Protracted anaphylaxis: what to know

Anaphylaxis can affect the skin, airways, breathing, circulation and digestive system. In a protracted reaction, symptoms do not settle as expected or recur after an initial improvement. Swelling of the lips or tongue, throat tightness, wheezing, trouble breathing, dizziness, collapse, widespread hives or repeated vomiting can occur. Food allergy, medicines, insect stings and other triggers may be involved. Symptoms can change quickly, and the absence of a rash does not rule out anaphylaxis.

Use an adrenaline auto-injector immediately if it has been prescribed for the reaction, then call emergency services. Follow the device instructions and use a second injector if directed or if symptoms persist while help is coming. Lie down with legs raised when possible; sit up only if breathing is easier that way, and avoid standing or walking. Do not rely on antihistamines or an inhaler as a substitute for adrenaline in anaphylaxis. Emergency teams may provide oxygen, fluids and further medicines, followed by observation.

Any suspected anaphylaxis needs emergency assessment, especially if breathing is difficult, wheezing is present, the throat feels tight, the person is faint or confused, or symptoms return after initial improvement. Do not drive yourself. After recovery, arrange specialist review to identify the trigger, create an emergency plan and check injector technique. Allergy testing may be considered when clinically appropriate.

What trigger is suspected, and should I have allergy testing? How many auto-injectors should I carry? What should family, school or colleagues do if symptoms return?