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Allergic emergency > Anaphylaxis
Which are the signs and symptoms of anaphylaxis?
As mentioned above in anaphylaxis, symptoms involve several organs, the skin, mouth and throat, airways, heart and blood vessels and digestive tract (stomach and intestines) being most often affected.
  • Skin. Nine out of ten people with anaphylaxis develop skin symptoms. The most common skin manifestations include:
    • Urticaria (hives) which can occur on a limited area of skin or can cover the whole body surface. Sometimes hives can merge giving rise to red plaques measuring several centimetres in diameter.
    • Swellings. The hives as well as the plaques can be flat but very often you may notice that they are swollen compared to areas of normal skin. Skin swellings frequently accompany swellings of the mouth or throat lining (mucosa).
    • Itching very often accompanies the skin eruptions. However, it can precede the appearance of urticaria or, more rarely, can be the sole skin symptom during an anaphylactic response.
    • Redness. Hives and plaques are usually red in appearance.
Very often, skin symptoms are the first ones to appear. Sometimes they can remain the sole manifestation of anaphylaxis but very often they are followed by other symptoms in other organs. Skin symptoms are not dangerous in themselves but you should pay particular attention to them and always consider them very seriously because they can be a warning sign of more severe and dangerous symptoms.
Tip: If you have experienced an anaphylactic reaction before, never underestimate the importance of any skin symptoms such as tingling, itching, redness, hives or swellings occurring suddenly, especially when you are in a similar situation to the one when the previous reaction has occurred. They can be the first sign of a new anaphylactic attack. Make sure that you have your epinephrine pen and the rest of your emergency kit available and ready to use. Tell the people you are with that you are not feeling well and tell them what to do if you lose consciousness. (Note: You may know Epinephrine on its an alternative name Adrenaline.)
Skin symptoms can remain present for the whole duration of the anaphylactic attack or they can be transient subsiding after a variable period of time. 
Tip:  disappearance of skin symptoms does not necessarily indicate the end of the anaphylactic attack. In many cases allergic symptoms (sometimes very severe ones) develop in other organs after the skin symptoms have faded. 


  • The mouth and throat are affected in approximately a half of people who suffer an anaphylactic attack.  
Tip: it is more likely that mouth and throat symptoms will develop if the allergen is ingested (as is the case of food allergens) than if the allergen is injected (i.e. insect venoms or many drugs). 

Most frequently an allergic reaction taking place in the mouth and throat will cause at least one of the following symptoms:
  • Swelling of the lips, tongue or throat lining. This is the most dangerous manifestation and will cause of all the symptoms bellow.
  • Speech difficulties 
  • Breathing difficulties 
  • Swallowing difficulties 
  • Itching and tingling which can be perceived in the lips, mouth or throat.  
Swelling (oedema) of the lining covering the mouth and the throat is the main expression of an allergic reaction taking place at this level with all the other symptoms being a consequence of mucosal swelling. The major danger is represented by extreme difficulty of breathing that can occur in the case of a massive swelling of the mouth or throat.
  • Organs involved in breathing. Breathing difficulties are the second most frequent manifestation of anaphylaxis. Up to six out of ten people with anaphylactic reactions develop breathing problems which can arise in the nose, mouth, throat, larynx or bronchi.  
Nose: up to 20% of people developing an anaphylactic response manifest rhinitis like symptoms:
  • Itching 
  • Sneezing 
  • Nasal dripping 
  • Nasal blockage  
These symptoms can be the first manifestation of anaphylaxis or they can accompany symptoms in other organs. They are not dangerous symptoms in themselves but should not be overlooked as they can be warning signs of development of more severe symptoms. 

Larynx involvement causes a swelling of its mucosa. This swelling can be so severe as to lead to asphyxia (breathing impossibility) due to a complete blockage of the larynx which prevents the air moving in and out of the lungs. The larynx is very often involved in parallel with the mouth and throat. Symptoms suggesting larynx involvement are:
  • Itching perceived in the throat 
  • Swallowing difficulties 
  • Hoarseness 
  • Sensation of a lump in the throat 
  • Breathing difficulties  sometimes associated with a whistling sound coming from the throat  
Breathing difficulties due to swelling of the mouth, throat and larynx are one of the major causes of death in anaphylaxis. Two critical aspects are essential in helping you to prevent breathing arrest:
  • You have to be very familiar with and able to recognize immediately the very early signs suggesting involvement of these organs
  • Immediate use of your epinephrine auto-injector, whenever these signs are present.   
  • Bronchi. In up to half the people, anaphylaxis causes an allergic response in the bronchi which manifests as an asthma attack. Sometimes the narrowing of the air passages can be so severe as to block them completely, leading to a total inability to breathe. This is another important cause of death in anaphylaxis. You should suspect a bronchial involvement whenever you have one or more of the following symptoms:
    • Dyspnoea is difficulty of breathing in and out
    • Wheezing sounds accompanying the breathing movements
    • Cough
    • Sensation of chest tightness  
  • Heart and blood vessels  are affected in about 1/3 of people manifesting an anaphylactic reaction.   
Most commonly when one of these organs is involved you will have at least one of the following symptoms:
  • Palpitations 
  • Increase in heart rate 
  • dizziness, sensation of light headedness and even loss of consciousness which are caused by a fall in blood pressure due to an extensive enlargement (dilatation) of the blood vessels.   
Severe fall in blood pressure and cardiac arrest, together with breathing difficulties, are the most important causes of fatalities related to anaphylaxis. 

Tip: breathing and cardiac arrest are the leading causes of death in anaphylaxis. 
Early and correct administration of an epinephrine shot from your auto- injector can save your life by reducing the swelling of the mouth, throat and larynx and reversing the narrowing of the airways and the fall in blood pressure.
  • Stomach and intestinal  symptoms are perceived by about 1/3 of people with anaphylaxis. The symptoms are caused by a swelling of the lining of these organs which can disrupt the flow of their contents and accentuate their normal contractions (which propel the contents). Symptoms perceived due to stomach and intestinal involvement:
    • Nausea 
    • Vomiting 
    • Diarrhoea 
    • Abdominal cramps