PREVENTING DEATH FROM ANAPHYLAXIS

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

 

by Helen Borel, RN,PhD

Recently, a young man asked 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, 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 survive, we'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 PEANUTS 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 - would be appropriate if anyone in your family starts to choke after being stung by an insect or upon eating something.

Not from 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 injection, should 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.,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 is fundamental for acute management."

Discussing the physiologic effects of epinephrine, Dr. Simons elaborates that "Adrenaline prevents and relieves laryngeal oedema 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 - 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 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 Dr. Helen Borel. All rights reserved.

For permissions and rights, email medical-healthalerts@earthlink.net and type into the Subject line "BOREL MEDICAL SYNDICATE"

You may also wish to read my mental health articles at http://hubpages.com/hub/PSYCH-NEW-YORK , my satirical fiction at http://hubpages.com/hub/BOREL-SATIRE-Freud-Bleuler-Breuer-Medical-Ad-Agency, and my writing advice at http://hubpages.com/hub/freelance-ad-writing

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Comments 18 comments

Constant Walker profile image

Constant Walker 8 years ago from Springfield, Oregon

This wouldn't happen to be about me, would it? ;) (And thanks, btw, for the "young man" reference). Actually this only further confuses me because I live on breads. I'm a sandwich-eating-fool, and I love all kinds of breads. Never have any problem with them. Just beer. And I'm fine so long as I don't drink any - which I don't.


Constant Walker profile image

Constant Walker 8 years ago from Springfield, Oregon

Thanks Creativity, would like to do that, but I'm just a working American and therefore, uninsured. I don't do anything medical unless it's absolutely necessary. Luckily, I'm so healthy, ay?

I'll just continue to stear clear of beer.


pjdscott profile image

pjdscott 8 years ago from Durham, UK

Very useful advice. So if you come into contact with anyone who you believe is having an anaphylactic attack and they can't communicate, the best thing is to search them for a syringe! Where is the best place to inject them (or help them inject themselves if they are capable)?


sixtyorso profile image

sixtyorso 8 years ago from South Africa

Being an allergy sufferer. Hay fever mostly, I empathise entirely. Everone else is often sceptical about allergies. "You must have a cold.. my cat could not do that to you" are common reactions to your reaction. Incredulity and disbelief are the norm just for a hayfever attack. A friend of mine and I used to eat copious amounts of Prawns until one day suddenly he had a reaction. fairly severe but not an Anaphylactic shock. He cannot eat any shellfish or food with iodine at all to this day because of the potential hazard to him. Initially, he felt that he had just eaten a bad prawn until he got tested (at my urging!).

Great Hub!


Helen 8 years ago

To pjdscott: Hi Peter - You got the idea that anaphylaxis is a dire emergency; but I wouldn't search someone in that condition. That would take too much time and the person is getting more in extremis as the seconds pass.

If they carried EpiPen with them, they'd know to use it stat (immediately) or they'd indicate in their purse or pocket where it is. Give it at a 90 degree angle into the thigh (upper front)area (this is a major muscle) or into the Gluteus Maximus muscle (this is the derriere site, the left or right outer hip area), again at a right angle to the site. It should be given right through the clothes; don't wait to remove the person's pants, or jeans or dress, or underwear. Just give it stat!!! right through the clothing. There's zero time to lose in this kind of emergency. ====

Yes, Sixtyorso, I know what you've experienced as an allergic person. For some strange reason, the medical profession hasn't communicated to the public here in the States, in Europe, or in other parts of the world THE SERIOUSNESS OF ALLERGIES AND ASTHMA. People think these are minor conditions, that is people who don't suffer allergies, and folks who don't have bronchospasms (asthmatic episodes). However, yearly there are deaths due to asthma because, outwardly, the asthmatic not getting enough air initially does not look to the observer to be blue, oxygen deficits can not be assessed by observers on the street, but by an oximeter in the ER...and stat medical attention is required. Also, someone can get a rash from, say penicillin one year (be itchy and get better) and if ever given penicillin again, by mistake, or given an analog of penicillin like Keflin (a cephalosporin) can get sudden anaphylaxis. That's why, when a patient is admitted to a hospital, all allergies are listed in red on adhesive tape, taped on the front of the patient's chart!

Thanx for your interest in this subject, gentlemen and for your comments. Helen


Mary 7 years ago

i just lost a friend 2 days back ..... he was allergic to prawns.. he had had a few episodes before but nothing serious.. just a sore throat is what he used to say .... and he usually avoids them to .. don't know what got over him this time.... he stayed with his brother... who i guess wasn't aware abt the seriousness of the condition...

wish he had read this post bfore ... maybe we could have saved his life....


Gabby 6 years ago

My daughter has a peanut allergy and I wanted to share my story. Although I completely agree with you about the use of epipens, this happened before she was diagnosed and although in retrospect I know we should have rushed her to the ER, we simply did what we could and thought was best at the time.

She had been helping Grandma shuck peanuts and had been eating a few when she started to get hives, and become wheezy and upset. Our immediate response was to give her a dose of liquid childrens Benadryl, which she was able to swallow. We kept her calm and sat her down in front of the TV with a show to monitor her and within 30 minutes the episode was over. Of course it could have been MUCH MUCH less of a happy ending.

After that we immediately took her for tests, and since diagnosis she has been an epipen carrier and also carries a medic-alert bracelet.

So, one question arises from this - if someone who is unaware that they have an allergy goes into anaphylactic shock, and therefore there is no epipen handy, what should one do? Is there a "home" remedy to give you some time to get to the ER or a safe way to clear their airway so you can immediately treat them before getting them to the ER? If that time is so crucial, I think it's important for people to know what to do when an epipen isn't immediately available to them.

I certainly believe that the Benadryl worked and I also feel that keeping ourselves calm (outwardly anyway) kept my daughter from panicking, and aided in her recovery in this instance.


jmj675 5 years ago

Gabby, I'm glad your daughter was okay. I actually went into anaphylactic shock about a year ago while I was alone in my house without an epipen. I had been given Bactriim (sulfa drug) for a supposedly infected lymph node but I had never taken Bactrim before and apparently I was allergic to it. The reaction started with a fever but I thought it was still from the lymph node. I didn't realize I was allergic until I broke out in hives a few mornings later.

I called my doctor who couldn't see me until late in the afternoon so I thought I would just wait it out. However, I suddenly got really bad acid reflux and had to throw up a little bit, which caused me to start coughing and then suddenly my throat closed. For one second I didn't realize what was happening and then I knew it was anaphylactic shock and I FREAKED OUT. For about 30 seconds I couldn't breath in or out and I just started to pace back and forth, bending over and trying with all my might to cough or breath. And then suddenly I did...I coughed and I was okay. I was so weak after it happened that my legs gave out and I just sat on my floor in shock. My whole body was rubber. The whole next day my body was sore.

I think that my own adreneline kicked in (from freaking out) and acted like the epipen. I know that's not a home remedy, but I've been curious myself to try to find other people who overcame anaphlyactic shock w/o an epipen (hence how I found this post). Because I feel like I am really, really lucky...although maybe not. I mean, how common is it for someone to go into anaphylactic shock and have their throat close and come out okay w/ no medical intervention? I honestly don't know. I remember clearly thinking...there is NO WAY I'm dying like this. It's an experience that's really stayed with me although most people don't get it and think I just panicked and that I'm exaggerating.


Suma 5 years ago

Hi there all of you, thank God I came across this and know that there are people out there who have had this choking experience. Yesterday I had this frightening experience of choking. There was nobody home except for my aged Mom who immediately went into panic. Fortunately I guess my throat wasn't entirely blocked, and there was an occasional deep breath I could take. I managed to call my hubby and daughter who had just driven out, and they rushed back. My throat had eased by then but it was a frightening experience. We rushed to a nursing home close by, and was given an im shot of Avil. I will be visiting an Allergy centre, but in the meantime would somebody tell me if Epipen is available in India, and under what name? I am sorry

to confess that emergency care in our country is not very effective, our version of 911 will take time to get to the patient, because of traffic and people.


Sara 4 years ago

Great Website!! :) I have multiple allergies to a lot of things, some anaphlatic like peanuts, treenuts, shellfish, kiwiis, avocados, mangoes, etc. The first time I went into anaphlatic shock I had a delayed reaction and didn't know what was happening, I thought I was having an asthma attack. My dad was unaware of my anaphlatic allergies at the time rushed me to the hospital and didn't administer the epi pen. Luckily, when I arrived at the hospital, I was immediately helped and eventually better! After we returned from the hospital, my entire family was informed of what to do when I'm having an anaphlatic reaction and we purchased a few more epi pens. I've had 6 anaphlatic reactions since then from allergies that have recently developed and I can't stress to you guys how important it is to use an epi pen immediately!! If you're afraid they might hurt, they don't, count to 15 and swing it in the fatty part of your leg, you'll feel a LOT BETTER!! Then call an ambulance, don't get driven there. If you're in an ambulance and your symptom redevelop or become worse, they have everything to help you. God bless! :)


Tony H. 4 years ago

This was the second time within the last year that I was eating peanuts when all of a sudden my throat closed and I could breath for about 3 minutes. I raised my hand above my head and tried to suck air in. I think I did but it did seam to be working until finaly,slowly I was able to breath. I eat peanuts from time to tiem and I don't have a problem but this time I did. I think I'll stay away from peanuts.


Me 4 years ago

how come you only put stuff about how to use an api pen. How about if i don't ha an epi pen!!!!!!!!!!!!!!!!


dave 4 years ago

this is great but what if you don't know you're allergic, like the other day I was eating peanuts, which I did the day before, and the day before that. I never had an allergy to peanuts, but this time it made me extremely dizzy and my mouth itched, I just ate some more and wasn't affected at all. It seems random? So if I went into anaphylaxis how would I have obtained an epi-pen without going to the ER?


Stacey 4 years ago

You call 911 and the EMT will administer it to you. I went into anaphalaxis yesterday for the third time in my life from multiple bee stings. I notice that each time the reaction to the sting gets worse. I was as close to dead as I have ever been and it happens FAST. Within a minute after being stung a blackness washed over me, i felt like I had to vomit and I was too weak to even walk to the couch or bathroom. I broke into an immense sweat and blacked out. My husband called 911 but living in a rural area it took a good 12 minutes to transport me to the fire hall and into the ambulance. There they injected me. Thank God I am alive. When the symptoms first hit me they were severe enough that all I could say was I don't want to die like this, not now, not like this. The moral of the story is ALWAYS have an epi pen in your house, check the expiration date on it, and pray you will never need it. Better to have it and not need it than the other eay around. Thanks for letting me get this off my chest. Well wishes to all.


Helen 3 years ago

This has happened to me about 40 times in my life ... Sometimes it hasn't been possible to inject myself and I have woken up in hospital at thatched to all kinds of breathing apparatus .. Make sure so done knows about your condition and what to do in an emergency !!!

I have been fortunate and I have schooled everyone I know so they know what to do if I have anaphalaxis in the future !!


Not said 2 years ago

Actually if you take a benadrylle right when the symptoms start, the antihistamine will attack the histamines being released through your body (Sorry if I spelled benadrylle wrong)


Jeez 2 years ago

Benadryl. You've never seen it spelled on paper??


Pesek 21 months ago

My son who is now 4 was diag with this severe penaut allergy' at about 10 months old. We were at a party, he took a bite of a PB cookie, I watched knowing it was his first taste of it. Immediate reaction and, well, now we know. Love your tips, and what I'll add is this. Educate others, but don't expect them to remember. We have friends with whom we do lots of things with. Every time we're together, and a meal or snack is involved, I have to ask if Mikey's sandwich is PB&J {it usually is.} They tell me yes, apologize, ask if Mikey shouldn't eat. No, not necessary, I'll just make sure my Lil Kiss eats on the other end of the table. They've know about his allergy since it was diagnosed, he ate the cookie at their house. But it's my responsibility to remind others and watch out for him, until he can watch out on his own.

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