and watery eyes, sneezing), trouble swallowing, drooling in children

Cardiovascular

Up to 45%

Pallor, weak pulse, dizziness or light headedness, collapse, hypotension**, shock

Gastrointestinal

Up to 45%

Nausea, pain or cramps, vomiting, diarrhea

Other*

Anxiety, sense of doom, headache, uterine cramps, metallic taste
Suddenly quiet, sleepy or lethargic in children

Question 5

Skin/Mucosal

Answer 5

Localized subcutaneous (or sub mucosal) swelling and tingling to face and mouth
Hives – may be delayed
Warm, itchy, red and blotchy

Question 6

Respiratory

Answer 6

Laboured breathing — hoarse voice, tight throat, rapid breathing, wheezing, coughing, nasal flaring, nasal and chest congestion
Rhinitis (stuffy or runny nose, itchy watery eyes and sneezing)
Shortness of breath, stridor, retractions, chest pain and cyanosis

Question 7

Cardiovascular

Answer 7

Weak and rapid pulse
Hypotension on its own after an exposure can represent anaphylaxis
Hypotension is less common in children
Shock

Question 8

Gastrointestinal

Answer 8

Nausea, vomiting, diarrhea
Abdominal pain or cramping
Dysphagia (difficulty swallowing)
Drooling in children

Question 9

Other

Answer 9

Anxious or feeling of “impending doom”
*Sudden lack of energy (lethargy) in children
Quietness or sleepiness in children*
Headache, light-headedness or dizziness
Decreased level of consciousness
Uterine cramps