Anaphylaxis is a form of shock which arises from a severe reaction to an allergen.  The allergen can literally be anything. Insect stings, peanuts, and shellfish are common examples.  Most people know what they are allergic to and take steps to avoid exposure.  But sometimes they, and we, are fooled.  For instance a person may have a severe reaction to a bee sting even though a previous sting did not affect them.  For some reason the first sting sets them up, and the second sting brings on a severe allergic reaction, resulting in dilation of the blood vessels, or anaphylatic shock.

Peanuts, or more specifically, peanut oil, can also be a problem because it is found, or shall we say hidden, in many prepared foods, particularly snack foods such as cookies and potato chips.  

The symptoms of anaphylaxis often begin with urticaria, or severe itching and welts all over the body.  Swelling around the face may follow, followed by elevated and heart and respiration rates rate as the victim struggles to breathe.  Eventually, if left untreated, the swelling may occlude the trachea and the person dies.  Therefore it is important to monitor the victim's airway at all times.

Individuals who know they have a severe allergy will usually carry an EpiPen, which is simply a spring-loaded syringe loaded with epinephrin, which is another word for adrenalin.  Lay persons are not permitted to administer EpiPens, except in certain specified situations, such as trained school staff, but we can help the individual find her EpiPen and prepare it for injection by her.  Injection is accomplished by removing the cap and jamming the business end of the EpiPen against the outside of the thigh and counting slowly to ten while the epinephrine is automatically injected into the patient.  The pen will go through some clothing, but it will not go through car keys or coins, so slow down and make sure the area of injection is clear of objects, or better yet, actually pull up the shorts or pull down the pants to visualize the person's thigh.

If you are in the wilderness, an EpiPen may not be available.  For this reason I carry liquid benadryl capsules.  Benadryl is a strong anti-histamine, and will help contract the blood vessels to a more normal state.   I will make a slight slit in  three or four capsules and ask the victim to hold the liquid under her tongue as long as possible before swallowing it.  There is huge vascularization under the tongue, and medications are immediately absorbed into the body there.  The victim may also bite the capsule to open it.

I also carry two or three instant coffee servings.   There is some evidence in the medical literature that coffee helps to contract the blood vessels, so I will make a couple of cups of strong, black coffee and ask the victim to drink them.  Note that this is a violation of the usual rule of not giving victims anything to drink, and you would never do this in a 911 response area.  But in the wilderness, things are different, and you will want to do anything that might help.

And of course don't forget to treat for shock, maintain the victim's airway and continually monitor the victim's condition.

    911 AREA
    When you are confronted with a medical emergency in a 911 area, your response, after you determine that the scene is safe for you to enter, is basically to check the victim for breathing and bleeding and call for help.  If the victim is not breathing,  CPR must be started.  If the victim is severely bleeding, a pressure bandage must be applied.  If the victim is breathing and not bleeding severely, you will apply a pressure bandage,  treat the victim for shock and monitor her condition until emergency medical services personnel arrive.

    WILDERNESS OR REMOTE AREA
    In a wilderness or remote situation things will be different:
    a.    You will have fewer resources, including less equipment, supplies and fewer (if any) trained personnel
    b.    You will have to do a more extensive assessment of the victim to find out everything that is wrong with him
    c.     You may have to treat the victim much longer, hours at least, and maybe days
    d.    You may have to move the victim out of immediate danger, e.g. a rising creek, or approaching fire
    e.    You may have to evacuate the victim
    f.     You may have to deal with severe environmental factors, e.g. adverse weather conditions and difficult terrain
    g.    You might be sick or hurt too
    h.    You will have to deal with the effects of the emergency on yourself and others, e.g. fatigue and emotional strain
    i.     You will need to keep a written record of the status of the victim to hand off to rescuers

    Obviously, in a medical emergency in a wilderness and remote situation, you and those around you are more important than when an ambulance is on the way.  Therefore it is important to carry sufficient supplies and equipment and complete appropriate training to be prepared for whatever may arise.