Anaphylaxis: Advice for Yacht Crew

There are several brands of adrenaline auto-injectors on the market that are available and affordable. Epinephrine itself is an inexpensive drug, but the auto-injector is an expensive method of delivery.

Information and education are therefore important in understanding the medical need and improving outcomes as well as avoiding unnecessary expenditure.

Anaphylaxis is a life threatening, extreme allergic reaction to a substance that you may encounter in everyday life. Once in contact with the body, it is known as an ‘allergen’ and this can be many things, typically a food such as shellfish and nuts, insect venom from bees or wasps or a toxin from jellyfish, moulds or algae.

When you are allergic to a particular substance, your immune system reacts by releasing chemicals that cause allergy symptoms, often mild on first exposure and possibly occuring in only one location of the body. On repeated exposure (and sometimes on first exposure), some people react strongly, known as an anaphylactic reaction, typically affecting more than one part of the body simultaneously.

Anaphylaxis requires immediate medical treatment including, but not limited to, an injection of adrenaline (epinephrine) and a visit to an emergency medical facility. If it isn’t treated properly, anaphylaxis is likely to be fatal.

The first signs of an anaphylactic reaction may appear like typical allergy symptoms, including a runny nose or a skin rash. Within minutes or seconds, more serious symptoms appear.

Symptoms of anaphylaxis include:

• Coughing, wheezing, itching or tightness in your chest

• Fainting, dizziness, confusion, weakness

• Rash, hives, painful swollen or red skin

• Runny or stuffy nose and sneezing

• Shortness of breath, difficult breathing and rapid heartbeat

• Swollen or itchy lips, tongue or throat

• Hoarse voice, trouble swallowing, tightness in your throat

• Vomiting, diarrhoea, or cramps

• Weak pulse, paleness

• Feeling of panic or a "sense of doom”

1 out of 5 people may have a second anaphylactic reaction within 12 hours of the first, known as a biphasic anaphylaxis, so close medical monitoring is essential after an initial reaction.

Treating anaphylaxis on board a yacht

Adrenaline (epinephrine) is the most effective treatment for anaphylaxis, and an intra-muscular injection should be given immediately, at the onset of symptoms. Quality medical kits on yachts provide epinephrine in ampoules or prefilled syringes and the dose is often higher than that found in an auto injector. These kits will also contain additional medicines and diagnostic equipment necessary to ensure adequate response to initial treatment.

Telemedical support during an anaphylactic episode is strongly advised so the on-call doctor can guide you through the proper treatment until the victim can be transported to a medical facility.

The auto-injector is designed to be carried and self-administered by people with known anaphylactic allergy. The dose of epinephrine in the auto-injector buys you approximately 10 minutes until additional medical intervention is required.

Storing the auto-injector inside the medical kit defeats the purpose of its design to some extent. Instead, if you have an ‘at risk’ guest or crew member, give them an auto-injector to carry during the duration of their trip. Proper training in the use of such medical tools can allow sufficient control of symptoms until a transfer can be made to an emergency medical facility.

If you’ve had an anaphylactic reaction before, you should wear an alert tag and carry at least two auto-injectors of epinephrine with you at all times. If you have asthma, eczema, or multiple allergies, you are at higher risk of anaphylaxis, and should be aware of the possible symptoms of an anaphylactic reaction.