I have had an anaphylactic reaction three times in my life: twice from bee stings when I was a teenager, and once from an antibiotic drug reaction several years ago. I was almost given that same drug by mistake when I was a patient in the hospital. Unless I had inquired what they were putting in my intravenous line, I would have had a fourth anaphylactic reaction. Even with all of the hospital safeguards, including my allergy listed prominently on my wrist band and chart, the nurse simply ignored it.
I can assure you that I now have a ready supply of epinephrine pens (called an EpiPen) at home, but when I had my last unexpected reaction to the antibiotic, my epinephrine had seriously expired. You would think I would know better. I have enough epinephrine in my house now to treat a small village.
More and more of my patients have serious allergic reactions listed on their chart. Recently, a 13 year old girl who was highly allergic to peanuts mistakenly took a bite of a Rice Crispy treat that had peanut butter in it. Even though she spit it out immediately and took an antihistamine, she developed an anaphylactic reaction. Her airway quickly became compromised and three shots of epinephrine were administered by her physician father. They did all of the right things, but they could not save her life. Sadly, these tragedies are not uncommon.
Anyone can develop a life-threatening allergic response, especially those with known allergies or asthma. For some, the reaction can be totally unpredictable. Even the elderly (now including myself), are at a higher risk from insect venom. I am among the 3% of adults who have bee sting and other insect allergies. Food allergies to things like peanuts, tree nuts, shellfish, fish, eggs, and milk are all too common now – 4% of the U.S. population or 12 million people have serious food allergies. Drug allergies are always a concern when I am prescribing them. Penicillin remains the most common drug allergy, but even ibuprofen can cause serious reactions in those who are allergic. Chemical reactions to latex (gloves, condoms) have also caused life-threatening allergic reactions. Up to 6.5% of the general population is allergic to latex and many do not even know it.
If you have a history of allergies, asthma, or serious allergic responses in the past, you must be proactive. Talk to your health care professional and make sure you have the proper medication, and know how to handle an allergic response in yourself or a family member. You need to have an auto-injection epinephrine pen (available generically or as the brand name EpiPen or Auvi-Q) and know how to use it.
Prevention is the key. While it may not always be possible to avoid every allergic trigger (like bees), every effort should be made to avoid the allergens that you do know. If you are allergic to one or two substances, you are likely to be allergic to more. Peanut butter hidden in a Rice Crispy Treat recipe or Chinese food cooked in peanut oil may end up being deadly. Letting your pharmacist know your drug allergies can be life-saving. For instance, a person who is highly-allergic to penicillin may not know that the antibiotic, Augmentin, contains a large dose of amoxicillin. Even in the best medical facilities, drug mistakes can happen, so an allergic person should always be on high-alert.
Some of the signs and symptoms of anaphylaxis can begin in seconds or even thirty or so minutes after exposure:
- Sudden wheezing and a compromised airway
- Itchy hives all over your body or redness
- Sudden swelling of the face, lips, or other parts of your body
- Rapid heartbeat or even a weak pulse
- Feeling anxious and confused
- Fainting or passing out
What to do in an anaphylactic emergency:
- If the person has an EpiPen or if an EpiPen is available, inject it immediately in a thigh muscle. More than one injection may be required. Be prepared for a second injection in about ten minutes if there is no response.
- Call 911 if they have not been called.
- Make sure the airway is open. If the breathing has stopped, start CPR until the paramedics arrive
Time is critical during these unexpected, life-threatening emergencies. The sooner the patient is handed over to the paramedics and on the way to the hospital, the better.