From the Guidelines
Persistent asthma itself does not cause anaphylaxis, but it can increase the risk of severe anaphylactic reactions, and a bear bite could potentially trigger anaphylaxis in anyone, including asthma patients. Anaphylaxis is a severe, potentially life-threatening allergic reaction typically caused by specific allergens like certain foods, medications, insect stings, or latex, as noted in the 2020 practice parameter update on anaphylaxis 1. While asthma and anaphylaxis are both conditions involving the immune system, they are distinct processes. However, patients with asthma may be at higher risk for more severe anaphylactic reactions when they occur, due to factors such as airway inflammation and hyperresponsiveness.
Regarding the potential triggers, some key points to consider include:
- Medications and stinging insects are the leading triggers in adults, with foods and stinging insects the most frequently implicated triggers in children and adolescents, according to the study 1.
- Food allergy impacts 8% to 11% of children and adults in the United States, while adverse drug reactions (ADRs) affect up to 10% of the population, as reported in the same study 1.
- Systemic reactions to Hymenoptera venom occur in 0.5% to 3.3% of the US population, with most fatalities occurring in patients who have no prior history of systemic allergic reaction to Hymenoptera, highlighting the unpredictable nature of anaphylaxis 1.
In the context of a bear bite, the primary concerns are trauma, infection, and rarely, allergic reactions to proteins in the bear's saliva. If someone experiences symptoms of anaphylaxis (such as difficulty breathing, swelling of the face/throat, rapid pulse, dizziness, or a drop in blood pressure) after any trigger, immediate treatment with epinephrine (0.3-0.5mg for adults, 0.15mg for small children) via an auto-injector like EpiPen is crucial, followed by emergency medical care, as emphasized in the guidelines 1. Asthma patients should ensure their asthma is well-controlled with appropriate controller medications and always carry rescue medications, as poorly controlled asthma could complicate an anaphylactic reaction if one occurs.
From the Research
Causes of Anaphylaxis
- Anaphylaxis is a severe, life-threatening allergic reaction that can be caused by various factors, including insect stings, food allergies, and medication allergies 2, 3.
- There is no direct evidence to suggest that a bear bite can cause anaphylaxis in patients with asthma.
- Persistent asthma is a chronic condition that can increase the risk of anaphylaxis, but it is not a direct cause of anaphylaxis 4.
Treatment of Anaphylaxis
- Epinephrine is the primary treatment for anaphylaxis, and it should be administered promptly to minimize morbidity and mortality 2, 3.
- Corticosteroids may be used in the emergency management of anaphylaxis, but there is no compelling evidence to support or oppose their use 5.
- Epinephrine auto-injectors are a convenient and effective way to administer epinephrine in emergency situations, and they should be readily available in schools and other public settings 6.
Asthma and Anaphylaxis
- Patients with persistent asthma may be at increased risk of anaphylaxis, and they should be aware of the signs and symptoms of anaphylaxis and know how to use an epinephrine auto-injector 4, 2.
- There is no evidence to suggest that persistent asthma is a direct cause of anaphylaxis, but it can increase the risk of severe allergic reactions 4.