What obvious physical signs can we look for?
Having a list of the symptoms of anaphylaxis may not be helpful to those of us who have never seen them. On this page we will show you photographs of actual people exhibiting some of the visible symptoms of anaphylaxis.
The skin redness that may be the first symptom of anaphylaxis can look like a blush or a menopausal flush. It is, however, usually a dry flush, which means that it is not usually accompanied by sweating. Sometimes an alert friend or family member may first notice the telltale color of someone beginning to flush. (For more information on “wet” versus “dry” flushes see the article, Flushing? Don't sweat it!)
Photographs 1, 2 and 3 show flushing on the face, chest, and neck. It's important to remember that anaphylaxis is not the only reason that a person may flush, and unless the person has either a history of anaphylaxis or another of the symptoms of anaphylaxis that occur in a different bodily system, anaphylaxis should not be suspected on the basis of a flush all by itself. The same is true of a number of the symptoms illustrated on this page.
Some people report that they get goosebumps, as in photograph 4, or can feel the hair on their skin stand erect. Often itching comes next, and the sensation of itchiness can be both intense and can occur in inconvenient places (groin, armpits, ears, back of throat). Some people then report a metallic taste in their mouthes — that kind of tinny, off-flavor that you might get after a bad cold.
The itching can turn into hives (see photographs 5 and 6), which can look more like a red rash or like discrete, raised wheals.
The same process that produces hives produces a different problem — swelling — in the deeper layers of the skin. This is called angioedema, and it can cause a person's face, eyes, throat, uvula, hands, feet, abdomen or other body parts to swell grotesquely. Unlike hives, angioedema doesn't itch, but it can be very painful, depending on the location and extent of the swelling. In photographs 7 and 8, the short-term and long-term effects of angioedema around the eyes is illustrated. (While angioedema may not itch, when the mast cells in our eyes degranulate, the effects can include intense itching.) In photograph 9, we see a man whose upper lip is extremely swollen after a misadventure with a honey bee.
The final two photographs illustrate an uncommon but potentially deadly form of edema or angioedema, namely, swelling of the uvula. Photograph 10 illustrates the normal anatomy of our mouths to help explain what the uvula is. It is a small bit of tissue that hangs down over the back of the tongue. Normally, it cannot interfere with breathing or swallowing, but if it swells (as in photograph 11), it can present a problem that is at least uncomfortable, if not life-threatening. This is not a common symptom of anaphylaxis (and it can also be caused by other conditions), but it is mentioned here to remind us of the broad range of symptoms that anaphylaxis can encompass.
It is important to remember that not every person having anaphylaxis has the same symptoms or has them to the same degree. ◊
Page last updated: May 16, 2011