The Science of Anaphylaxis – An Allergic Storm


“Education leads to enlightenment.  Enlightenment opens the way to empathy.  Empathy foreshadows reform.”  -  Derrick A. Bell

The death of Ammaria Johnson is heart-wrenching for all of us.  An innocent 7 year old dies at school from peanut-induced anaphylaxis because her life-saving medication, epinephrine, was not available to her.  This is a grim reminder of the life-threatening nature of food-induced anaphylaxis and a very serious reminder of the critical need for massive food allergy education.

So, here’s what I am going to do.  I am going to teach you what happens in your body during an allergic reaction.  I want to do this for two main reasons:

1.  TO EMPOWER YOU.  Science is power.  It’s the proof.  And because food allergy is a term used relatively loosely, food allergy families and friends often find themselves feeling like they have something to prove. If you can use the words “mast cell” and “histamine” when you are describing food allergy to someone, they will have less opportunity to question you, to doubt you.

2.  TO HELP YOU EDUCATE OTHERS. If you have a clear understanding of how food allergy works and why epinephrine will save the life of someone who is experiencing anaphylaxis then you can be a better and more confident educator.  You will become an authority on food allergy.  You’ll have the facts in your back pocket.  People will listen because science is power.

I was at a kindergarten social for Sal and two fathers asked me why Gino and Milo didn’t go to the same school as my older son.  I explained that for preschool we hired a teacher for the boys because they have life-threatening food allergies and we didn’t think they were ready for a traditional food-filled preschool setting.  They just looked at me.  I felt doubt.  I felt judgment.  I felt misunderstood.  So instead of continuing with the normal, “So, anyway, I grew up in Bourbonnais.  What about you?” conversation, I thought I would give something else a try.  I asked them if they would mind if I took a few minutes to explain, scientifically, what happens during an allergic reaction.  They agreed, mostly to humor me.  (How could I blame them?  It was a pretty nerdy opening line.) As I spoke, the way they looked at me changed.  Their body language shifted from cross-armed and distant to relaxed with their body’s leaning in toward mine.  They were shifting from doubt to empathy before my eyes.  They were engaged.  As I was teaching them, they had no choice but to learn.  It was a powerful moment for me and later, I found out, for them too.  I am going to tell you what I told them.

The human immune system has an extraordinary eloquence and precision.  Nothing man-made can compete with its beauty and power. With that being said, this is a greatly simplified version of what happens during an allergic reaction but I think it is all you need to become an empowered educator.  Okay, friends, are you ready?

There are two main allergic cells in your body, the mast cell and the basophil.  These cells contain within them pockets (or granules, seen in red in image below) filled with chemicals that mediate allergic disease.  Mast cells are found docked in tissues whereas basophils are floating around in the blood.   Both of these types of cells have receptors on their surface.  Some of these receptors have IgE (immunoglobulin type E) antibodies attached to them. Think of the IgE antibody as a hand that projects out from the cell (seen in dark blue, shaped like a “Y” in image below).  Each of the hands will only grab onto specific food proteins.  They have a favorite food, so to speak.

Those are the main cellular players.  Now here’s what they do.  An individual eats a food to which he or she is allergic.  Let’s say it is a peanut but it could be virtually any food.  The peanut enters the gastrointestinal (GI) tract, whether it is peanut residue that cannot even be seen or an actual piece of a peanut.  At some point, the tiny allergenic peanut protein passes thru an insecure barrier in the wall of the GI tract.  The peanut protein then finds its way, through a series of events, to the blood stream and tissues.  Here is where the peanut protein finds the mast cells and basophils.

Now, there are those “Y”-shaped IgE antibodies (the hands) on these mast cells and basophils, remember?  The hands on some of the cells of a peanut-allergic person are looking for peanut protein.   When these hands make contact with the peanut protein, they grab onto it and in turn, the cell becomes “excited”.

The pockets of chemicals (granules) found within the cells quickly move to the edge of the cell and pour their chemical contents out into the bloodstream or tissues (degranulation). The chemicals spewing from these cells (seen in red in image below) include histamine and tryptase, among others. This process of degranulation can occur very rapidly and does not just occur in a few cells but instead in many cells all over the body.  This process occurs even if there was only a miniscule amount of peanut protein that originally started the reaction, even if the blood test showed a low number for peanut, even if all of the past reactions were minor.  If this process were not deadly, I would say that the efficiency and rapidity of the reaction borders on fantastic.

Histamine, tryptase and the other chemicals that are now swirling in the blood and the tissues start to wreak immediate havoc and the signs and symptoms of anaphylaxis are quickly evident.  Anaphylaxis hits as sudden as a summer storm.  The damage is frightening and widespread.  Histamine causes many changes to occur in the body.  Some of these effects are more considerable than others.  Histamine causes smooth muscles to contract leading to abdominal pain, cramping, nausea, vomiting and diarrhea.  It can lead to wheezing (like asthma) from airway constriction that can ultimately lead to respiratory distress, respiratory arrest and death.  Histamine also causes vasodilatation.  This is when blood vessels get bigger and have less ability to contract to get blood back to the heart.  This can cause a decrease in blood pressure that can lead to dizziness, feeling faint, shock and death.  Histamine also induces microvascular leakage.  This means that both cells and fluid that are supposed to stay in the blood vessels are able to leak out of the blood vessels.  This can lead to hives, itching, and swelling of the throat leading to suffocation.  If enough fluid leaks out of the blood vessels, there can be accompanying decrease in blood pressure leading to shock and death.  Histamine can also cause marked mucosal edema and mucus secretion.  It can cause the airways to become swollen and filled with mucus making it difficult for oxygen to get from the air we breathe into the blood that circulates around our body.

Now we are in the midst of anaphylaxis, WE MUST STOP IT.  YOU MUST USE INJECTABLE EPINEPHRINE.  How does epinephrine work to stop an allergic reaction?  You need to know this.  You need to understand WHY you must carry this everywhere you go.  You need to know WHY you must use this medication when your son or daughter, parent, grandchild, student, or friend is having a serious allergic reaction.  I told you how fast these reactions occur (and many of you have seen the speed of a reaction first hand) so there is no time to waste. If someone is experiencing anaphylaxis, injectable epinephrine must be given immediately.  Be a hero. Save a life. Don’t be afraid. Once you give the injectable epinephrine as instructed, here is what it does…

Epinephrine constricts blood vessels.  This is important because it curbs that microvascular leaking that leads to decreased blood volume and plummeting blood pressure, potentially leading to shock and death.  Epinephrine relaxes airways.  So while histamine is trying to make the airways tight, epinephrine tries to relax them in order to allow air to pass more easily.  Epinephrine helps to decrease swelling in the upper airway so that air is not obstructed from getting to the lungs.  It decreases cramping of the GI tract.  It helps to block the hives and itching that accompany an allergic reaction.  Epinephrine can help to stop anaphylaxis from progressing to death if given early and appropriately.   It is the only thing that can.  Antihistamines can relieve some of the skin symptoms (hives, itch) but they do not have the ability to save a life from anaphylaxis.

To summarize:  The food that one is allergic to enters the body.  It finds its way to allergic cells (mast cells and basophils) that recognize only certain foods through their IgE antibodies.  Once the allergic food protein binds to that IgE, the cell pours out chemicals (histamine and tryptase) that cause swelling, itching, decreased blood pressure, and can ultimately lead to death.  Epinephrine counteracts these effects.  It decreases swelling, increases your blood pressure, makes your heart pump better and helps to prevent a fatal reaction.

That is anaphylaxis in a nutshell, so to speak.   This is why it can be deadly and this is why epinephrine can save a life.  Please share this post with your friends, families, teachers, administrators, school nurses, physicians, and anyone else you can think of.  I know it is a long post but it is so very important.  If we do not push to educate others, I’m afraid that we are going to continue to lose our sweet and innocent food allergic children to anaphylaxis.  We simply cannot stand for this and, if I know anything about families who have children with food allergies, I know we won’t stand for this.  There is too much at stake.

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110 Responses to The Science of Anaphylaxis – An Allergic Storm

  1. Lynn says:

    Thank you very much for this explanation. It is simpler than others I’ve seen (and we can probably simplify it even more, since simplicity seems to work best in communicating about this condition). Your blog is a public service and I’ve enjoyed reading it.

  2. Becca says:

    Beautiful job, Sarah. I learned a lot!!!

  3. Shannon says:

    Fantastic! Thank you so much!!!

  4. Kelli Gill says:

    This is a fantastic description of Anaphylaxis and food allergy. I love it. My daughter has an allergen alert service dog, he smells and alerts to peanut residue. We are headed to a few local schools to educate kiddos, teachers and whoever else will be there, on food allergies and diversity of service dogs. May I use some of your content to explain to the groups about food allergies and anaphylaxis? It is very important to hit home with down to earth understandable explanations…and not a bunch of huge words kiddos won’t understand. I will be sure to quote you and give out your web address here so they can follow your posts as well. God Bless and many prayers to you and yours.

    • Sarah says:

      I would be honored if you would use this information to continue to educate! That is exactly why I started this blog, so, thank you! Please let me know how it goes!
      Good luck!

      • Kelli Gill says:

        I will keep you updated on how things go. Thank you for allowing me to use some of this. :) Going to be heading to a College Campus as well as elementary schools. Love the story about Santa Clause as well. Very well written and a tear jerker. It would be very hard having children who are very ill whispering wishes to you… I know when we were fund-raising for my daughter’s Allergen Alert Service dog, we had children who were very sick put money into our collection can. Two that stick out in my mind are a little boy, maybe 5 or 6 years old…had a cancerous tumor on his neck/jaw area, been through multiple surgeries and such..he walked slowly to my table and put a dollar in our can. Also a mother of a little 14 month old baby girl. She gave me a dollar. Her baby girl was suffering from kidney and liver failure. Had oxygen tubes coming out of her nose. It was heart wrenching. Well, again…thank you. God Bless you and yours.

  5. Erin says:

    Sarah, thank, again, for nailing it on the head. Thanks for starting the blog. Unfortunately sad we have to deal with food allergies, and I can’t imagine being as overwhelmed with multiple anaphylactic allergies as you are. What you are doing for everyone is fabulous. (and oh, the pic of the storm on LSD is fabulous, making me nostalgic for Loop living. May have to steal that for my profile photo). Hug your kids and yourself for me…. xo

    • Sarah says:

      That was one seriously scary storm! When I was trying to find a picture that depicted anaphylaxis, it was the first to come to mind. One of my favorite things to do is to take pictures… especially of the sky over the lake!
      Thank you for you kind comments, as always…

      • Anonymous says:

        I had a few friends post pictures of the storm…. friends who live on 680 LSD and a few other random places have cool photos, too, but yours is the best I’ve seen. And yep, depicts anaphylaxis so very well.

        • Sarah says:

          Thank you!! What a great compliment! I LOVE taking photos, especially of the storms that come in over the lake. That one was incredible.
          Thank you for reading!

  6. Dallas says:

    I wonder if you would mind clarifying a couple of questions that come to mind.

    “The peanut enters the gastrointestinal (GI) tract… the tiny allergenic peanut protein passes thru an insecure barrier in the wall of the GI tract (squeezes through a weak point in the fence). The peanut protein then finds its way, through a series of events, to the blood stream and tissues.” Does this mean that allergic reaction does not happen if the protein never gets out of the GI tract, only when it hits the blood stream? If your child has a “leaky gut” are they more at risk of that miniscule amount getting through and could they be safer if you take steps to heal the gut wall, such as with the GAPS diet protocol–even if they are still allergic?

    Thanks a million!
    Dallas, mom of multiple food allergies

    • Sarah says:

      Hello Dallas,
      Thank you for your questions. Many of these questions do not have definitive answers. Here is a quote from an article I will link you to: “Recently, studies in both murine models and human subjects have suggested that alteration of the physiologic barrier function (eg, decreased gastric acidity caused by potent antacids) can lead to increased IgE sensitization in both children and adults.17 Additionally, altered intestinal permeability leading to increased exposure to intact proteins might promote sensitization and might enhance the severity of food- induced allergic reactions.18″ How we fix this? I wish I knew… :)
      Take care,

      • Dallas says:

        Thank you! I’m feeling a little sick to my stomach about the Zantac she was on from 4 to 16 months. :(

        • Sarah says:

          My little guy was on it too. Ya know what, it’s only a hypothesis, a guess. We don’t know it for sure. Never blame yourself. If they are destined to be allergic, they will be. I had twins, did the same thing for both of them, one is allergic to two things and the other 20+. It’s written in the stars… You are a great mom.
          Thanks for reading!

          • Anonymous says:

            Yikes! My FAK also has bad reflux and eosinophilic esophagitis….has been on Zantac basically since birth. uuuugh. If not one thing, another, right? (and btw…a few EPIC articles I’ve read have had a loose ass’n btwn EE and anaphylaxis…. like, less of a chance my kid will outgrow the FA’s. Awesome). (note sarcasm).

          • Sarah says:

            EE… another allergic beast… We haven’t had our son tested/scoped but I just know that he has EE. It is so hard to add that on top of FPIES and anaphylaxis. Maybe they won’t lose their allergies on their own as easily but all the more reason to work even harder toward finding a treatment!
            Thank you for reading!

  7. John Conversa says:

    I’m going to have to read this a few more times to get it, but it always amazes me how these things are discovered and even more so how they are treated! Thank God for Science, Research and all of you in the Medical Field!

  8. Jennifer says:

    Thank you for sharing this. The way you explain the reaction, with illustration, is brilliant. I will be sharing this with family, friends, and relatives.

    • Sarah says:

      I am so happy to hear that you will be sharing this information. It is SO important as you know!
      Thank you SO much!!

  9. Gretchen says:

    Please sign the letter to the senate to make epi-pens available in schools without a prescription: It’s easy! Pass it on.

  10. Renata says:

    What a clear and simple explanation of anaphylaxis! I am sharing it with all my social media connections as I type this.
    Thank you for your great service to the FA community!

  11. Lindsey says:

    Thank you so very much for this simple explanation of exactly what occurs in the body during an allergic reaction. This is incredibly valuable information, I will certainly share this with my world, I know others will as well with their own.
    Education is so very important, thank you for helping us help others!

    • Sarah says:

      I am so glad that you found this information so valuable. You are doing such a big part in spreading the education by sharing this post. I appreciate your support!

  12. Carolyn Conversa says:


    Thanks for the thorough explanation! Quite amazing! The summary will come in handy when I inquire about what systems are in place for protecting children with allergies with our daughter’s future High School Principal. Happy New Year to you & your family!

    Carolyn Conversa

    • Sarah says:

      Please let me know if there is anything that I can help with in terms of school education. Thank you for reading! Happy new year to you and yours too!!

  13. Pamela Price says:

    Thank you so much for sharing this description. And you’re right–we have to push ourselves to educate others.

  14. Diana says:

    This is great, Sarah, thanks for writing this out for us. It is so scary and I try not to think about it most of the time but you are right, knowledge is power.

    We need to keep this tragedy from happening again.

    • Sarah says:

      As I wrote and rewrote and rewrote this, I found myself tearing up many times… thinking that I was talking about a reaction that could happen to my children… It is so very hard to read. Thank you for reading though.
      Take care,

  15. Sarah,
    Being a healthcare educator for the majority of my adult life, I can only tell you how much I appreciate your approach in educating the world regarding food allergies through your words, illustrations and photos. Your blog is being read worldwide and what you described is universal. My hope and prayer is that your lesson gets spread to the world! I feel that if every doctor who hands over a new diagnosis of food allergies would send their patient and/or parents to your website to get a deeper understanding of food allergies they would be giving these people some power, as you said, “science is power.” Momma

    • Sarah says:

      Thank you, Mom. I think that watching you educate my whole life gave me wonderful insight into helping people understand what you are trying to teach them. I learned by example, yours… Thank you!! Love you.

  16. Poonam says:

    first of all i’d like to congratulate you for starting something so great like this. there are a lotta ppl out there who need to be educated who just dont understand and know the ‘seroiusness’ of food allergies and anaphylaxis.
    your article is gonna help so many moms like me in teaching and reaching so many others. i always used to think HOW can i explain to ppl about an anaphylaxis or exactly what happens inside the body during an attack and your article has JUST answered IT.
    thank u so much sarah for such an informative article.
    God bless u and ur kids a long and healthy life :)


    • Sarah says:

      Thank you so very much! I was really hoping that this article would reach people in a new way and that they would be able to use it as a resource in educating their friends, family, schools or anyone else they come in contact with where food allergy is an issue. Hearing from you and how you plan on using this blog is very important for me. Thank you from the bottom of my heart.
      And God bless you as well,

  17. Heather Haigh says:

    Thank you so much for this piece! I think it will be a great resource for education and training of teachers, parents and family. Thank you and best wishes for your family.

    • Sarah says:

      Thank you for reading and for your kind comment. Please use this article to teach as many people as you can!
      Take care,

  18. Malea says:

    Thank you for sharing this information! I plan to do a blog post about our allergy experience, and will add a link to your incredibly informative post.

    We are constantly sharing information about allergy with our friends, family, and strangers. It is vital that we do so even though my son has never had a life-threatening reaction (although he has choked while vomiting from a food allergy reaction – a whole different kind of life-threatening reaction with that, right?).

    Thanks again for the great info.

    • Sarah says:

      Thank you for planning to share this link on your blog. The more we can get this important information out there, they better off we all are!
      Take care,

  19. Jewelles says:

    do you have a printer friendly copy of this post? This is a great explanation of food allergies and I have already shared the link on my social networks sites. I personally have multiple food allergies and both my sons have allergies as well (one has multiple and the other only one food allergy).
    I have a few family members who are not on the internet and I would like to send them a copy of this article.
    thank you so much for posting this. I can assure you not a single doctor that we have seen has explained anaphylaxis this well.

    • Sarah says:

      I really do not know how to make this a printer-friendly copy via the website but you could perhaps just copy and paste in Word? It is hard with the photos but you could print these out separately. Sorry that I don’t know how to make this easier for you!
      Thank you for reading and for the wonderful compliment!

  20. Angie says:

    I have a question, if you don’t mind. When someone has an anaphylaxis reaction, it happens quickly, it can set in say hours later? Also, how do you know when someone is having an anaphylaxis reaction and not choking? Also, you stated “Epinephrine can help to stop anaphylaxis from progressing to death if given early and appropriately., how early do you give it to make sure it saves their life?

    My daugther has multiple food allergies, and while she has never had an anaphylaxis reaction, I want to make sure I am as prepared and educated as possible in case it ever happens. Thanks so much!!!

  21. Lori says:

    Hi Sarah,
    Thanks for this post! I have incorporated the information into a power point presentation I am planning to use to educate staff at my children’s school. Food allergies are not taken at all seriously here in South Africa and I have been trying for the last 3 years to get them to have a workable allergy protocol as well as staff training. I am slowly getting there. Now I have the science behind it, so I am a very happy person!
    Question1: What is tryptase and what does it do?
    Question2: Do the “hands” only look for food protein the body is allergic to, or do they pick up all food proteins (according to their favourite) and just not react to the ones they see as “okay”?
    I anticipate these questions being asked.

    • Sarah says:

      So happy that this will be so helpful for you! Tryptase also is released from mast cells during an allergic reaction. It is similar in function to histamine. It lasts for a shorter time in your blood stream and it can be used as a marker for anaphylaxis. The “hands” question gets very complicated. There are some people who have IgE “hands” that bind a certain food but in fact, do not react. This does not happen very often so if they ask this question, focus them back on the food allergy conversation :)
      Let me know how these talks go, please!
      Take care,

      • Jenni says:

        You state above that “Tryptase can be used as a marker for anaphylaxis”, does that mean one can be tested to find out if their reaction will be anaphylaxis? My PA child has only vomited as a reaction (2x) and we take all of the precautions (carry Epi-pen, etc…) but it would be nice to know. Thanks for your explanation and blog!

        • Sarah says:

          Tryptase can be used as a marker of anaphylaxis if obtained shortly after an allergic reaction occurs, as it is released by mast cells. Food-induced anaphylaxis may not always result in an increased tryptase however. Tryptase is not used to determine the possibility of having anaphylaxis. It is always good to take all the precautions because there is very little that can determine the seriousness of each encounter with the allergenic food.
          Thank you for your question and for reading!

  22. amy says:

    Thank you for writing this as it can be very difficult to explain to non-allergic people. I hope some day for a cure. I have a 10 yr old who is absolutely anxiety ridden about her allergy and it is so sad that she can’t just be a carefree kid. But having that said, she is extremely responsible where carrying her Epipen and Benedryl with her where ever she goes!

    • Sarah says:

      I hope this post will be able to help you as you continue to educate. I am so sad to hear about your daughter’s food-related anxiety. It is so prevalent. Does she have any friends who have food allergies? If not, have you thought about trying to get her connected with another girl her age who has similar allergies? Just an idea. Well, I am proud of her for carrying her medications everywhere, that should ease some of her anxiety. She will be prepared if she needs it. Big hug to her and you!

  23. Pingback: The Science of Anaphylaxis / We Need Epi-Pens in Schools! | World (and Lunar) Domination

  24. Rebecca says:

    Thank you for posting this. I am a nutritionist and I always try to come up with a better way to teach my clients and I also have a 2 y o son who has PA. Thanks again.

  25. Bea says:

    Thank you so much for this amazing explenation. My son is 15 months and has multiple allergies which I feel I’ve become a slave to them. Its all very new to me so I am lerning as we go. My family and friends often think
    I am over reacting but in all honesty I am just worried abut my son’s life. I could not bare it if something were to happen t him. My biggest fear is when he comes to the age were he has to go to school; Will they care for my darling boy like I would? The 7 year old girl that just died really hit home for me and just hope all the schools get it together and educate themselves when it comes to FA.

    • Sarah says:

      Thank you for your kind words about my post.
      I can completely understand your fear about school. I worried about this up until the day they first started kindergarten and now that they are in school, I still worry everyday… but having a school that works with you, is educated about food allergy and has a school nurse who understands how to evaluate and treat food allergies is how you will be able to do it.
      Don’t let people make you feel like you are overreacting. It takes a while to find a good balance. The older the kids get, the easier it gets (not that it is ever easy!) When I was first getting bombarded with food allergy and the kids were so young, I was so overwhelmed and scared and protective. What was my other choice? You do what you have to do to keep your child safe. That’s it. Keep with it. It does get a bit better.
      Feel free to reach out to me or other people who comment for support,

  26. Ilene says:

    Your description exactly describes how I feel when having a reaction. This is a great explanation that I can use with people I meet. Some people seem to have a hard time understanding the word allergy. Having a technical description of what happens will really help.

    • Sarah says:

      I am so happy that you feel that this explanation will be helpful to you when you educate others about food allergy. That is exactly why I took the time to write it!
      Take care,

  27. Alex says:

    Thanks for the easy to understand explanation.

  28. Marisa Nachman says:

    Very detailed explanation. Requires a few readings. Epinephine should be in First Aid kits.

    • Sarah says:

      It definitely requires a few reads to get a really god handle on it. It isn’t easy stuff!! Thank you for taking the time to read and learn. And I agree, Epi should be in first aid kits.

  29. Carlee says:

    Thank you for enlightening us all and for your continued advocacy for all our kids!

  30. Anne Burgess says:

    Thank you, Sarah, for your continued education to us in the FA community and helping educate the world. I’m always looking for new or better ways to provide education to others when speaking about my son’s peanut allergy & the importance of always having that epi available. Having had an anaphylactic reaction myself recently(trigger unknown), I can tell you that shot of epinepherine is like gold running through your body. Keep up the wonderful work!

    • Sarah says:

      I really appreciate you reading my blog and for your kind words. I hope that this post helps you to continue to do the education that you must do in order to keep your son (and yourself!) safe. Thanks again!

  31. Melinda says:

    As a mom of a 3 year old boy who has experienced anaphylaxis twice, I want to thank you for posting this. I have devoted much of the last 2 years to learning as much as I can about food allergies and anaphylaxis, and this is by far the best explanation that I have found. I have shared it on Facebook and Twitter, and emailed it to several family members and friends.

    Thank you again.

    • Sarah says:

      What a compliment! Thank you very much for reading and for sharing this post with others. So sorry to hear that you have had to witness your son experience anaphylaxis twice – I hope there is a treatment soon so that we don’t ever have to watch our children so sick again.
      Take care,

  32. Teri says:

    You have most likely saved lives with this article. I’m not joking. So few people understand just WHY an Epi-pen is so crucial. So many adults who have fatal food allergies don’t carry an Epi-pen thinking that food allergies are a kids’ problem–and so many of the adults they’re around wouldn’t even know to call 911 in the event of anaphylaxis. It’s a massive failing of governments from federal to local; we have over-education about things like obesity and yet nothing on this basic, basic type of first aid. I would love to see the day that every child in every school is taught how to administer an Epi-pen just as they might be taught the Heimlich maneuver, and adults see public service ads on TV and diagrams everywhere from company cafeterias to their doctors’ offices on how to administer epinephrine.

    Epi-pens need to be more ubiquitous than defibrillators; they need to be available anywhere food is consumed. Anyone can become anaphylactic at any time; I know adults who have spontaneously started with anaphylaxis to tree nuts and shellfish. It’s not just people like me who started with anaphylaxis spontaneously at the age of 6, despite the fact that I’d eaten peanuts for much of my short life. It still shocks me that fatal allergies to foods, drugs, and insect stings are so common, and yet so routinely ignored by public health officials in our government. The School Access to Emergency Epinephrine bill is a start, but as your article explains so clearly, we need to do so much more.

    Thank you for writing the best, most useful, and most detailed analysis of anaphylaxis I’ve ever read. I have spread the word and continue to spread the word that until we take anaphylaxis seriously, we are only dehumanizing people with fatal food allergies, at a tremendous cost to all society.

    • Sarah says:

      Wow, thank you for such a wonderful compliment about this post! I do hope that it saves lives – that is exactly why I spent so much time writing it. I have been thrilled with how much this article is being read and shared. I couldn’t agree more that we all need to step up and get everyone to understand the reality of anaphylaxis and understand how to treat it. It feels like an uphill battle but I think we are starting to make some progress. Please keep sharing the link to this article and encourage others to share it too. Thank you again, Teri.
      Take care,

    • Deidra says:

      You make a great point about how Epi-Pen is needed in any establishment that serves food. I ate nuts as a part of my every diet until one day, I suddenly had an anaphylactic reaction. I then realized that there were indicators, that I could be developing an allergy to nuts among many other things for quite some time, but I neglected to take it seriously just as you mentioned above. The point is that this could have happened to me anywhere. Luckily, I am less than 5 minutes away from a hospital but it would have been comforting to know that I could have been helped anywhere.

  33. Lisa Shaw says:

    Hi! Thank you so much for this article. My dtr has severe PA based on RAST test but we have not had to give meds before because her initial reaction was a small rash, prompting allergy testing, at 18 mos, and I have been vigilant about keeping her safe ever since. I have been told if she is having a localized reaction, lik a rash around her mouth, then give Benadryl, but if systemic signs are seen, use the Epipen. I think though if I had even an inkling she may be having any reaction, I would want to give the Epipen…is it risky to give it if you aren’t sure if she is having a severe reaction? Thank you so much! She did, btw, spend her 1st year of life on a PPI and even took it again during her third year of life for prolonged gastritis. I guess I should be thankful she does not have multiple FAs!

    • Sarah says:

      Thank you, I am so glad that you enjoyed the article. This link to Food Allergy Initiative’s website may help you in terms of when to give epi. Epi is a very safe medication for most individuals and if you think she is having a severe reaction, it is better to use it earlier than later. I hope you continue to read and share!

  34. Liosha says:

    Great Article!!! My son’s (6) school is in the same county as little Ammaria Johnson’s and I was heart broken. My son just recently suffered a bout with paint that included egg yolk as one of the ingredients. He begin to experience symptoms of Anaphylaxis, just from contact with the paint (got some on his shirt) . But I must say the school handled it very well and administered his EpiPen and called 911. He did fine and they did too! It is a learning process, not only for us parents, but for the teachers and administrators at school. But I must say, we as parents must be advocates for our children.

    • Sarah says:

      Thank you! I am so glad that your school’s response was good and that your son did well. It is definitely a learning process for everyone involved. There’s always something new that pops up… egg yolk in paint? Ugh.
      Take care,

  35. Pretty! This was a really wonderful post. Thanks for providing this information.

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  38. Susan Zebley says:

    Thank you for the explanation. I have a question. Does everyone have the the mast cell and the basophil cells in their body and food allergic people react differently than non allergic people or are these cells only found in people with food allergies?

    • Sarah says:

      Hi Susan,
      Everyone has these cells and yes, the cells of allergic people respond differently in terms of allergic disease. These cells have other beneficial roles in the immune system. Wonderful question. Thank you for your comment and for reading! I appreciate it!

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  43. Cindy in GA says:

    I’ve had a couple of questions floating in my head in the months since I first read this post.

    First, I know that most reactions occur soon after ingestion (within 20 minutes or so?). Yet, it’s surprising that a tiny amount of the allergen protein would find its way through the wall of the GI tract and into the bloodstream that quickly. Aren’t proteins generally digested in the stomach, then absorbed into the bloodstream through the small intestine – hours later? Why is it that food allergy reactions tend to occur so quickly after ingestion? I’ve seen it happen; I just don’t understand why!

    Second, if only a small amount of the protein is present, how do many mast/basophil cells all over the body react (releasing histamine/tryptaste/etc.)? Is it a chain reaction, where the chemicals released stimulate the other cells to do the same?

    • Sarah says:

      You’re really thinking! It is amazing how quickly these reactions can occur. The digestive process begins as soon as food hits your mouth and saliva. If you eat the food you are allergic to in the context of a large meal, it may take longer for the protein to be digested/absorbed etc. If the allergenic food is the primary food you are eating, the process can be even quicker. And yes, there is a chain reaction of sorts, a cascade. The cytokines are chemicals that can quickly float and disperse causing other cells to react in distant places. It is quite remarkable how swiftly this process can occur. Thank you!

  44. Carol says:

    Hi, I am a little late coming to this blog – my oldest who is egg and nut allergic has just started school, so we are navigating the world ‘outside’ for the first time. He is going to a small school and he and another boy in his class are the first ‘serious’ allergies the school has dealt with – which has been challenging to say the least. The more research I do, the more shocked I am at how little I know about all of this, even though we have been dealing with it for four years now. Can you explain to me – my son has very severe reactions to his allergens, vomiting, crazy hives, eczema for weeks on end after any exposure, however his dr said we do not require an epipen as his reactions (only two in four + years) have never resulted in him stopping breathing. We were supposed to be reviewed with the allergy department at the children’s hospital before school started, but now six months in to his first year we have been told that they ‘lost’ our most recent referral (in Australia you have to have a current referral from a gp to see a specialist – and referrals are current for 12 months) and the current waiting list for reviews is 24-36 months. this means we are now looking at up to four years between reviews and therefore access to an epipen prescription. The school has assured me that they will use the other boy’s on my son should they need it, but I am wondering after reading all of this if I should be storming the local drs office demanding a script…as i don’t have one at home. So my question is, how do I know if he really needs one? He has never ingested nuts since his very first reaction, and has never eaten egg at all. His other reaction was a contact with oil that made him break out in hives etc. My son’s allergies have been confirmed via skin and blood tests at age one, and were reviewed when he was three (egg reduced but still present, all nuts at least doubled)…Thank you so much for any advice/information you can give me – I love your blog, feel like I know your family now xx

    • Sarah says:

      If my child were diagnosed with food allergy, I would not leave the doctor’s office without a prescription for injectable epinephrine. A child diagnosed with food allergy, if they weigh enough to have an injectable epinephrine prescription, needs one. I would not depend on the school to give my child someone else’s epipen. There is no guarantee that the next reaction will be the same as the previous. In some cases, subsequent reactions can be more severe than the first reaction. Do you have a pediatrician/gp who can write a prescription for you?
      I am so glad that you found my blog! Thank you for your important comment/question.
      Feel free to reach out any time!

      • Carol says:

        Thanks Sarah – we have managed to find a gp who specializes in allergies who can see us in a few weeks (as opposed to months or years) – the local gp refused a script without further testing as the allergists said it was not necessary. This time I will not be leaving without my script!! Thanks for the response, I really appreciate it. All the best to you and your family and thanks again for your warm and informative blog,

        • Sarah says:

          You’re very welcome. I am glad that you were able to get an appointment with someone who can help you! Take care.

  45. Randi says:

    Hi Sarah,

    How does someone tell the difference between an asthma attack and an allergic reaction?? For example: My 8 month old son spiked a fever (he has severe excema) within ten minutes his excema symptoms spread ten-fold and about an hour later, he was having an “asthma attack”.

    I’m unsure if my son has severe allergies or asthma. Should I be speaking to a doctor about asthma or an allergist?

    • Sarah says:

      An allergic reaction to food can definitely flare or be the trigger of an asthma “attack” and children with asthma can have “attacks” that are independent from food. Luckily most allergists manage both food allergies and asthma, and they should be able to help you put together the pieces of the puzzle. Differentiating the two can be difficult sometimes but if you provide the allergist a detailed history with timing of food ingestion and when all of his reactions occurred, they may be able to help. Mentioning the fever will also be an important piece of information to provide. I hope this helps.
      Have a great day!

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  48. Kara says:

    My sister-in-law just shared this with me and I wanted to say thank you for a well written explanation. I have found some people look at me like I have two heads when I talk about all the precautions that we have to take with my daughter who has a milk allergy or people who think I’m just being overbearing and difficult when I ask 20 million questions about how something is prepared, but I simply can’t risk it. Thank you. I will be sharing this with others.

    • Sarah says:

      I wrote this post exactly for this reason. Take it with you when you explain it to people – babysitters, schools, family members, etc to give you a little help with the conversation/education.
      Thank you for writing and being part of this community!

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  50. Stacey says:

    Thank you so much for sharing this information. My mother continues to experience anaphylaxis for unknown reasons and my son who is 8 had his first episode on Monday – again the cause is still not known. I will share with all in my family and friendship circle!


    • Sarah says:

      Thank you for reading and for your comment. It is such a difficult time when you are trying to figure out what the cause is for an episode of anaphylaxis. I hope that you figure this out soon. Thank you for sharing this blog with your friends and family. I appreciate it. Hope you continue to read!
      Take care,

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