Let’s start with hay fever. Pollen will enter your body through your eyes, nose and/or mouth. If your body is sensitive to the pollen it will produce a substance called histamine, which acts as a hormone and will create symptoms to try to push the pollen back out of the body – sneezing, watery eyes, runny nose, etc. Histamine is useful to our bodies in keeping them free from things that might harm us, but unfortunately sometimes it’s triggered by things like pollen which are unlikely to do much harm, but cause the histamine-reaction side effects which many of us suffer with. To stop the body reacting, we take antihistamines – not anti-pollens! The problem is not really the pollen, it’s our reaction to the pollen. A daily dose of an antihistamine usually does the trick and alleviates symptoms and with stronger dose medications, such as Fexofenadine, now available over the counter, many can now control their symptoms without the need of a GP’s help.

There are many other substances which our bodies can be either allergic or intolerant to – common foods which create problems include gluten, peanuts, nuts, citrus fruits, strawberries, dairy, eggs, fish and shellfish. Most people with a low level food allergy or intolerance will suffer from digestive issues if they should ingest them – again, this is the body working hard to remove the ‘harmful’ substance, but unfortunately it’s usually not pleasant! Vomiting, diarrhoea and stomach cramps are common in people sensitive to foods or drinks, sometimes along with a rash for those who are allergic. What’s the treatment? Well, most don’t need a treatment – they simply avoid eating or drinking whatever they are intolerant to, or if it’s an allergic reaction rather than an intolerance, they may take a daily antihistamine, particularly if their allergy is to something environmental where it’s trickier to control being exposed to it, e.g. washing powders, stings or bites.

Occasionally, a substance might cause more of an issue than can be solved by the body’s reaction to remove it (or taking an antihistamine to control the reaction when it happens). In people who are at the extreme end of the allergy scale, their body will react by going into anaphylactic shock – the histamine reaction will kick in, but in addition the body will also react by dilating the blood vessels, and the vessel walls become leaky. This causes blood pressure to fall, and the heart to beat faster to compensate for the drop in pressure – its main job is to push oxygen around the body to keep vital organs functioning. Swelling may well also occur, around the casualty’s airways and face, leading to difficulty in breathing and therefore a further reduction in oxygen. The body goes into shock and without prompt treatment, it may be fatal.

Most anaphylactic reactions build up over time – the initial exposure may result in tingly lips, a little bit more difficulty in breathing and hives, but is not usually life-threatening. The casualty visits their GP, who may prescribe an adrenaline injection (known by many as an Epipen, although an alternative brand Jext is also available), or may tell them to monitor the situation and return if it happens again. The more the casualty is exposed to the allergen, the worse the reaction gets, so once the offending substance has been identified, the best course of action is to avoid it. Many people are prescribed Epipens but never have the need to use them as they avoid whatever they are allergic to.  

It is possible that someone may suffer from a life-threatening reaction the first time they are exposed to the substance, but it’s rare. If the following symptoms are present, call 999 and explain the symptoms, stating ‘anaphylaxis’ if you can remember the name!  

Symptoms:

• Anxious
• Difficulty breathing
• Swelling around the face and neck
• Hives or other rash
• Fast heartbeat

For anyone struggling to breath, the tripod position is the best position to be in, but if they begin the feel dizzy and go pale, they are best on the floor with their legs raised whilst you wait for the ambulance (shock position).    

If they have an Epipen or Jext, retrieve it and allow them to administer it if they are able; if they can’t, you will need to do this for them.

• Remove the safety cap (blue for Epipens, yellow for Jext).
• Holding the device around the middle (do not put your thumb on either end) push the orange (Epipen) or black (Jext) end into the upper outer thigh, through clothing, avoiding seams or anything in their pockets.
• Push the device hard enough to click, and hold it in place for several seconds.
• Pull the device out (the needle will be covered and will not be seen) and massage the area for a few seconds.
• Call 999 (even if they seem to improve rapidly – it is ALWAYS a 999 call if an Epipen has been administered).

The 999 call handler will remain on the call with you; if the casualty hasn’t improved after 5 minutes, they will direct you to administer the second Epipen into the other leg.

Quick action can saves lives with anaphylaxis, but if you are ever in doubt and need guidance, then phone 999.