Allergy nurse explains ‘within 2-hours’ rule for 2.4million adults – and when to dial 999

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An allergy specialist is warning people of the key signs that they might be having an allergic reaction – and the timeframe to be aware of. Figures from Allergy UK show around 21million people – one in three of the population – live with some form of allergic condition. Hay fever alone affects 16million people while 2.4million adults have food allergies.

The reactions can vary from mild rashes and sneezing through to severe, life-threatening ones such as struggling to breathe, throat swelling and falling unconscious. Hannah Kramer, Clinical Nurse Specialist at The Allergy Centre of Excellence (ACE) in Harley Street, London, says the reaction can start in just minutes and she has explained what you should watch for – and what to do if it happens.

She says: “When someone has an immediate food allergy the reaction typically begins within seconds or minutes of exposure to the food, and within a 2-hour window from there.

“Interestingly, people having anaphylaxis often describe ‘an impending sense of doom’, a sense of panic and fear in response to their physical bodily symptoms. The important thing is that anaphylaxis can begin with quite subtle symptoms, such as, for example, that tickly cough that isn’t going away and wasn’t there before. Many people think that anaphylaxis is dramatic and obvious, which of course it can be, but not always.”

And she warns the action needed may be different depending on the severity of the attack with the most severe allergies needing urgent treatment. And she said there were some occasions that it was essential to treat it with one thing – a shot of adrenaline, a prescription medication available to those with a known allergy.

What is anaphylaxis?

Anaphylaxis is an allergic reaction affecting a person’s airway, breathing or circulation. The NHS explains: “Anaphylaxis is a life-threatening allergic reaction that happens very quickly. It can be caused by food, medicine or insect stings. Call 999 if you think you or someone else is having an anaphylactic reaction.”

Hannah shares the ABC rule which happens during an attack:

• A: Starting at the top of the body we have the airway – a person could develop tongue swelling, or throat tightening. Throat tightening can present as a hoarse voice or cry, difficulty swallowing, or a persistent tickly throat clearing cough
• B: Down in the lungs you could hear a wheeze or a tight cough, the person may be having difficulty breathing or breathing faster or harder than usual
• C: Circulation, during a severe allergic reaction, blood pressure can drop quite suddenly, so the person may become pale, drowsy, dizzy, confused, or fall unconscious.

• Mild symptoms to watch for

  Symptoms of a typical (mild) reaction might include:

  • Itching in or around the mouth
  • Facial swelling
  • Sneezing or suddenly runny nose
  • Skin rashes
  • Nausea
  • Vomiting
  • Itchy hives appearing

  Hannah adds: “These symptoms would be treated with a dose of antihistamine (either liquid or tablet form). However, mild symptoms can sometimes very quickly progress into severe life-threatening symptoms.”

• Severe life-threatening symptoms

  Examples of severe life-threatening symptoms might include:

  • Tongue swelling
  • Throat swelling (characterised by a tickly cough, change in voice, or difficulty swallowing)
  • Wheeze
  • Breathing difficulties
  • Becoming pale
  • Dizziness
  • Falling unconscious

  Hannah warns: “Any one of these symptoms alone is reason enough to use adrenaline (either via injection into the thigh, or with a nasal adrenaline spray).” She adds: “The most important thing we can teach our families is that if in doubt about what to do, and you think the person is showing any one of the symptoms we just mentioned, give adrenaline.

  “It is a very safe medication that wears off within minutes, no harm will be done if you’re wrong. But the longer you wait to give adrenaline, the worse and more dangerous the outcomes could be.”

• The NHS also has advice for people having a sudden anaphylactic reaction including when you should dial 999. It says: “Call 999 if:

  • your lips, mouth, throat or tongue suddenly become swollen
  • you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
  • your throat feels tight or you’re struggling to swallow
  • your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
  • you suddenly become very confused, drowsy or dizzy
  • someone faints and cannot be woken up
  • a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

  “You or the person who’s unwell may also have a rash that’s swollen, raised or itchy. These can be signs of a serious allergic reaction and may need immediate treatment in hospital.”

  It says if you think you or someone you’re with is having an anaphylactic reaction:

  • Use an adrenaline auto-injector (such as an EpiPen) if you have one – instructions are included on the side of the injector.
  • Call 999 for an ambulance and say that you think you’re having an anaphylactic reaction.
  • Lie down – you can raise your legs, and if you’re struggling to breathe, raise your shoulders or sit up slowly (if you’re pregnant, lie on your left side).
  • If you have been stung by an insect, try to remove the sting if it’s still in the skin.
  • If your symptoms have not improved after 5 minutes, use a 2nd adrenaline auto-injector.

  It adds: “Do not stand or walk at any time, even if you feel better.”

  What affects the strength of reaction?

  Hannah says: “There are not certain foods that are more likely than others to illicit certain types of reaction. What predicts the type and severity of reaction a person has is: how allergic they are to the food, how much they have eaten, if they are tired/stressed or unwell at the time of eating.”

  The Allergy Centre of Excellence (ACE) is a leading institution dedicated to providing personalised care for children with food allergies. Founded by Professors Adam Fox, George Du Toit, and Gideon Lack. It offer a variety of cutting-edge diagnostic tests and treatments for adults and children who have allergic disorders, specialising in Oral Immunotherapy (OIT), also known as Oral Tolerance Induction (OTI), a carefully controlled treatment that involves gradually introducing allergens to increase tolerance.