Anaphylaxis Treatment and Management in Singapore
Anaphylaxis is a severe allergic reaction that develops rapidly and can affect breathing, blood pressure and other vital systems. It is considered a life-threatening medical emergency, and immediate treatment is essential.
Once the immediate emergency has been managed, identifying what triggered the reaction is an important part of reducing the risk of future episodes and having this knowledge can help prepare you if another reaction occurs.
What Is Anaphylaxis?
Anaphylaxis occurs when the immune system overreacts to a normally harmless substance, known as an allergen. This triggers the rapid release of chemicals, including histamine, which cause widespread changes throughout the body.
These chemicals can widen blood vessels, increase the leakage of fluid into surrounding tissues and cause the airways to narrow. As a result, blood pressure may fall, swelling can develop and breathing may become difficult. Because multiple body systems can be affected simultaneously, symptoms can worsen quickly and require immediate emergency treatment.
Unlike milder allergic reactions, which may only cause localised symptoms such as itching or a rash, anaphylaxis affects the body as a whole. Symptoms typically develop within minutes of exposure to the trigger, although in some cases they may occur slightly later. Prompt recognition and treatment are essential, as delaying treatment increases the risk of serious complications.
What Should You Do During an Anaphylactic Reaction?
Anaphylaxis requires an immediate response. If you or someone around you develop symptoms that suggest anaphylaxis, such as difficulty breathing, swelling of the throat or tongue, or feeling faint after exposure to a known or suspected allergen, call 995 and seek emergency medical assistance immediately. If the person has been prescribed an EpiPen® because they are at risk of anaphylaxis, it should be administered without delay according to the prescribed instructions.
The following steps should be taken if an anaphylactic reaction is suspected:
Administer the prescribed EpiPen® immediately, if available.
An EpiPen® is a prescription adrenaline auto-injector carried by individuals who have been identified as being at risk of anaphylaxis. Use it according to the prescribed instructions, as adrenaline is the first-line treatment for anaphylaxis.
Call 995 for emergency medical assistance immediately.
Even if symptoms begin to improve after using the EpiPen®, emergency medical assessment is still required because symptoms can recur or worsen.
Help the person into a safe position while waiting for help.
If possible, lay them flat with their legs elevated to help maintain blood flow. If they are having significant difficulty breathing, they may be more comfortable sitting upright. Pregnant individuals should be positioned on their left side.
Administer a second EpiPen® if needed.
If symptoms do not improve or return after 5–15 minutes, a second prescribed EpiPen® may be administered if one is available, following the instructions provided with the device.
Remain under medical observation.
Even if symptoms appear to have resolved, medical observation is recommended because a second phase of the reaction can occasionally occur.
What Can Trigger Anaphylaxis?
Anaphylaxis develops after exposure to a substance that the immune system mistakenly identifies as harmful. Although many reactions occur in people with a known allergy, anaphylaxis can occasionally be the first indication that an allergy is present.
Common triggers include:
Foods such as peanuts, tree nuts, shellfish, milk, eggs and wheat
Medications, including certain antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs)
Insect stings, particularly from bees, wasps and hornets
Latex and, less commonly, certain medical products or substances
In some cases, exercise or a combination of factors, such as eating a particular food before physical activity, may also trigger anaphylaxis. Occasionally, no clear trigger can be identified despite thorough assessment.
Identifying the underlying trigger is an important part of reducing the risk of future episodes. This may involve reviewing your medical history, the circumstances surrounding the reaction and, where appropriate, allergy testing to confirm the cause.
Who Is at Risk of Anaphylaxis?
While anaphylaxis can occur in anyone, certain individuals have a higher risk of developing a severe allergic reaction.
Risk factors include:
A previous episode of anaphylaxis
A family history of certain allergic conditions or hereditary disorders associated with severe reactions
Asthma, particularly if it is poorly controlled
A known food, medication, insect sting or latex allergy
Certain underlying mast cell disorders, which increase the likelihood of severe allergic reactions
Having these risk factors does not mean anaphylaxis will occur, but recognising them can help identify individuals who may benefit from further assessment and emergency preparedness.
How Is the Cause of Anaphylaxis Identified?
Following an episode of anaphylaxis, identifying the trigger is an important part of reducing the risk of future reactions. An allergy specialist can conduct a detailed review of your symptoms, medical history and the circumstances surrounding the reaction, such as what you ate, medications you took or whether you were exposed to insect stings or other potential allergens.
Depending on your clinical history, further investigations may be recommended to confirm the underlying cause.
At Aaria Rheumatology, these tests may include:
Allergy Skin Tests
Allergy skin tests involve introducing small amounts of suspected allergens to the skin to assess whether an allergic reaction occurs. They can help identify allergies to foods, environmental allergens and insect venom, allowing your doctor to determine whether these substances may have contributed to your anaphylactic reaction.
Allergy Blood Tests
Allergy blood tests measure allergen-specific IgE antibodies in your blood to help identify substances that may have triggered the reaction. They may be recommended when skin testing is unsuitable or alongside skin tests to provide additional diagnostic information.
Allergy Provocation Challenge Test
In selected cases, an allergy provocation challenge test may be performed to confirm or exclude a suspected allergy when the diagnosis remains uncertain. As this involves carefully controlled exposure to a potential allergen, it is only carried out under close medical supervision when clinically appropriate.
Accurately identifying the underlying trigger allows your doctor to develop a personalised management plan that helps reduce the risk of future episodes.
How Can Future Episodes of Anaphylaxis Be Prevented?
Once the allergic trigger has been identified, the focus shifts to reducing the risk of future episodes and ensuring you are prepared should another reaction occur. Depending on your diagnosis, your management plan may include:
At Aaria Rheumatology, these tests may include:
Avoiding known allergens
Learning which foods, medications, insect stings or other substances triggered your reaction allows you to make informed decisions to reduce future exposure.
Regular specialist follow-up
Allergies and risk factors may change over time. Ongoing review allows your management plan to be updated as needed, ensuring you continue to receive appropriate guidance and support for long-term prevention.
Having an emergency action plan
Understanding how to recognise the early signs of anaphylaxis, when to use your EpiPen® and when to call 995 helps ensure you are prepared should another reaction occur.
Carrying a prescribed EpiPen®
Individuals at risk of recurrent anaphylaxis are typically prescribed an EpiPen® and advised to carry it with them at all times so that adrenaline is available if another reaction occurs.
Allergy immunotherapy
For selected patients with certain allergies, allergy immunotherapy may be recommended to reduce sensitivity to specific allergens. While it is not suitable for every type of allergy, it may help lower the risk of future allergic reactions in appropriate cases.
Be Prepared for Future Anaphylactic Reactions
with Dr Anindita Santosa
Anaphylaxis can develop rapidly and requires immediate emergency treatment, but care should not end once the reaction has resolved. Identifying the allergen responsible and knowing how to avoid it, recognise warning signs and respond to another reaction can help reduce the risk of serious outcomes in the future.
At Aaria Rheumatology, patients can receive personalised allergy assessment and long-term management following an anaphylactic reaction. As an allergist, Dr Anindita Santosa can investigate potential triggers through appropriate allergy testing and develop an individualised plan to help you avoid known allergens and prepare for future reactions.
If you have experienced anaphylaxis or a suspected severe allergic reaction, do not wait for another episode before seeking specialist assessment. Book an appointment with Dr Anindita Santosa to better understand your triggers and how to manage your risk.
