Nina Dobrev was recently hospitalized after going into anaphylactic shock. Here's what the extreme allergic reaction involves and how to handle it.

By Rachael Schultz
November 13, 2019

Earlier this week, Nina Dobrev was hospitalized after going into anaphylactic shock. The severe allergic reaction, chronicled by Dobrev's bestie Julianna Hough on Instagram, looked pretty scary.

Fortunately, though, it didn't seem to be a huge deal to Dobrev, who's already on the road to recovery. "It's pretty routine/has happened to me quite a few times because I have a lot of allergies," Dobrev wrote in her Instagram Stories. "Depending on the severity, I sometimes go into anaphylactic shock as a result."

Instagram/@nina

ICYDK, anaphylactic shock is serious—if not treated right away, it can cause respiratory or cardiac failure, says Omid Mehdizadeh, M.D., otolaryngologist (ear, nose, and throat doctor) and laryngologist at Providence Saint John's Health Center in Santa Monica, CA. But on the bright side, most people with these types of severe allergies are aware of the issue, increasing the likelihood they'll get treatment ASAP, as it sounds like Dobrev did.

What happens when you go into anaphylactic shock?

Neither Dobrev nor Hough specified what exactly caused Dobrev's reaction. Regardless of the cause, though, all anaphylaxis starts the same way, explains Dr. Mehdizadeh. First, your body quickly releases a flood of histamine (a chemical involved in immune responses that causes many types of allergy symptoms, like runny nose or sneezing) into the bloodstream. This causes a severe influx of fluid into the body's soft tissues, which makes you swell up. Sometimes it's just the skin that swells, but in other, more worrying cases, swelling can happen in the floor of the mouth, under the tongue, the tongue itself, in the lips, the soft palate, the back of the throat, the uvula, even down into the voice box. "If these structures swell enough, that can potentially completely obstruct your airway and cause someone to suffocate," says Dr. Mehdizadeh. (Related: This Woman has Life-Threatening Allergic Reactions to the Cold Temperatures)

Anaphylactic shock is the extreme end of anaphylaxis, aka a severe allergic response. The difference between anaphylactic shock and anaphylaxis comes down to whether your vitals actually change: That fluid transfer inside your blood vessels (anaphylaxis) can cause enough swelling to impair blood flow so your heart is seeing less circulating volume, which can then cause your blood pressure to drop and your heart rate to skyrocket (anaphylactic shock), explains Dr. Mehdizadeh. This "shock" can cause hypotension, arrhythmias, even cardiac arrest, all of which could kill you if you aren't treated in time, he says.

How common is it for a severe allergic reaction (anaphylaxis) to develop into anaphylactic shock?

Fortunately, anaphylaxis isn't super common, and full-blown anaphylactic shock even less so: Up to 5 percent of people in the U.S. have experienced anaphylaxis to some degree, but less than 1 percent of sufferers have died from the reaction, according to research published in The Journal of Allergy and Clinical Immunology. The most common causes of anaphylaxis include certain foods like nuts and shellfish, insects (like bee stings), medications like penicillin, and latex, per the research. (Related: 5 Signs You Might Be Allergic to Alcohol)

Again, most people who have a severe allergy are aware of it, as it usually starts happening in childhood, says Dr. Mehdizadeh. However, if you aren't exposed to an allergen like shrimp or penicillin as a child, that allergy could be a surprise in adulthood, he explains. Plus, you can develop an allergic or anaphylactic reaction to something as an adult, even if it's something you previously had no issues with whatsoever. (FYI: No one really knows why or how these later-in-life allergies develop, adds Dr. Mehdizadeh.)

What's scary, however, is that you don't necessarily have to ingest or come into direct contact with your allergen to have a reaction. "If you're severely allergic to shellfish and you breathe in cooking fumes at a restaurant, those fumes have the same proteins that may cause your body to react," explains Dr. Mehdizadeh. Similarly, if you're severely allergic to peanuts, having your seatmates tear into bags of the stuff on an airplane could send you into anaphylaxis. FWIW, while the Federal Aviation Administration (FAA) does require airlines to carry vials of epinephrine and a syringe on planes, they aren't required to carry an auto-injecting EpiPen (though you can bring your own EpiPen on the plane). Even scarier, still: The FAA recently granted U.S. airlines exemptions that allow passenger planes to fly without any epinephrine in their onboard medical kits if the airline "runs out" of the drug; the airline simply has to claim it cannot replenish the drug in a cost-effective way, according to the New York Times.

What are the signs of anaphylactic shock?

While anaphylaxis isn't super common and sufferers are usually aware of the risk, it is serious enough that everyone should know the signs of the reaction, says Dr. Mehdizadeh. (Related: 4 Surprising Things That Are Affecting Your Allergies)

Initial symptoms can include a little bit of hoarseness or a raspy voice thanks to swollen vocal cords, explains Dr. Mehdizadeh. If your throat starts to swell, it'll create a "hot potato voice" which essentially sounds muffled, like you're trying to talk through hot food in your mouth. Many people also experience a scratchy sensation and wheezing, adds Dr. Mehdizadeh. If you reach stridor—a narrowing of the airways that creates noisy, labored breathing—your anaphylaxis is getting serious, he says.

Most people with a history of severe allergies carry an EpiPen on them at all times, explains Dr. Mehdizadeh. But any swelling of the airways, shortness of breath, wheezing, or chest tightness should be an alarm bell to head to the emergency room. Even if the initial reaction seems like it's not that bad, anaphylaxis can progress and cause you to go into anaphylactic shock hours after coming into contact with the allergen, says Dr. Mehdizadeh. (If you have a rash or mild swelling of the skin, just take a Benadryl and keep an eye on it, he adds.)

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