What to do when you have really bad allergies

An allergic reaction may happen anywhere in the body but generally appears in the nose, eyes, lungs, lining of the stomach, sinuses, throat and skin. These are places where special immune system cells are stationed to fight off invaders that are inhaled, swallowed or come in contact with the skin.

Allergic Rhinitis (Hay Fever)

Allergic rhinitis is a general term used to describe the allergic reactions that take put in the nose. Symptoms may include sneezing, congestion, runny nose, and itching of the nose, the eyes and/or the roof of the mouth. When this problem is triggered by pollens or outdoor molds, during the Spring, Summer or Drop, the condition is often called «hay fever.» When the problem is year-round, it might be caused by exposure to home dust mites, household pets, indoor molds or allergens at school or in the workplace.

Atopic and Contact Dermatitis/Hives/Skin Allergies

Atopic and contact dermatitis, eczema and hives are skin conditions that can be caused by allergens and other irritants.

Often the reaction may take hours or days to develop, as in the case of poison ivy. The most common allergic causes of rashes are medicines, insect stings, foods, animals and chemicals used at home or work. Allergies may be aggravated by emotional stress.


Asthma symptoms happen when airway muscle spasms block the flow of air to the lungs and/or the linings of the bronchial tubes become inflamed. Excess mucus may clog the airways. An asthma attack is characterized by labored or restricted breathing, a tight feeling in the chest, coughing and/or wheezing. Sometimes a chronic cough is the only symptom. Asthma trouble can cause only mild discomfort or it can cause life-threatening attacks in which breathing stops altogether.


Anaphylaxis is a rare, potentially fatal allergic reaction that affects numerous parts of the body at the same time.

The trigger may be an insect sting, a food (such as peanuts) or a medication. Symptoms may include:

  1. a dangerous drop in blood pressure
  2. swelling of the throat and/or tongue
  3. vomiting or diarrhea
  4. difficulty breathing
  5. redness of the skin and/or hives
  6. loss of consciousness.

Frequently these symptoms start without warning and get worse rapidly. At the first sign of an anaphylactic reaction, the affected person must go immediately to the closest Emergency Room or call 911.

What Are the Symptoms of an Allergy?

An allergy occurs when the body’s immune system sees a substance as harmful and overreacts to it.

The symptoms that result are an allergic reaction. The substances that cause allergic reactions are allergens. Allergens can get into your body numerous ways to cause an allergic reaction.

  1. You can inhale allergens into your nose and your lungs. Many are little enough to float through the air. Examples are pollen, home dust, mold spores, cat and dog dander and latex dust.
  2. Your body can own allergens injected into it. This includes medicine given by needle and venom from insect stings and bites.
  3. You can ingest allergens by mouth. This includes food and medicines you eat or swallow.
  4. Your skin can absorb allergens. Plants such as poison ivy, sumac and oak can cause reactions when touched.

    Latex, metals, and ingredients in beauty care and household products are other examples.

What Are Eye Allergies?

Eye allergies are common.

What to do when you own really bad allergies

Eye allergies are a reaction to indoor and outdoor allergens that get into your eyes.The tissue that lines the inside of the eyelid and exterior of the eyeball becomes inflamed and swollen and leads to itching, redness, tearing and irritation of the eyes.

What Is Sinusitis?

Sinusitis is an infection or inflammation of the sinuses. A sinus is a hollow space. There are numerous sinuses in the body, including four pairs inside the skull.

They serve to lighten the skull and give resonance to the voice. These sinuses are lined with the same helpful of tissue that lines the inside of the nose. The same things that can cause swelling in the nose – such as allergies or infection – can also affect the sinuses. When the tissue inside the sinuses becomes inflamed, mucus discharge is increased. Over time, air trapped inside the swollen sinuses can create painful pressure inside the head. This is a sinus headache.

Medical Review November 2015.


The severity of symptoms during an allergic reaction can vary widely.

Some of the symptoms of an allergic reaction include:

  1. Sneezing
  2. Diarrhea
  3. Itchy nose
  4. Hives (a rash with raised red patches)
  5. Vomiting
  6. Runny nose
  7. Rashes
  8. Itchy, watery eyes
  9. Stomach cramps
  10. Bloating
  1. Pain
  2. Feeling faint, light-headed or “blacking out”
  3. Redness
  4. Throat closing
  5. Chest tightness and losing your breath
  6. Tongue swelling
  7. Cough
  8. Swelling
  9. Wheezing (a whistling sound when you breathe)
  10. A sense of “impending doom”

Some of these symptoms can be sign of a life-threatening allergic reaction.

Anaphylaxis: Synopsis

Updated: April, 2019
Updated: September, 2012
Originally Posted: July 2004

Richard F.

Lockey, MD
Professor of Medicine, Pediatrics and Public Health
Director of the Division of Allergy and Immunology
Joy McCann Culverhouse Chair of Allergy and Immunology
University of South Florida College of Medicine and the James A. Haley Veterans' Hospital
Tampa, Florida, USA

This disease summary is provided for informational purposes for physicians only.

Causes of Anaphylaxis

Cytoxic and Immune Complicated – Complement-Mediated Reactions


Latex is a milky sap produced by the rubber tree Hevea brasiliensis. Latex-related allergic reactions can complicate medical procedures, for example, internal examinations, surgery, and catheterization.

Medical and dental staff may develop occupational allergy through use of latex gloves.

Anaphylaxis caused by radio-contrast media

Mild adverse reactions are experienced by approximately 5% of subjects receiving radio-contrast media. U.S. figures propose that severe systemic reactions happen in 1:1000 exposures with death in 1:10,000-40,000 exposures.


Examples of miscellaneous agents which cause anaphylaxis are insulin, seminal proteins, and horse-derived antitoxins, the latter of which are used to neutralize venom in snake bites.

Individuals who own IgA deficiency may become sensitized to the IgA provided in blood products. Those selective IgA deficient subjects (1:500 of the general population) can develop anaphylaxis when given blood products, because of their anti-IgA antibodies (probably IgE-anti-IgA).

B = Breathing

Assess adequacy of ventilation and provide the patient with sufficient oxygen to maintain adequate mentation and an oxygen saturation of at least 91% as sure by pulse oximetry.

Treat bronchospasm as necessary. Equipment for endotracheal intubation should be available for immediate use in event of respiratory failure and is indicated for poor mentation, respiratory failure, or stridor not responding immediately to supplemental oxygen and epinephrine.

Muscle relaxants

Anaphylaxis to muscle relaxants occurs in approximately 1 in 4,500 of general anesthesia, with fatalities occurring in 6% of these cases. Risk factors are female sex (80% of cases). Atopy is not a risk factor; previous drug allergy may be a risk factor. In patients with a history of anaphylaxis, skin tests to diverse muscle relaxants may be helpful.

If the test result is positive, the muscle relaxant should not be used. A negative result provides evidence that the muscle relaxant can probably be istered safely.


Exercise alone can cause anaphylaxis as can food-induced anaphylaxis, Exercise-induced anaphylaxis can happen during the pollinating season of plants to which the individual is allergic.

Catamenial Anaphylaxis

Catamenial anaphylaxis is a syndrome of hypersensitivity induced by endogenous progesterone secretion.

Patients may exhibit a cyclic pattern of attacks during the premenstrual part of the cycle.

Aspirin, Ibuprofen, Indomethacin and other Non-steroidal Anti-inflammatory Agents (NSAIDs)

IgE antibodies against aspirin and other NSAIDs own not been identified. Affected individuals tolerate choline or sodium salicylates, substances closely structurally related to aspirin but diverse in that they lack the acetyl group.

Non-immunologic Mast Cell Activators

Idiopathic Anaphylaxis

Flushing, tachycardia, angioedema, upper airway obstruction, urticaria and other signs and symptoms of anaphylaxis can happen without a recognizable cause.

Diagnosis is based primarily on the history and an exhaustive search for causative factors. Serum tryptase and urinary histamine levels may be useful, in specific, to law out mastocytosis.

How do you diagnose allergic rhinitis?

Your doctor will confirm the specific allergens causing your rhinitis by taking a finish symptom history, doing a physical examination, and performing skin prick tests.

Emergency Treatment of Anaphylaxis

B = Benadryl (diphenhydramine)

Antihistamines are not useful for the initial management of anaphylaxis but may be helpful once the patient stabilizes.

What to do when you own really bad allergies

Diphenhydramine may be istered intravenously, intramuscularly or orally. Cimetidine offers the theoretical benefit of reducing both histamine-induced cardiac arrhythmias, which are mediated via H2 receptors, and anaphylaxis-associated vasodilation, mediated by H1 and H2 receptors. Cimetidine, up to 300 mg every 6 to 8 hours, may be istered orally or slowly I.V. Doses must be adjusted for children.


Narcotics are mast cell activators capable of causing elevated plasma histamine levels and non-allergic anaphylaxis.

They are most commonly observed by anesthesiologists.

Idiopathic Causes


In theory, any food glycoprotein is capable of causing an anaphylactic reaction. Foods most frequently implicated in anaphylaxis are:

  1. Tree nuts (walnut, hazel nut/filbert, cashew, pistachio nut, Brazil nut, pine nut, almond)
  2. Seeds (cotton seed, sesame, mustard)
  3. Fish
  4. Milk (cow, goat)
  5. Chicken eggs
  6. Peanut (a legume)
  7. Shellfish (shrimp, crab, lobster, oyster, scallops)
  8. Fruits, vegetables

Food sensitivity can be so severe that a systemic allergic reaction can happen to particle inhalation, such as the odors of cooked fish or the opening of a package of peanuts.

A severe allergy to pollen, for example, ragweed, grass or tree pollen, can indicate that an individual may be susceptible to anaphylaxis or to the oral allergy syndrome (pollen/food syndrome) (manifested primarily by severe oropharyngeal itching, with or without facial angioedema) caused by eating certain plant-derived foods.

This is due to homologous allergens found between pollens and foods. The main allergen of every grasses is profilin, which is a pan-allergen, found in numerous plants, pollens and fruits, and grass-sensitive individuals can sometimes react to numerous plant-derived foods.

Typical aero-allergen food cross-reactivities are:

  1. Birch pollen: apple, raw potato, carrot, celery and hazelnut
  2. Ragweed pollen: melons (watermelon, cantaloupe, honeydew) and banana
  3. Mugwort pollen: celery, apple, peanut and kiwifruit
  4. Latex: banana, avocado, kiwifruit, chestnut and papaya

Food-associated, exercise-induced anaphylaxis may happen when individuals exercise within 2-4 hours after ingesting a specific food.

The individual is, however, capable to exercise without symptoms, as endless as the incriminated food is not consumed before exercise. The patient is likewise capable to ingest the incriminated food with impunity as endless as no exercise occurs for several hours after eating the food.

Whole Blood, Serum, Plasma, Fractionated Serum Products, Immunoglobulins, Dextran

Anaphylactic responses own been observed after the istration of whole blood or its products, including serum, plasma, fractionated serum products and immunoglobulins.

One of the mechanisms responsible for these reactions is the formation of antigen-antibody reactions on the red blood cell surface or from immune complexes resulting in the activation of complement. The athletic by-products generated by complement activation (anaphylatoxins C3a, C4a and C5a) cause mast cell (and basophil) degranulation, mediator release and generation, and anaphylaxis. In addition, complement products may directly induce vascular permeability and contract smooth muscle.

Cytotoxic reactions can also cause anaphylaxis, via complement activation.

Antibodies (IgG and IgM) against red blood cells, as occurs in a mismatched blood transfusion reaction, activate complement. This reaction causes agglutination and lysis of red blood cells and perturbation of mast cells resulting in anaphylaxis.

Sulfiting Agents

Food-induced anaphylaxis

The prevalence of food-induced anaphylaxis varies with the dietary habits of a region. A United States survey reported an annual occurrence of 10.8 cases per 100,000 person years. By extrapolating this data to the entire population of the USA, this suggests approximately 29,000 food-anaphylactic episodes each year, resulting in approximately 2,000 hospitalizations and 150 deaths.

Similar findings own been reported in the United Kingdom and France. Food allergy is reported to cause over one-half of every severe anaphylactic episodes in Italian children treated in emergency departments and for one-third to one-half of anaphylaxis cases treated in emergency departments in North America, Europe and Australia. It is thought to be less common in non-Westernized countries. A study in Denmark reported a prevalence of 3.2 cases of food anaphylaxis per 100,000 inhabitants per year with a fatality rate of approximately 5%.

Risk factors for food anaphylaxis include asthma and previous allergic reactions to the causative food.

A = Airway

Ensure and establish a patent airway, if necessary, by repositioning the head and neck, endotracheal intubation or emergency cricothyroidotomy.

Put the patient in a supine position and elevate the lower extremities. Patients in severe respiratory distress may be more comfortable in the sitting position.

A = Adrenalin = epinephrine

Epinephrine is the drug of choice for anaphylaxis. It stimulates both the beta-and alpha-adrenergic receptors and inhibits further mediator release from mast cells and basophils. Animal and human data indicate that platelet activating factor (PAF) mediates life-threatening manifestations of anaphylaxis.

The early use of epinephrine in vitro inhibits the release of PAF in a time-dependent manner, giving support to the use of this medication with the first signs and symptoms of anaphylaxis. The usual dosage of epinephrine for adults is 0.3-0.5 mg of a 1:1000 w/v solution given intramuscularly, preferably in the anterolateral thigh, every 10-20 minutes or as necessary. The dose for children is 0.01 mg/kg to a maximum of 0.3 mg intramuscularly, preferably in the anterolateral thigh, every 5-30 minutes as necessary.

What to do when you own really bad allergies

Lower doses, e.g., 0.1 mg to 0.2 mg istered intramuscularly, preferably in the anterolateral thigh, as necessary, are generally adequate to treat mild anaphylaxis, often associated with skin testing or allergen immunotherapy. Epinephrine should be given early in the course of the reaction and the dose titrated to the clinical response. For severe hypotension, 1 cc of a 1:10,000 w/v dilution of epinephrine given slowly intravenously is indicated.

The patient's response determines the rate of infusion.

Sodium and Potassium Sulfites, Bisulfites, Metabisulfites, and Gaseous Sulfur Dioxides

These preservatives are added to foods and drinks to prevent discoloration and are also used as preservatives in some medications. Sulfites are converted in the acid environment of the stomach to SO2 and H2SO3, which are then inhaled. They can produce asthma and non-allergic hypersensitivity reactions in susceptible individuals.

IgE-Mediated Reactions

Radiocontrast Media, Low-molecular Weight Chemicals

Mast cells may degranulate when exposed to low-molecular-weight chemicals.

Hyperosmolar iodinated contrast media may cause mast cell degranulation by activation of the complement and coagulation systems. These reactions can also happen, but much less commonly, with the newer contrast media agents.

C = Circulation

Minimize or eliminate continued exposure to causative agent by discontinuing the infusion, as with radio-contrast media, or by placing a venous tourniquet proximal to the site of the injection or insect sting.

Assess adequacy of perfusion by taking the pulse rate, blood pressure, mentation and capillary refill time. Establish I.V. access with large bore (16- to 18-gauge) catheter and ister an isotonic solution such as normal saline. A second I.V. may be established as necessary. If a vasopressor, such as dopamine becomes necessary, the patient requires immediate transfer to an intensive care setting.

The same ABC mnemonic can be used for the pharmacologic management of anaphylaxis:

Penicillin-induced anaphylaxis

One percent to 5% of courses of penicillin therapy are complicated by systemic hypersensitivity reactions. Point two percent is associated with anaphylactic shock, and mortality occurs in 0.02% of the cases.

If a patient has a strongly positive skin test or circulating IgE antibody to penicillin, there is a 50-60% risk of an anaphylactic reaction upon subsequent challenge. In patients with a case history suggestive of penicillin allergy and negative skin tests, the risk of anaphylaxis is extremely low. Atopy and mold sensitivity are not risk factors for the development of penicillin allergy.

C = Corticosteroids

Corticosteroids do not benefit acute anaphylaxis but may prevent relapse or protracted anaphylaxis. Hydrocortisone (100 to 200 mg) or its equivalent can be istered every 6 to 8 hours for the first 24 hours.

Doses must be adjusted for children.

What is the impact?

About 20 per cent of the general population suffers from rhinitis. Of these people, about one third develops problems before the age of 10.

The overall burden of allergic rhinitis is better understood when you consider that 50 per cent of patients experience symptoms for more than four months per year and that 20 per cent own symptoms for at least nine months per year.

Those affected by hay fever suffer more frequent and prolonged sinus infection, and for those who also own red, itchy eyes, there is the risk of developing infective conjunctivitis due to frequent rubbing.

Persistent symptoms and poor quality sleep can result in lethargy, poor concentration and behavioural changes and impact on learning in young children.
Allergic rhinitis may predispose people to obstructive sleep apnoea, due to the upper airways collapsing during sleep.

This results in reduced airflow, a drop in oxygen levels and disturbed sleep.

Patients with allergic rhinitis also suffer from more frequent and prolonged respiratory infections, and asthma has been shown to be more hard to control unless allergic rhinitis is also managed.

How is allergic rhinitis treated?

It is useful to identify your triggers and attempt and avoid them. This can be difficult.

Pets: Make certain you hold it exterior and never let it in the bedroom. It is never simple trying to decide on a new home for a pet, but in some cases this might be the best option.

Even after you own removed your pet from your home, the allergens remain in furnishings for endless periods afterwards and can cause symptoms. You will need to thoroughly clean your walls, floors and carpets to remove the allergen.

Dust mites: Home dust mite reduction measures include mite-proof covers for the mattress, duvet and pillows. Removing items that collect dust from the bedroom will assist. A excellent quality vacuum cleaner with HEPA filter for the exhaust air is essential to ensure that allergen is not disseminated in the atmosphere.

Bedding should be washed frequently in water hotter than 55ºC. If you own soft toys, freeze them overnight and air in the sun.

Pollen: It is hard to avoid pollen, however you can avoid going exterior when pollen counts are high. The quantity of pollen in the air is highest:
• In the morning
• Outside
• On windy days
• After a thunderstorm

See our pollen calendar for more information.


Food-associated, exercise-induced anaphylaxis

This is more common in females, and over 60% of cases happen in individuals less than 30 years of age.

Patients sometimes own a history of reacting to the food when younger and generally own positive skin tests to the food that provokes their anaphylaxis.

Antibiotics and Other Drugs


Penicillin is the most common cause of anaphylaxis, for whatever reason, not just drug-induced cases. Penicillin and other antibiotics are haptens, molecules that are too little to elicit immune responses but which may bind to serum proteins and produce IgE antibodies. Serious reactions to penicillin happen about twice as frequently following intramuscular or intravenous istration versus oral istration, but oral penicillin istration may also induce anaphylaxis.

Neither atopy, nor a genetic history of allergic rhinitis, asthma or eczema, is a risk factor for the development of penicillin allergy.


Muscle relaxants, for example, suxamethonium, alcuronium, vecuronium, pancuronium and atracurium, which are widely used in general anesthesia, account for 70-80% of every allergic reactions occurring during general anesthesia.

What to do when you own really bad allergies

Reactions are caused by an immediate IgE-mediated hypersensitivity reaction.


Hymenoptera venoms (bee, wasp, yellow-jacket, hornet, fire ant) contain enzymes such as phospholipases and hyaluronidases and other proteins which can elicit an IgE antibody response.

Elective Medical Procedures

Allergen immunotherapy

Modulators of Arachidonic Acid Metabolism

Insect venom anaphylaxis

Studies from Australia, France, Switzerland and the USA propose incidences of systemic reactions to Hymenoptera stings ranging from 0.4% to 4% of the population.

In the USA, at least 40 allergic deaths happen each year as a result of Hymenoptera stings.


Allergy / immunology specialists frolic a uniquely significant role to confirm the etiology of anaphylaxis, prepare the patient for self istration of epinephrine, educate the patient and/or family about allergen avoidance, and law out any underlying condition, such as mastocytosis, which can predispose a patient to develop anaphylaxis.

Referral to an allergist / immunologist is indicated for patients with this disease.

Why? Let us turn to 19th-century London.

The British Journal of Homeopathy, volume 29, published in 1872, included a startlingly prescient observation: “Hay fever is said to be an aristocratic disease, and there can be no doubt that, if it is not almost wholly confined to the upper classes of society, it is rarely, if ever, met with but among the educated.”

Hay fever is a catchall term for seasonal allergies to pollen and other airborne irritants.

With this thought that hay fever was an aristocratic disease, British scientists were on to something.

More than a century later, in November 1989, another highly influential paper was published on the subject of hay fever. The paper was short, less than two pages, in BMJ, titled “Hay Fever, Hygiene, and Household Size.”

The author looked at the prevalence of hay fever among 17,414 children born in March 1958.

What to do when you own really bad allergies

Of 16 variables the scientist explored, he described as “most striking” an association between the likelihood that a kid would get hay fever allergy and the number of his or her siblings.

It was an inverse relationship, meaning the more siblings the kid had, the less likely it was that he or she would get the allergy. Not just that, but the children least likely to get allergies were ones who had older siblings.

The paper hypothesized that “allergic diseases were prevented by infection in early childhood, transmitted by unhygienic contact with older siblings, or acquired prenatally from a mom infected by contact with her older children.

“Over the past century declining family size, improvements in household amenities, and higher standards of personal cleanliness own reduced the chance for cross infection in young families,” the paper continued.

“This may own resulted in more widespread clinical expression of atopic disease, emerging in wealthier people, as seems to own occurred for hay fever.”

What is allergic rhinitis?

Hay fever is the common name to describe allergic rhinitis and involves a recurrent runny, stuffy, itchy nose, and frequent sneezing. It can also affect your eyes, sinuses, throat and ears.

Love any other allergy, allergic rhinitis is an inappropriate immune system response to an allergen – most commonly home dust mite, pet, pollen and mould.

The allergen comes into contact with the sensitive, moist lining in your nose and sinuses and sets off the allergic response.

Hay fever is often considered a nuisance rather than a major disease and most people will self-treat.

What to do when you own really bad allergies

However, recent studies own revealed that hay fever has a huge impact on quality of life.

Prevention of Anaphylaxis

Agents causing anaphylaxis should be identified when possible and avoided. Patients should be instructed how to minimize exposure.

Beta-adrenergic antagonists, including those used to treat glaucoma, may exacerbate anaphylaxis and should be avoided, where possible.

What to do when you own really bad allergies

Angiotensin-converting enzyme (ACE) inhibitors may also increase susceptibility to anaphylaxis, particularly with insect venom-induced anaphylaxis.

Epinephrine is the drug of choice to treat anaphylaxis. Individuals at high risk for anaphylaxis should be issued epinephrine syringes for self-istration and instructed in their use. Intramuscular injection into the anterolateral thigh is recommended since it results in immediate elevation of plasma concentrations and has immediate physiological effects.

Subcutaneous injection results in delayed epinephrine absorption. Patients must be alerted to the clinical signs of impending anaphylaxis and the need to carry epinephrine syringes at every times and to use it at the earliest onset of symptoms. Unused syringes should be replaced when they reach their use-by/expiration date, as epinephrine content and bioavailability of the drug decreases in proportion to the number of months past the expiration date.

Pre-treatment with glucocorticosteroids and H1 and H2 antihistamines is recommended to prevent or reduce the severity of a reaction where it is medically necessary to ister an agent known to cause anaphylaxis, for example, radio-contrast media.

Other significant patient instructions include:

a) Personalized written anaphylaxis emergency action plan
b) Medical Identification (e.g., bracelet, wallet card)
c) Medical record electronic flag or chart sticker, and emphasis on the importance of follow-up investigations by an allergy/immunology specialist

What is the link between allergic rhinitis and asthma?

Allergic rhinitis has been found to be an extremely common trigger for asthma in both children and adults.

Allergic rhinitis can also exacerbate asthma, and it can make the diagnosis of asthma more difficult.

Around 80 per cent of people with asthma suffer from allergic rhinitis, and around one in four with allergic rhinitis has asthma.

There is now extremely excellent evidence to support the thought that asthmatics who glance after their upper airways well need less asthma medication and fewer hospital or GP visits.

When treating both asthma and allergic rhinitis, the first step is to discover out the cause of your problem. Once the causes own been identified, management regimes can be put into put to minimise the impact of the allergy, and this then reduces the need for medication.

What are the symptoms?

Symptoms of allergic rhinitis can be any combination of itching in the back of the throat, eyes or nose, sneezing, runny eyes or nose, and blocked nose.

A person may own any or every of the following:

  1. frequent throat-clearing
  2. chronic freezing without much fever
  3. breathing through the mouth
  4. repeated nosebleeds
  5. nasal voice because of blocked nasal passages
  6. rabbit-like movements of the nose
  7. a horizontal crease across the nose as a result of constant rubbing
  8. snoring
  9. bouts of sneezing, especially in the morning
  10. frequent earaches, fullness in the ear, ear infections or hearing loss
  11. reddened, pebbly lining in the lower eyelids
  12. watery discharge from the nose every the time, occasionally or during certain seasons of the year
  13. stuffy nose every the time or during specific seasons
  14. dizziness or nausea related to ear problems
  15. headaches because of pressure from inside the nose
  16. dark circles under the eyes as a result of pressure from blocked nasal passages on the little blood vessels.

    Also known as "allergic shiners".

Differential Diagnosis

The differential diagnosis for anaphylaxis includes:

  1. foreign body aspiration
  2. cold urticaria
  3. pulmonary embolism
  4. pheochromocytoma
  5. cholinergic urticaria
  6. myocardial infarction
  7. carcinoid syndrome
  8. epiglottitis
  9. hereditary angioedema
  10. seizures
  11. status asthmaticus
  12. respiratory difficulty or circulatory collapse, including vasovagal reactions
  13. globus hystericus
  14. overdose of medication
  15. hypoglycemia
  16. sulfite or monosodium glutamate ingestion

Upper airway obstruction, bronchospasm, abdominal cramps, pruritus, urticaria and angioedema are absent in vasovagal reactions.

Pallor, syncope, diaphoresis and nausea generally indicate a vaso-vagal reaction but may happen in either condition.

If a reaction occurs during a medical procedure, it is significant to consider a possible reaction to latex or medication used for or during anesthesia.

Definition of Anaphylaxis

Anaphylaxis is an acute, potentially life-threatening hypersensitivity reaction, involving the release of mediators from mast cells, basophils and recruited inflammatory cells.

Anaphylaxis is defined by a number of signs and symptoms, alone or in combination, which happen within minutes, or up to a few hours, after exposure to a provoking agent. It can be mild, moderate to severe, or severe. Most cases are mild but any anaphylaxis has the potential to become life-threatening.

Anaphylaxis develops rapidly, generally reaching peak severity within 5 to 30 minutes, and may, rarely, final for several days.


The term anaphylaxis is often reserved to describe immunological, especially IgE-mediated reactions. A second term, non-allergic anaphylaxis, describes clinically identical reactions that are not immunologically mediated.

The clinical diagnosis and management are, however, identical.

When does allergic rhinitis develop?

Allergic rhinitis typically develops in childhood. It is part of what we call the Allergic March, where children first develop eczema in infancy, sometimes followed by food allergy, and then go on to develop allergic rhinitis and then asthma.

The onset of dust mite allergy occurs often by the age of two, with grass pollen allergy beginning around three to four years of age. Tree pollen allergy develops from about seven years of age.

It is not unusual to develop hay fever during adulthood.

It can take as few as two to three seasons to become sensitised to pollen, but it depends on the individual.

Symptoms and Signs of Anaphylaxis

The initial manifestation of anaphylaxis may be loss of consciousness. Patients often describe "a sense of doom." In this instance, the symptoms and signs of anaphylaxis are isolated to one organ system, but since anaphylaxis is a systemic event, in the vast majority of subjects two or more systems are involved.

Gastro-intestinal: Abdominal pain, hyperperistalsis with faecal urgency or incontinence, nausea, vomiting, diarrhea.

Oral: Pruritus of lips, tongue and palate, edema of lips and tongue.

Respiratory: Upper airway obstruction from angioedema of the tongue, oropharynx or larynx; bronchospasm, chest tightness, cough, wheezing; rhinitis, sneezing, congestion, rhinorrhea.

Cutaneous: Diffuse erythema, flushing, urticaria, pruritus, angioedema.

Cardiovascular: Faintness, hypotension, arrhythmias, hypovolemic shock, syncope, chest pain.

Ocular: Periorbital edema, erythema, conjunctival erythema, tearing.

Genito-urinary: Uterine cramps, urinary urgency or incontinence.

Severe initial symptoms develop rapidly, reaching peak severity within 3-30 minutes.

There may occasionally be a quiescent period of 1–8 hours before the development of a second reaction (a biphasic response). Protracted anaphylaxis may happen, with symptoms persisting for days.

What to do when you own really bad allergies

Death may happen within minutes but rarely has been reported to happen days to weeks after the initial anaphylactic event.

What causes allergic rhinitis?

The most common triggers for people with allergic rhinitis are pollen, dust mite, pet and mould allergens.

Seasonal allergic rhinitis (hay fever) is generally triggered by wind-borne pollen from trees, grass and weeds. Early spring symptoms point to tree pollen, while nasal allergy in tardy spring and summer indicates that grass and weed pollens are the culprits. And overlapping the grass season is the weed pollen season, which generally starts in tardy spring and extends through to the finish of summer.

In New Zealand the seasons are not extremely distinct and they vary throughout the country because of the diverse climates.

The season starts about one month earlier at the top of the North Island than the bottom of the South Island. Thus the hay fever season is not extremely well defined.

Allergic rhinitis that persists year-round (perennial allergic rhinitis) is generally caused by home dust mites, pets, or mould. People with allergic rhinitis are often allergic to more than one allergen, such as dust mite and pollen, so may suffer from symptoms for months on finish or every year round.

Irritants such as strong perfumes and tobacco smoke can aggravate this condition.

Foods do not frolic as large a role as had been thought in the past.


Non-sedating antihistamine tablets or liquid are useful in alleviating some of the symptoms of rhinitis.

They are helpful in controlling sneezing, itching and a runny nose, but are ineffective in relieving nasal blockage. They can be used alone or in combination with other medications, such as nasal sprays.

Corticosteroid (anti-inflammatory) nasal sprays reduce the inflammation in the lining of the nose. They work best when used in a preventative manner, just love preventers for asthma. For example, they may be used for weeks or months at a time during an allergy season. Enquire your doctor about the appropriate medication for your condition.

Decongestant nasal sprays can be used to unblock the nose, but should not be used for more than a few days at a time.

Prolonged use may result in worsening of the nasal congestion.

Eye drops: The eye problems that sometimes happen with allergic rhinitis may not always reply to the above medications. Eye drops containing decongestants alone or in combination with antihistamine are available for mild to moderate eye problems. Eye irritation is one side effect. Prolonged use of decongestant eye drops can also cause rebound worsening when stopped. Some brands of eye drops can be used preventatively and are safe to use for prolonged periods — enquire your doctor for more specific information.

Saline washes may assist to clear your nose and soothe the lining of your nose.

These are available from most pharmacies.

Desensitisation, or immunotherapy, is used to 'turn off' the abnormal response of the immune system to an allergen if medication does not work. It is mainly used to relieve the symptoms of hay fever and allergic asthma to pollen, mould, home dust mite and pet allergen, as well as to control severe reactions to insect stings.

To start, a extremely dilute dose of the substance you are allergic to is istered by injection once or twice a week. This dose is gradually built up over three to four months on average, until a maintenance dose is achieved.

Shots are then given monthly for at least three years.

This method of treatment is the only one that deals with the underlying cause of allergic rhinitis. Not everyone benefits from treatment, however the vast majority of patients show at least some degree of improvement. Enquire your allergy specialist about whether you are a excellent candidate for immunotherapy.

Sublingual immunotherapy is another method, where drops of the allergen solution are taken under the tongue.

It is not widely used exterior of Europe.

This information is available as a fact sheet.

December 2008

This fact sheet is based on information available at the time of going to print but may be subject to change. It is significant to remember that we are every diverse and individual cases require individual medical attention. Please be guided by your GP or specialist.

Acknowledgments: We would love to Associate Professor Rohan Ameratunga, Clinical Immunologist, Auckland Hospital, for assistance in writing this information.

This fact sheet is also based on information provided by the Australasian Society of Clinical Immunology and Allergy and the National Asthma Council Australia.

What Are Skin Allergies?

Skin allergies happen when your skin comes in contact with an allergen that your skin is sensitive or allergic to. Also, allergies to other things, love food you eat or proteins you inhale or touch, may cause symptoms to appear on your skin. The allergic reaction generally appears within 48 hours after the initial exposure to the allergen. Symptoms often include the following: redness, swelling, blistering, itching, hives and rashes.

The allergen doesn’t own to be new to you. It can be something you’ve been using or eating for numerous years. Common skin allergies include allergic contact dermatitis, eczema, chronic urticaria and angioedema.

What Is Anaphylaxis?

Anaphylaxis (anna-fih-LACK-sis) is a severe allergic reaction that can be life-threatening and requires immediate medical attention. It happens quick and may cause death. Symptoms generally involve more than one part of the body, such as the skin or mouth, the lungs, the heart and the gut. Study more about anaphylaxis.

What Is Rhinitis (Nasal Allergies)?

The expression rhinitis means “inflammation of the nose.” When the nose becomes irritated by allergens or irritants, it may produce more and thicker mucus than usual.

This drainage can irritate the back of the throat and cause coughing. Allergic reactions can also cause congestion, itchy nose or throat, sneezing, a runny nose and itchy, watery eyes.