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.
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
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).
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.
complete airway impedence which prevents oxygen from
reaching the lungs.
Why a Person in Anaphylaxis Needs
an Immediate Epinephrine Injection
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.
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.
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.
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
of Your Choking Episode
As soon as swelling, itching and pharyngeal (throat)
tightness intrude, take this syndrome very seriously!
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 conditionis 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!"
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.
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.
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.
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.
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 survive, we'd not be able to revive the brain
to it's pre-hypoxic state.
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 survive, we'd not be able to revive the brain
to it's pre-hypoxic state.
Important Lessons to
Prevent Death from Anaphylaxis
Prevent Death from Anaphylaxis
(1) Never try to swallow anything during a choking
allergic reaction!
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.
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.
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.
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!
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.
letter to keep yourself safe from now on.
Allergies Run in Families...
So be Prepared for Your Children's Sakes
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.
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!
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!
or walk or be carried to the ER. EpiPen® stat!!!
No deviation from that prescribed protocol. Ever!
Only AFTER you've taken your epinephrine
injection, should someone take you to the ER for
follow-up monitoring and care!
injection, should someone take you to the ER for
follow-up monitoring and care!
Current Clinical Guidelines
Support My EpiPen ® Protocol
Support My EpiPen ® Protocol
According to Pediatric Professor
F. Estelle R. Simons, M.D.,1 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."
F. Estelle R. Simons, M.D.,1 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."
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."
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."
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!
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.
Treatment of Anaphylaxis," British Medical
Journal, No. 336 (May 24) 2008, pp. 1141-42.
© Copyright 2008-2015 Dr. Helen Borel.
All rights reserved.
All rights reserved.
For permissions and rights, email me at:
medical-healthalerts@earthlink.net
and type into the Subject line ANAPHYLAXIS
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:
My PsychoTherapy Zone
here: http://PsychDocNYC.blogspot.com
and Neuroscience issues and diagnoses?
Then visit the companion site to this one:
My PsychoTherapy Zone
here: http://PsychDocNYC.blogspot.com
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