Monday, June 1, 2015

EpiPen on the Spot...When Bee Stings, Peanuts, or Other Allergens Cause Choking

PREVENTING DEATH FROM ANAPHYLAXIS

Recently, a young man asked me about his possible allergy to
yeast or barley because of a severe reaction he experienced
while drinking beer. First, I advised him to stay away from beer 
altogether and also to avoid breads, soups, cakes, cereals 
and any other foods that might contain components of beer.
Common Allergic Reactions and
Rare Allergic Anaphylactic Reactions
I also urged him to get examined and tested by an Allergist - a 
medical doctor specializing in immune system instigations of 
rashes, itchings, bronchospasms (asthmatic attacks), sneezing, 
wheezing, and laryngopharyngeal edema (swelling of the voice 
box and throat) due to allergens (substances that produce 
those allergic symptoms which can be life-risking).
The most extreme allergic response is ANAPHYLAXIS -
complete airway impedence which prevents oxygen from 
reaching the lungs.
Why a Person in Anaphylaxis Needs 
an Immediate Epinephrine Injection
But the first-hand account of a woman with a peanut allergy
who, upon eating some peanuts, experienced sudden itching
and swelling in the facial area with tightness in her throat, sent
shivers up my clinical nursing spine.
In response to this dire emergency, she did everything
wrong and nearly died because she was totally
unprepared for her sudden ANAPHYLACTIC REACTION.
She had no emergency epinephrine (otherwise known as 
adrenalin) with her. Also wrong, she tried to swallow 
Benadryl® (diphenhydramine), an antihistamine. Then 
she had someone drive her to an ER (Emergency Room) 
at a hospital some distance away.
That she survived is a miracle. The delay in adrenalin
administration, the added delay while she tried to down the 
diphenhydramine, and the long time elapse while she was 
driven to the ER all could have killed her.

Don't Mishandle the Initial Manifestation
of Your Choking Episode
As soon as swelling, itching and pharyngeal (throat) 
tightness intrude, take this syndrome very seriously!
When you know you are allergic to nuts, to bee or wasp
stings, to shellfish, to strawberries, or to any other 
allergenic substances, you must have EpiPen®
(epinephrine, same as adrenalin) on hand with you 
at all times!   

An Anaphylactic Reaction is Sudden, Alarming and
Breath-Taking! That's how serious your condition
is as soon as the swelling, itching and throat
symptoms start!
So, I was horrified to hear that this peanut-allergic woman told
her friends about her choking brush with death as though this
were a humorous tale. "You nearly died," I told her. "You
had an Anaphylactic Reaction. This is where the top of
your airway literally closes so that no oxygen can get to
your lungs. Death will be rapid in such cases unless the
airway can be opened stat! (Immediately!)"
"Next time...and I pray there won't be a next time...you should
not even consider walking to, or being driven to an ER. You 
need emergency treatment right THEN AND THERE! As
soon as you notice the pruritis (itching), the edema
(swelling) in your mouth and throat, the dyspnea (difficulty
breathing), and BEFORE YOU START CHOKING TO DEATH!"
THE TREATMENT IS EpiPen® (epinephrine, same as
adrenalin) which, now that you know you are sensitized to 
peanuts, you absolutely must carry with you at all times.
Every allergic person should be aware of the availability
of EpiPen®. The unit is provided as a swiftly injectable 
single-dose-syringe which you must not even wait to drop
your pants to take (that is how dire Anaphylaxis is). It is
meant to be given right through your clothing because 
there isn't a moment to lose when an anaphylactic
reaction begins. There are two versions: one for 
children under 12, the other (twice the child's dosage) 
for patients 12 and older.
Please also note: It is never wise to take
Benadryl® (diphenhydramine) in these circumstances
First of all, in anaphylaxis, you are in no condition to swallow
anything. Not only is your throat rapidly closing and 
excluding oxygenation, the edema (swelling), inflammation
and related symptoms of this severe, life-threatening allergic
reaction also makes swallowing anything - a tablet, capsule, 
water - impossible and an added danger by further irritating
the already inflamed pharynx (throat) and upper airway.
Not only that, no pill or capsule I know of works immediately, 
even if by some magic you managed to get it down. Most
oral tablets or capsules will take approximately 30
minutes to even begin to take effect, some longer
rarely only 15 minutes.But even 15 minutes is too long
to save the life of a person in Anaphylactic Shock.
Please remember: The brain cannot be deprived of
oxygen for too long before you lose neurologic viability
After 8 minutes of respiratory-oxygen-lack, the brain 
suffers severely - a condition called hypoxia 
(decrease in, or lack of, oxygen). So even if the heart
helps you survivewe'd not be able to revive the brain
to it's pre-hypoxic state.

Important Lessons to
Prevent Death from Anaphylaxis
(1) Never try to swallow anything during a choking 
allergic reaction!
(2) Never attempt to leave the place you're at 
during an Anaphylactic Reaction to get emergency 
care elsewhere! 
By the time you get to an ER, it is often too late. 
DEATH IS RAPID IN THESE CASES.
(3) Once you know you are highly allergic, 
ALWAYS CARRY AN EpiPen® with you from then on! 
Your physician should prescribe this for you.
(4) Have several EpiPen® units at home at all times.
And teach whoever is with you (in case you are too 
incapacitated to perform the injection yourself...
usually in the thigh) how to use the EpiPen®
It comes with detailed instructions and is simple to use.
(5) NEVER, NEVER, EVER, EVER EAT or expose 
yourself to whatever you know you're allergic to 
ever again!
(6) You must follow these instructions to the 
letter to keep yourself safe from now on.

Allergies Run in Families...
So be Prepared for Your Children's Sakes
Importantly, since tendencies toward allergies run
in families genetically, one's children or grandchildren
may be susceptible to allergic responses just like you...
maybe not from peanuts but from shellfish, or 
strawberries, or something else, even from hymenoptera
(bees or wasps) stings. Epipen® - half the adult amount
in your syringe for kids under 12 - is appropriate if any 
child in your family starts to choke after being stung 
by an insect or upon eating something.

Epinephrine (adrenalin), however is 

not the immediate treatment for food caught

in the trachea (windpipe); for that you do

the Heimlich Maneuver.


When you suspect the inception of anaphylactic
choking, don't wait more than a second or two
to make the decision! Epinephrine won't kill anyone
who isn't having an anaphylactic reaction, but it is life-
saving  for someone who is. Please take this condition
seriously. Anaphylaxic Shock is life-threatening
and never a laughing matter!
Remember: There is never enough time to travel
or walk or be carried to the ER. EpiPen® stat!!! 
No deviation from that prescribed protocol. Ever!
Only AFTER you've taken your epinephrine
injectionshould someone take you to the ER for
follow-up monitoring and care!

Current Clinical Guidelines
Support My EpiPen ® Protocol
According to Pediatric Professor
F. Estelle R. Simons, M.D.,from the Faculty of Medicine
of Canada's University of Manitoba at Winnipeg, recently
updated guidelines by the United Kingdom's Resuscitation 
Council on "...emergency treatment of anaphylactic 
reactions....stress the importance of an early call for help
from a resuscitation team or an ambulance. They
introduce the ABCDE approach (airway, breathing
 circulation, disability [level of consciousness], and
exposure [of the skin]). They emphasise that prompt 
intramuscular injection of adrenaline (epinephrine) is the 
initial treatment of choice, along with other measures as
indicated....They also advise subsequent referral to an
allergy specialist for risk assessment and institution of 
long term measures  to reduce risk."
She points out that "Few published [Canadian] guidelines
are available on the treatment of anaphylaxis, but they all 
agree that adrenaline [epinephrine] is fundamental for 
acute management."
Discussing the physiologic effects of epinephrine
Dr. Simons elaborates that "Adrenaline prevents and 
relieves laryngeal oedema [swelling] and circulatory 
collapse through its alpha1 adrenergic effects. It provides
bronchodilation and reduces the release of histamine and 
other mediators through its beta2 adrenergic effects. 
A brief window of opportunity seems to exist, during
which even a relatively low intramuscular dose - 
such as 0.3 mg [3 tenths of a milligram] - 
is efficacious. Failure to inject adrenaline promptly
increases the risk of a biphasic anaphylactic reaction,
and death. Although adrenaline is sometimes blamed for 
causing myocardial ischaemia [reduced blood flow to the 
heart muscle] and cardiac dysrhythmias, anaphylaxis itself 
can cause these problems before adrenaline is given. 
Transient palpitations, tremor, and pallor after injection of 
adrenaline reflect the anticipated pharmacological effects
 of the drug."
Finally, warns Dr. Simons, "In community settings...
even when [adrenalin is] readily available and 
affordable [it is] underused during anaphylactic
reactions."
So please, allergic people, carry your EpiPen® 
with you at all times. And USE IT SWIFTLY, 
ON THE SPOT. Don't let a sudden anaphylactic 
reaction catch you unprepared 
and choke the life out of you!
1. Simons, F. Estelle R.: "Editorials: Emergency
    Treatment of     Anaphylaxis," British Medical 
    Journal, No. 336 (May 24)     2008, pp. 1141-42.
© Copyright 2008-2015  Dr. Helen Borel. 
All rights reserved.
For permissions and rights, email me at:
medical-healthalerts@earthlink.net
and type into the Subject line ANAPHYLAXIS
Interested in Psychiatric, Psychotherapeutic,
and Neuroscience issues and diagnoses?  
Then visit the companion site to this one: 
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here: http://PsychDocNYC.blogspot.com 

1 comment:

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