Does the Severity of Previous Allergic Reactions Predict Future Reactions?

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The severity of a previous allergic reaction to a food does not predict the severity of future reactions to the same food.

An individual whose peanut or other allergy reactions have been mild might suddenly have a severe, even life threatening response. The chances of experiencing a totally different, unexpected reaction to an allergen is 25 percent.

The Past Is Not the Future

If yours, or your child’s reaction to an allergen has always been mild, it is dangerous to assume all future reactions will be mild. The next allergen contact, or the one after that, might trigger severe symptoms—you always need to have life-saving medication (e.g., Benadryl, epinephrine) with you.

Fatalities from anaphylactic responses to a food are largely owed to delayed administration of epinephrine—most often because the person does not have medication with them and does not receive medical attention soon enough.

It is equally important that people who are usually around you, or your child (at school or work), know about the allergy and what to do in an emergency.

Also, be aware that blood tests for allergies do not have predictive value. Someone testing positive for a peanut allergy could subsequently experience tingling in the mouth, a breakout of hives, or anaphylaxis after contact with peanuts.

Why Symptom Severity Is Variable

Though allergic reactions are reproducible, meaning the same food allergen will trigger allergic symptoms whenever it is consumed, there are several variables that can cause reactions to be severer than usual:

  1. How a person with an allergy comes in contact with the food, including the length and type of food preparation (e.g., baked, raw, roasted, boiled), and the route of exposure (ingestion or skin contact).
  2. A person’s general state of health, including having other types of allergies such as eczema, asthma, or chronic sinus problems.
  3. Our level of exercise, alcohol consumption, the use of NSAID pain relievers (e.g., aspirin, ibuprofen, naproxen), having a cold or other type of infection, and our level of emotional and physical stress.

Allergy First Aid

When an allergic reaction occurs - if severe symptoms are present or suspected - inject epinephrine and then call 911 right away. If symptoms are not reduced after five minutes, give a second injection of epinephrine.

Severe reactions include one or more of the following symptoms.

  • Respiratory: wheezing, shortness of breath, repetitive cough.
  • Cardiovascular: pale or blue coloring, feeling faint, dizziness, confusion, weak pulse.
  • Throat and mouth: tight throat, problems breathing or swallowing, hoarseness, obstructive swelling of the tongue or lips.
  • A lot of hives over the body.
  • A combination of symptoms from different body areas; for instance, hives and itchy skin plus diarrhea, vomiting, or stomach cramps.

For mild symptoms such as an itchy mouth, a few facial hives, mild skin itch, or mild nausea/stomach distress, administer an antihistamine and notify a medical professional. Give epinephrine if the symptoms progress, and call 911.

Sources: UCLA; Stanford; Wall Street Journal Photo credit: liz west / flickr

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