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What is anaphylactic shock?

Anaphylactic shock (also called anaphylaxis) is a severe allergic reaction. It's one of the most critical health emergencies a parent can face. It starts when your child's immune system mistakenly responds to a relatively harmless substance as if it were a serious threat, triggering the release of histamine and other chemicals that cause the rapid onset of sometimes life-threatening symptoms, including these:

• Hives, and swelling of the skin, lips, or face

• Wheezing or severe breathing problems

• Rapid pulse

• Sweating

• Dizziness, fainting, loss of consciousness

• Nausea, vomiting, abdominal cramps, diarrhea

• Extremely pale skin

What kinds of allergens are most likely to cause a severe reaction?

A wide variety of allergens can cause anaphylaxis in children who are sensitive to them. Here are the most common triggers:

• Foods such as eggs, milk, seafood, wheat, peanuts, and other nuts

• Drugs such as penicillin (note that the popular antibiotic Amoxicillin is in the penicillin family)

• Insect bites or stings

• Latex and other industrial substances

What should I do if my child seems to be going into anaphylactic shock?

Keep in mind that anaphylaxis can take a few forms. That is, a child who is having her first anaphylactic reaction to something may break out in hives all over her body or complain that her throat is itchy, but that's it. If your child is old enough to tell you that she's having these symptoms (probably age 4 or 5), go ahead and give her a dose of liquid Benadryl, which can lessen the severity of the attack. (Younger kids may choke on the Benadryl.) Then call her doctor immediately. "If you have anaphylaxis, it shouldn't be treated at home and then forgotten about," says Stuart Abramson, a pediatric allergist and immunologist at Texas Children's Hospital. "You need to see a physician to determine what caused the anaphylactic reaction so you can prevent future episodes."

If your child seems to be having a severe anaphylactic reaction — that is, she is having trouble breathing or passes out — call 911 immediately. Meanwhile, have her lie down with her feet elevated to reduce the risk of shock. Try to keep her calm by talking to her and remaining calm yourself. This is not the time to try the Benadryl trick, regardless of your child's age, because she may choke on it if she's having trouble breathing, warns Abramson. Some children can have severe anaphylaxis during their first episode, so don't be shy about calling 911. (If the trigger for her allergic reaction was a bee sting, don't worry too much about trying to remove the stinger. Once the bee's venom has entered your child's bloodstream, taking the stinger out won't do anything to stop the reaction.)

When the paramedics arrive, they will most likely treat your child on the spot with an injection of epinephrine that will stop the reaction within minutes. Most likely they'll still want to take her in to the hospital for an examination and to make sure you know what caused the reaction, especially if this was the first time. You should also follow up with your pediatrician, who will probably refer you to a pediatric allergist so you can pinpoint exactly what it is your child is allergic to.

What can I do to protect my child from anaphylactic shock?

The best prevention is to avoid the substances that cause serious allergic reactions. If your child is allergic to certain foods, it's important to read labels carefully and ask at restaurants or friends' houses whether a meal contains any of the allergy-provoking items. You'll need to be vigilant about this for your child until she can do it for herself. For more tips, check out the Food Allergy Network.

If insect bites or stings cause trouble, help your child find places to play that are bug-free. Don't rely on bug sprays; they don't keep away bees and fire ants, which commonly sting children. In addition, don't let your child walk around barefoot outside. Many children are stung when they unintentionally step on fire ants or a bee.

Once your child has had a severe allergic reaction, your pediatrician may recommend that you carry an EpiPen, a pen-like injection device loaded with epinephrine and available by prescription only. (Your doctor can show you how to give the shot in the muscle of the outer part of the upper thigh.) Even if you aren't sure the reaction is anaphylaxis, don't wait for full-blown symptoms to surface; give the shot right away. It could save your child's life, says Abramson. And even if your child recovers quickly with EpiPen treatment and seems to have returned to normal, call your pediatrician immediately. Your child should still be seen and the reaction should be noted in her records.

The EpiPen carries a dose appropriate for children over 66 pounds (30 kilograms). If your child weighs between 33 and 66 pounds(15 to 30 kilograms), she'll get the EpiPen Jr., which carries a smaller dose. Your child's caregivers should have one as well if she's ever had a reaction before, and it's wise to keep an extra kit in your purse or pocket, since allergic reactions can happen anywhere and anytime. (Don't keep the kit in your car since the adrenaline can't withstand high temperatures.)

Finally, once your child has a severe reaction such as anaphylaxis, it's important for her to wear a medical-alert ID bracelet (available in most pharmacies), which will alert healthcare providers to her condition in case of an emergency.