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Anaphylaxis, also called anaphylactic shock, is a potentially life threatening condition.  I write about it tonight because yesterday afternoon my friend's mum called me to come next door to see what was wrong with her.

When I got there she was having extreme difficulty breathing, had broken out in hives, and had swollen lips.  She was crying because of fear (EVERYONE panics when they can not breathe) and the pain from the rash.

I knew immediately that she was in trouble.  I told her mum to call the paramedics and asked if she had any diphenhydramine (trade name Benedryl).  She did not.

I went back to my house and found some, and I thought that I had used all of mine.  As if by Providence I did have one blister sheet left.  I took it to her and gave her 50 mg as soon as I could.  About 20 minutes later the paramedics arrived and started checking her.  I told them that I had given her the drug, and one of them said, "Well, that is what we would have done, except we might have given her epinephrine as well."  I explained that we did not have any available that that was the best that we could do at the time.  He told us that I did the right thing, and her airway was already opening and the rash was resolving.  Her lips had gone back to near normal as well.

Her chest sounded OK to them and her blood pressure was normal for a 19 year old.  They told her that she did not need to go to the Emergency Department because of the diphenhydramine, but to call again if she got worse.  We all thanked them and they left.  Everyone thanked me for coming through with the proper treatment, and I just spoke with he a few minutes ago.  She has her voice back, although she still has a little chest tightness.  That is not surprising since she has asthma.

I found it interesting that her mum called me before she called the paramedics.  Over the course of time they have learnt to trust my judgment is such matters.  It made me feel good to be the resource of first choice to help my friend.

Now that the personal story is told, let us look at this very common and life threatening syndrome.  It is not a single malady, but rather a constellation of symptoms, some of which may or may not present.  It is the most severe allergic reaction known.

To understand anaphylaxis we first must become familiar with a couple of cell types and some chemical signaling agents that they carry.  The two most important cell types are basophils and mast cells.  Those are important because they contain large granules which contain chemical signaling agents important for allergic reactions.

The most important chemical signaling agents are histamine and several prostaglandins.  In anaphylaxis, histamine release is the most important cause.  Histamine is well known as the cause of allergic rhinitis (runny nose) and watery eyes from seasonal allergies ("hay fever").  In these cases, the histamine release is relatively small but prolonged.

Histamine actually gets a bad rap because it is necessary for our immune systems to function properly.  It is only when histamine release gets out of control that bad things happen.  Here is the structural formula for histamine:

Photobucket

It is rather small molecule as far as biological systems go, but quite important.  It is a neurotransmitter, working with melotonin to control the sleep/wake cycle.  The presence of histamine tends to produce wakefulness, and that is why the first generation antihistamine drugs, like diphenhydramine, tend to cause drowsyness.  They cross the blood/brain barrier and occupy the receptor in an antagonistic manner to prevent histamine from doing its job.

This is primarily because those older antihistamatic drugs occupy the H1 receptor and that is the one that has to do with sleep.  The new generation antihistamines are relatively nonsedating because they do not cross the blood/brain barrier much and so can not bind to that receptor in the brain.

These same receptors outside the central nervous system are also responsible for allergic reactions, one of those being anaphylaxis.  There are two ways that large amounts of histamine and other chemical signaling agents can be released.  One is through the immune system, whilst the other does not involve the immune system.

For the first type, immunogloblulin E (IgE) latches to some antigen to which the IgE recognizes as a foreign and unwelcome invader.  This is normal for attacking germs and is an essential part of the human immune response.  The activated complex then triggers mast cells and basophils to degranulate (release histamine and other chemical signaling agents, named because they are contained in granules in those cells) to attract white blood cells to attack the invaders, also an essential part of the immune response.

In anaphylaxis, this system goes into warp drive, and often substances other than harmful invaders trigger the response.  At high levels, those signaling agents, in particular histamine, cause the symptoms of hay fever if the immune system (where only slightly higher than normal levels are released) is only slightly hypersensitive to full anaphylaxis when very high levels are released.

The other way to cause these cells to degranulate is by direct interaction by either physical or chemical means.  I have experience with this because years ago the former Mrs. Translator had taken a bad fall and hit the back of her head.  She was having headaches and went to a neurologist to be checked.  As soon as they injected the X-ray contrast dye she went into anaphylaxis and almost died.  After in injection of epinephrine and IV diphenhydramine she got OK.  The very same thing happened to our neighbor's sister and she almost died.  It turns out that contrast media cause this reaction quite often and clinics are now on the lookout for it.

Temperature extremes and mechanical shock can also trigger these reactions, and so can opiate drugs.  I have a theory that Janis Joplin may not have died from a herion overdose but rather from anaphylaxis induced by the heroin (or some other substance in it).  As I recall, her death was atypical for heroin overdose and that there was froth in and around her mouth.  More about that later.

One of the effects of high levels of histamine is bronchoconstriction along with smooth muscle contraction in the lungs and trachea.  Hives are also produced in many cases.  In addition, the H1 receptor and the H2 receptors cause vasodilation, making the capillaries leak fluid.  The combination of smooth muscle contraction and vasodilation conspire to close the airway because of swelling (from the vasodilation) and tightening of the muscles.

Think of it this way.  Imagine that the trachea is surrounded by a balloon with a little water in it, representing the smooth muscle.  The vasodilation causes the balloon to take on extra water, causing it to expand while at the same time the smooth muscle contraction make the balloon harder.  It it takes on enough water, the trachea is squeezed shut.  At the same time, the vasodilation causes the lungs to tend to fill with fluid, a possible explanation for the froth in and around the mouth of the late Ms. Joplin.

Another effect of the vasodilation is often a dramatic and life threatening drop in blood pressure.  Since the GI tract is rich with smooth muscle, nausea, vomiting,and cramps are not unusual.

My friend had many of the classic symptoms.  Her lips were swollen because of the vasodilation, her trachea was nearly blocked because of the combination of the vasodilation and smooth muscle contraction, and she had hives.  Although I did not let on at the time because I had to take charge, I was terrified.  I knew that there might just be a few minutes that could make the difference whether I would see my friend again.  Whilst I was at my house to get more diphenhydramine for her for later (anaphylaxis often returns) the paramedics told her that I most probably had saved her life by giving her it.

She was going to go to the clinic today because she still had a little throat tightness and hives, but was very much better than yesterday afternoon.  I called her and told her that she should ask about getting an epinephrine self injector (one brand is the EpiPen) to keep on hand, and always to have diphenhydramine close at hand.

Epinephrine is specific for anaphylaxis because it is a potent vasoconstrictor, thus reversing the vasodilation caused by histamine.  This rapidly opens the airway by taking water out of the balloon to use our previous analogy.  However, it is rapidly metabolized in the body and may have to be given repeatedly.  This is particularly probable in anaphylaxis caused by food allergies because the causative agent is continuously triggering the reaction until it is either digested or eliminated.  For single, short term exposure to an allergen (for example, a bee sting for sensitive individuals), a single injection is often adequate.  Here is the structure of epinephrine:

Photobucket

Interestingly, bee venom actually contains histamine, but not enough to cause anaphylaxis.  It does cause pain at the sting site, though.  Bee venom anaphylaxis is an immune system modulated reaction.

The second line of treatment (and the first one for us yesterday) are antihistamines, and diphenhydramine is usually the drug of choice.  It is a potent inverse agonist of the H1 receptor.  Although it does not work as fast as epinephrine, it has a longer half life in the body.  It is a very old drug (FDA approved it for allergies in 1946), is well tolerated by almost anyone, and has an extremely wide separation betwixt therapeutic and toxic doses.  Here is its structure:

Photobucket

Whilst treatment is often effective, sometimes it comes too late.  People with known sensitivities to drugs, foods, stings, and so forth should keep a self injector and diphenhydramine with them at all times.  For drug (and latex) triggers, a bracelet is a good idea.  The bracelet is a form of prevention, and prevention of life threatening conditions is always preferable to treatment.

People with food allergies are at high risk.  I went to graduate school with a guy who had extreme reactions to peanuts.  Whilst he was there for his campus visit before he enrolled, the welcoming committee took him to one of the local Mexican restaurants.  Doug almost died.  Unknown to anyone but the kitchen staff, they used peanut butter in the enchilada sauce.  After a long time in hospital, he got OK.

If you look on food packaging you will often see a statement like "this product was produced with equipment that also processes peanuts" or some such.  You may also see words like "this product contains soy".  These warnings are for those who have severe food allergies, but at restaurants the only thing that can be done is ask.  Do not assume that the wait staff know; ask the kitchen staff.

It is possible to desensitize sufferers from specific triggers by giving them repeated, small doses of the trigger to get the immune system accustomed to the trigger.  However, it is also possible for this treatment to provoke an attack.

My friend's anaphylaxis is of the idiopathic kind, meaning that a definite cause is not known.  Unfortunately, up to 50% of cases are like hers.  We have some suspicions but nothing really concrete.  I hope that we can figure out what triggered her paroxysm, but the fact is that we may never know.

The bottom line is that anaphylaxis is life threatening and all too common.  I have personally know four people who had such a reaction, and two of them were and are very dear to me.  Somewhere betwixt 500 and 1000 people die from in in the US every year, and the lifetime risk for having such a reaction is betwixt one half and 2%.  That means that up to one person in 50 may have such a reaction sometime during their life.

This is NOT medical advice, but IS what I would do if my throat started to tighten and I was breaking out.  I would take 50 mg of diphenhydramine immediately and call the paramedics.  If I knew that I had a specific trigger, I would keep a self injector with me at all times.  By the way, those need to be replaced rather frequently because epinephrine is not particularly stable in aqueous.  I would also wear a bracelet if I knew that drugs or latex triggered it in me.

This story has a happy ending.  My friend is alive and well (well, much better) today.  I know that I will be able to see her tomorrow, and I am happy.  I have a real sense of making a contribution that may be what kept her alive yesterday, and I am glad of that.  Her little girl still has her mommy, too!  I had better stop before I get too emotional.

Before I close, I would like to take the opportunity to thank those who serve and have served in our armed forces.  Having worked as a civilian for the Army, I have many personal friends who were and are serving.  It is something that I would have found difficult to do because of my temperament, and I respect those who can.  In particular, I honor those who were killed or wounded in my defense.

Well, you have done it again!  You have wasted many more einsteins of perfectly good photons in reading this shocking piece.  And even though Donald Trump realizes that he is merely an impish clown when he reads me say it, I always learn much more than I could possibly hope to teach by writing this series, so please keep those comments, questions, corrections, and other feedback coming!  Tips and recs are also always welcome.  I shall stay around tonight as long as comments warrant for Comment Time and shall return tomorrow around 9:00 PM Eastern for Review Time.

I promised to give periodic updates about my experience with melatonin (link above).  It really puts me to sleep, but too often I fight it because I like to write in the wee hours.  One side effect that is quite welcome is that my lower digestive system problem has just about resolved, and it is not possible to express how nice it is to be able to eat a meal and not have immediately to go to the bathroom!  Melatonin will be part of my life for a long, long time.

Now I have about 80% of function back in my right hand.  I am typing with all ten fingers now, except for the bad habits that I acquired whilst it was weak.  I wear the splint only in bed, when typing, and when eating now.  I can type for a little while without it, but the muscles are still weak from disuse.  I am doing some weight therapy on it now to improve the muscle tone.

UPDATED 20120528 at around 8:00 PM Eastern

My friend went to the Emergency Department yesterday and got a full evaluation.  They gave her quite a bit of medicine, and I shall evaluate it later (she has been out with her mum and daughter most of the day).  They reaffirmed what the paramedics said:  if she had not taken the diphenhydramine that I gave her when she did, she would not have lasted until the paramedics got there.  I saved her life.

UPDATED 20120529 at around 7:35 PM Eastern

I spoke with her a while ago and she went to her personal physician and secured an epinephrine self injector.  I feel much better that she has this piece of lifesaving equipment.  Now I have to make sure that she carries it EVERYWHERE.

Warmest regards,

Doc, aka Dr. David W. Smith

Crossposted at

The Stars Hollow Gazette

Docudharma, and

firefly-dreaming

Originally posted to SciTech on Sun May 27, 2012 at 06:00 PM PDT.

Also republished by Community Spotlight.

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Comment Preferences

  •  Thanks for the information, and the personal (13+ / 0-)

    story to go along with it! I'm glad things worked out well.

  •  I'm allergic to Poinsettia. Given the right (7+ / 0-)

    amount of exposure, I go into respiratory distress.  'Normal' accidental exposure will cause my throat to start to close up and chest tighten, like after 5 minute exposure.  I liken it to having someone sit on my chest while trying to strangle me.  I try like hell to avoid cats, poinsettia, and smoke as they are known triggers for asthma.  I know I'm sensitive to many perfumes/scents/colognes, but I'm not willing to go through the pain to find out exactly which ones.  So, I try to avoid all of them.

    Remember when M&M took the red ones out because of the red dye allergy thing and later found a new 'safer' dye to bring it back.

    •  I was running long. (6+ / 0-)

      but it turns out that people with asthma are much more likely to have these episodes than those who are not, likely because of an already overactive immune system.  Both my friend and the former Mrs. Translator have asthma.  I think it is because their mast cells have some fundamental sensitivity not shared with folks without asthma.

      Warmest regards,

      Doc

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Sun May 27, 2012 at 06:24:34 PM PDT

      [ Parent ]

      •  It wouldn't surprise me in the least. (4+ / 0-)

        I've also been told that it's impossible for me to be allergic to poinsettia.  I'd gladly trade places with them in December.  I'm rather fond of breathing without assistance.

        •  We think that it MIGHT (5+ / 0-)

          be cornstarch that triggered my friend's attack.  With the possible exceptions of water, salt, sugar, and a few other substances essential for life, I think that is possible to be allergic to just about anything.

          Warmest regards,

          Doc

          I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

          by Translator on Sun May 27, 2012 at 06:32:08 PM PDT

          [ Parent ]

          •  Corn starch is going to be difficult to eliminate. (3+ / 0-)
            Recommended by:
            Translator, Lefty Ladig, JeffW

            It's in lots of things.  Then if it is corn starch, what are the chances of being allergic to corn in general??  Corn is in everything these days.

            •  Her little girl had (4+ / 0-)

              spilt a lot of it on the floor and she was sweeping it.  It may be that the physical assault of the dust may have triggered the degranulation of mast cells directly, and not by an immune reaction.  Mind ye, this is just speculation.

              Warmest regards,

              Doc

              I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

              by Translator on Sun May 27, 2012 at 06:38:50 PM PDT

              [ Parent ]

            •  There are web sites for corn allergies. I am (11+ / 0-)

              reactive to corn and any corn products. The worst thing about prepared products is that they don't always list ingredients as a corn product. I weeded my refrigerator after the lastest episode when I stupidly thought one ear of corn couldn't hurt... Bleeding internally & externally, pain, rash from my neck to the base of my spine, swelling belly so bad I looked like a balloon. I took antihistamine but it had corn starch in it as a filler and I got worse... Thats when I started having shortness of breath ( I am already on O2 at 4 PSI so it was frightening). Have resorted to home made bread, veggies, organic meats and absolutely no dressings, catsup, tartar sauce, grated cheese, cereals, crackers, etc.  From what I have read elsewhere about 10 million people in the US are now reactive to corn.

              Did you know corn is in toothpaste, lotions, shampoos, treatment of some new clothing, flour, powder sugars, ... Which is why I am a LABEL fanatic ... because not knowing may kill me one day. Not just because of breathing issues but the ulceration of my digestive tract is a serious issue (shows up in occult blood tests that I perform myself).

              Good diary as usual.

              Proud Slut...Fear is the Mind Killer

              by boophus on Sun May 27, 2012 at 09:06:48 PM PDT

              [ Parent ]

        •  Why is it impossible? I've certainly heard of (5+ / 0-)
          I've also been told that it's impossible for me to be allergic to poinsettia.
          other people being allergic to poinsettia.  Why can't you be?  People who are sensitive to latex are often sensitive to poinsettia also.  

          Renewable energy brings national global security.     

          by Calamity Jean on Mon May 28, 2012 at 01:16:47 AM PDT

          [ Parent ]

  •  Interesting and informative, thank you. (9+ / 0-)

    My son has never gone into full-blown anaphylaxis, although he came close a couple of times. He's allergic to sesame seeds and all types of nuts. Even peaches and apricots will trigger mild hives and a "funny" feeling in his mouth and throat. I read something about fruit with a single pit that can cause a problem, but there was more to it than I remember.

    Of course, he avoids those things, but sometimes something like peanut oil will sneak in. If there's not too much of it, he's okay. If there's a lot, it usually resolves itself with a dramatic bout of vomiting. When he was younger, we equipped him with an epi-pen in his bookbag and informed everyone of the possible problem. He's on his own now, and careful, but I still worry.

    Thanks again.

    •  There is hope. (7+ / 0-)

      It turns out that children often grow out of their allergies as they get what is essentially desensitization therapy during life experiences.  I was highly allergic to cow's milk when I was little (fortunately, soy formula had just come on the market), but now drink a gallon of skim and half a gallon of buttermilk every week.

      Since it is the proteins in peanuts that trigger most reactions, refined peanut oil has little of the allergen, but in large amounts can have enough to trigger a response.

      I hope that he gets over them.  Thank you for taking the time to read and respond!  Please read every week and comment!

      Warmest regards,

      Doc

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Sun May 27, 2012 at 07:00:18 PM PDT

      [ Parent ]

      •  Well, he's in his 20's (3+ / 0-)
        Recommended by:
        Translator, weck, Lefty Ladig

        and still has adverse reactions. Sesame (seeds and oil) is a real problem. So are egg whites. I know he sounds like a delicate creature, but he's strong and healthy. The allergies (not to mention Celiac disease--oy!--are a PIA for him, though. But he handles them much better than I know I would.

        The peanut thing isn't as bad as it used to be, unless there's too much of it. When he was about a year old, I gave him a small taste of peanut butter and he almost immediately broke into hives. I'd read about the potential for peanut allergy and knew not to give him anymore. Gotta admit, though, I was disappointed that there would be no pb&j sandwiches in his lunchbox!

      •  I remember having hives (1+ / 0-)
        Recommended by:
        Translator

        as a 4-year-old (allergic to broccoli), but outgrew it in a few years.

        The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

        by ybruti on Mon May 28, 2012 at 03:35:15 PM PDT

        [ Parent ]

        •  My broccoli allergy (0+ / 0-)

          has to do with the gene that makes it taste bitter to me.

          Warmest regards,

          Doc

          I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

          by Translator on Mon May 28, 2012 at 06:04:04 PM PDT

          [ Parent ]

    •  anaphylaxix twice: chemo therapy (7+ / 0-)

      It happens FAST! I barely could spit out, "somethings wrong" before I felt like an elephant on my chest and I passed out.

      I get red patchs about 3 in in diameter from a bee sting--was told the next one could bring about  anaphalectic shock. I've forgoteen to ever ask about the epi pens.

      •  Those agents, since (6+ / 0-)

        they are designed to kill aberrant cells, can be potent mast cell destablizers.  It depends on the cancer and the drug, but as cancerous mast cells are killed they degranulate immediately.  The medical community is hip to this now and have the drugs at hand to terminate the episode.

        I sincerely hope that you have a full recovery.

        Warmest regards,

        Doc

        I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

        by Translator on Sun May 27, 2012 at 07:08:10 PM PDT

        [ Parent ]

  •  I had a problem with Benadryl once (17+ / 0-)

    The problem was finding a product with the right active ingredient for the person who asked for it.

    (I think I may have mentioned this in a Pique the Geek before, years ago, but it is worth repeating.)

    You see, in the USA Benadryl may be used as the trade name for the antihistamine Diphenhydramine and never anything else, but that is not the case internationally. In the UK, that brand name is used for a range of antihistamine allergy products. In Australia and NZ, Benadryl is a range of cough syrups, most of which do contain any antihistamine at all.

    I remember an episode around 15 years ago when a visitor from the USA staying with me in New Zealand needed (US) Benadryl, and it took a couple of visits to the pharmacy along with an internet search (it wasn't as wasy to find what you wanted back then) to figure out the antihistamine that was wanted and identify a local equivalent.

    Lesson learned for travelling: know the active ingredient of any medicine you may need, and do not assume - even if travelling to other Western industrialized nations - that the brand name you know will have the same active ingredients or even exist there.

    Thanks for another interesting Pique, Doc!

    •  Thank you for bringing this (9+ / 0-)

      to the attention of the readership.  That is why I am VERY careful to use the generic name first, then the US brand name.  However, that does always work, and here is an example.

      The very dangerous (and I think that should be Rx only) drug called acetaminophen generically in the US is called by a different generic name,  paracetamol, in the Commonwealth.

      Go figure!

      Warmest regards,

      Doc

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Sun May 27, 2012 at 07:17:46 PM PDT

      [ Parent ]

    •  That is scary (11+ / 0-)

      (the Benadryl not having antihistamine in it)..

      I have a few allergies.

      One time, I had a CT Scan at the local hospital and they used the contrast dye.  Jokingly, I asked what would happen if I was allergic to it.

      They told me it was OK because I was in a hospital.

      Good thing I was in a hospital.  Halfway through the scan, my back started getting itchy (I usually get uticaria first, then other symptoms with my allergies) so I asked them to check my back.

      They did.  I was covered in hives. And my tongue was getting thick.

      Ended up in the emergency ward, with benadryl on an IV, and they wouldn't let me leave for 6 hours, until they were sure I was OK.

      Not more CT scans with contrast dye for me.

      I have an interesting side effect with benadryl too, Doc; unlike some folks who get sleepy from it, I get really hyper as if I drank a couple of cups of coffee (which I don't normally drink).  Keeps me up late at night if I take it later in the day.

      If I take chlorpheniramine maleate I sleep like a baby, and it kills the symptoms too.

      •  You make several interesting points. (4+ / 0-)

        The contrast agents are really prone to cause this reaction and I need to find out why.  The trees are calling to me, I've got to find out why.  Sorry, that is from one of my other series, Popular Culture, now discussing The Moody Blues on Fridays and 9:00 PM Eastern.  How is that for a very subtle diary pimping effort?

        You reaction of being stimulated by diphenhydramine is called a paradoxical reaction, and it is not that uncommon.  It occurs mainly in children, to the chagrin of parents who want to spend some time with each other whilst the little one sleeps, but can occur in anyone.

        It probably has to do with subtle changes in the structure of the H1 receptor geometry, but that is quite speculative.

        Finally, chlorpheniramine maleate was the drug of choice for my father when I was little to combat his "hay fever".  It was Rx at the time, called Polaramine.  It came in red, rounded tablets and was highly sedating.  Dad would take one and zonk out for a couple of hours, then awaken and not too sniffly.  Thanks for triggering my memory of that!  I always prefer the comments to the actual text.

        Warmest regards,

        Doc

        I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

        by Translator on Sun May 27, 2012 at 07:31:37 PM PDT

        [ Parent ]

        •  Chlorpheniramine maleate (4+ / 0-)

          is sold, by pharmacists (ie not OTC but not RX) here in Canada under the brand name Novo Pheniram.

          $10 for 100 (4 mg).

          Cheap like borscht.  Unlike the epy pen.  Which is $95. (RX only.)  

          I have a number of drug allergies. Wonder if this is somehow connected to the reaction to benadryl? (I'm thinking out loud here.)

        •  Thanks for the explanation of the paradoxical (2+ / 0-)
          Recommended by:
          Translator, wilderness voice

          reaction to benadryl.  For me it is almost like taking an amphetamine (not that I would do such a thing) except with benedryl I am hyper but cannot focus.

          Democrats give you the Bill of Rights; Republicans sell you a bill of goods!

          by barbwires on Sun May 27, 2012 at 08:46:28 PM PDT

          [ Parent ]

        •  Chlorpheniramine maleate gives me an asthma (3+ / 0-)
          Recommended by:
          nchristine, JeffW, Translator

          attack.  Interestingly, BROMpheniramine maleate (very nearly the same molecule) is very effective and doesn't bother me at all.  

          Renewable energy brings national global security.     

          by Calamity Jean on Mon May 28, 2012 at 01:26:30 AM PDT

          [ Parent ]

        •  While I do believe in "paradoxical" drug ... (1+ / 0-)
          Recommended by:
          Translator

          ... reactions, I sometimes think we're too fast to label them as such without looking for other causes.

          I am highly reactive to red food colorings, they give me insomnia & low-grade hyper-activity. When OTC diphenhydramine is formulated with red dye, my reaction to the coloring negates the drowsiness caused by the drug. Fortunately, there are dye-free forms available, because I occasionally use diphenhydramine as a sleep aid.

      •  I tried to give platelets once and had a bad (1+ / 0-)
        Recommended by:
        Translator

        reaction to whatever they put in the blood to keep it from clotting in the machine. Had a moment's panic when I realized I was gonna puke and I had needles in both arms and was strapped into the seat. Oops. The tech saw the gray look on my face and unhooked me quick!

  •  i'm ASA (3+ / 0-)

    can't take ibuprofen either, or the thing that came out after that.  

    the shock of "hit the floor" from the benadryl and "hit the ceiling" from the epi dose, wowza.  

    called the then mr. jlms from the doctor's once and told him to come and get me.  we were a one-car family then and he said "i can't, you have the car".  i hung up the phone.  he eventually showed up in a taxi.

    thankfully, my bio son does not seem to share this allergy.  

    oh, and i get hives wherever i had allergy shots - sympathy hives.  my doctor took photos.  and brought residents to look at them.  

    for anti-inflammatory needs as i approach middle age, i use ice, take fish oil and eat fruits and veggies.  and if i had a totally awful migraine, i can get a shot of toradol.  

    •  You might want to look into (3+ / 0-)

      melatonin.  It holds promise against migraine, and it pretty much cured my IBS.

      Warmest regards,

      Doc

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Sun May 27, 2012 at 07:53:47 PM PDT

      [ Parent ]

      •  Translator, would you... (5+ / 0-)

        ...expand on the benefit of melatonin for IBS?

        You most likely saved your friend's life.  How very fortunate for her that you were near by.

      •  Melatonin can help with migraine, potentially? (2+ / 0-)
        Recommended by:
        jlms qkw, Translator

        Interesting. I use it intermittantly when I know I need to rest well given I am now at an age where restful sleep can be difficult to attain.  It does seem to help with that. I have suffered migraines for years although again, given the hormone changes at my age, those seem to be much more rare (thank goodness) but not rare enough as they can still be triggered by a few things.

        I had not thought melatonin might be helpful though. Very interesting.

        I use ibuprofen when I feel I may be heading towards migraine, imitrex when I have crossed the line...a trip to the Dr if the imitrex is unhelpful. Fortunately, that has been a very, VERY rare occurrance.

        "one useless man is a shame, two is a law firm, and three or more is a congress" -- John Adams

        by blue armadillo on Mon May 28, 2012 at 10:20:12 AM PDT

        [ Parent ]

    •  I am allergic to all NSAIDs (2+ / 0-)
      Recommended by:
      jlms qkw, Translator

      At this point, I take nothing for regular pain like a headache etc.

      Fish oil helps?  

      Where ignorance is our master, there is no possibility of real peace. - Dalai Lama

      by kimoconnor on Mon May 28, 2012 at 10:52:14 AM PDT

      [ Parent ]

      •  based on the theory that i have (1+ / 0-)
        Recommended by:
        Translator

        general inflammation based on stress, i try to eat non-inflammatory foods.  even eating salmon and anchovies and such now, to try to help.  

        i take some tylenol, but i track the dose very carefully.  and some days i'd rather have a drink than tylenol so i try to choose carefully.  

        ice, heat, tylenol.  steam, stretching, meditation.  

        •  Reply to both: (1+ / 0-)
          Recommended by:
          jlms qkw

          I have not done enough research about fish oil to make an intelligent statement.  The reason that I think that acetaminophen should be Rx only is that very few people have the good sense that jlms qkw has about monitoring dosage.

          Warmest regards,

          Doc

          I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

          by Translator on Mon May 28, 2012 at 06:10:47 PM PDT

          [ Parent ]

  •  Penicillan, Pen Vk and corn. Gonna get some epi (4+ / 0-)

    Already keep antihistamines around without corn starch since that makes my skin bleed somewhere... usually on my head on my belly... Though thye rash is painful it is minor any more compared to the rest of the symptomology.  Last time I was excposed to corn I had a shortness of breath reaction ... not as bad as the Penicillan in which I ballooned up like a water filled sack... and could not swallow liquid for nearly an hour.

    I really should get an epi pen... Is a prescription required?

    Proud Slut...Fear is the Mind Killer

    by boophus on Sun May 27, 2012 at 08:53:34 PM PDT

  •  I get an anaphylactic response to nutrisweet. (5+ / 0-)

    Even making something like crystal light while I'm nearby will cause a reaction because it gets into the air and I inhale it, so all nutrisweet is banned from the house. Also someone taste tests  my drinks at restaurants because I've been accidently served the wrong ones in the past (I got the diabetic at the other table's diet coke, he got my dr. pepper). One swallow and my throat started to close.
    I've also had reactions to wild fire smoke, still don't know what burned that I was allergic to.
    My daughter had one to cephalasporins (a family of antibiotics) when she was 8 months old. Luckily we were already in the hospital at the time (she had RSV), so it was taken care of very quickly and she suffered no damage from it. The nurse said the rash could have been from the RSV and not the antibiotic, but it wasn't worth risking a more serious reaction to try them again when there are so many other antibiotics out there, so she's listed as allergic. As quickly as it appeared after they gave her the shot of antibiotics, it's my opinion it likely was the cause.

    "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

    by FloridaSNMOM on Mon May 28, 2012 at 04:54:04 AM PDT

    •  Wildfires in the South often burn ... (3+ / 0-)

      ... large quantities of poison ivy. It is a know fact that folk severely allergic to poison ivy have died from breathing the smoke from bonfires that accidentally include the stuff.

      •  Actually I've rarely seen poison Ivy down here. (1+ / 0-)
        Recommended by:
        Translator

        And I'm highly allergic to it, but it wasn't poison ivy that I had, I've gotten that from smoke up north. this was hives and a closing throat, swollen tongue, etc. I've not gotten poison Ivy since I moved to Florida, it doesn't seem to do well down here.

        "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

        by FloridaSNMOM on Mon May 28, 2012 at 10:55:09 AM PDT

        [ Parent ]

        •  Urishiol reactions typically (1+ / 0-)
          Recommended by:
          FloridaSNMOM

          occur rather slowly, so it is unlikely that it was poison ivy.

          Warmest regards,

          Doc

          I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

          by Translator on Mon May 28, 2012 at 06:15:46 PM PDT

          [ Parent ]

    •  It might have been from the (1+ / 0-)
      Recommended by:
      FloridaSNMOM

      preservatives in the injectable form.  That is hard to say.  I suspect that many injectable drug allergies are from other materials in the solution.  I am glad that she got better.

      Warmest regards,

      Dop

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Mon May 28, 2012 at 06:14:40 PM PDT

      [ Parent ]

      •  That's possible as well, (1+ / 0-)
        Recommended by:
        Translator

        but as the nurse said, there are many other families of antibiotics out there, why risk a reaction with that one? Unless she contracts something that cephalsporins are the only good cure for, we'll just avoid them. Anaphalxis is nothing to toy with, so we'll just keep listing her as allergic.

        "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

        by FloridaSNMOM on Mon May 28, 2012 at 06:29:36 PM PDT

        [ Parent ]

  •  As the mother of a peanut-allergic (3+ / 0-)

    son I deeply appreciate the information you have provided here.  My son is going into his 3rd year in college and (knock wood) has not had an allergic reaction since he was 4 years old when he took a bite of a Snickers mini from a birthday party goody bag that I had yet to go through.  Both he and I have been very careful since then.  It irks me, though, how, still, too many people dismiss these allergies as no big deal - so the more information out there the better......thank you.

    •  Thank you for the kind words! (0+ / 0-)

      Food allergies ARE a big deal, and people get sick every day from them.  Some die.

      Warmest regards,

      Doc

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Mon May 28, 2012 at 06:16:51 PM PDT

      [ Parent ]

  •  hey doc (3+ / 0-)

    great diary!

    i find melatonin a wonder drug on many levels, for the deeper sleep, but also for a sense of well-being that comes too.

    be well!

    why? just kos..... *just cause*

    by melo on Mon May 28, 2012 at 06:24:34 AM PDT

    •  I have noticed that I DO (0+ / 0-)

      have a more serene aura the past week or two.  I do not know if it was caused by the melatonin or just accepting my situation better, but the relief of IBF is tangible.

      Warmest regards,

      Doc

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Mon May 28, 2012 at 06:49:36 PM PDT

      [ Parent ]

  •  I have an interesting variation (11+ / 0-)

    of anaphylaxis called chronic idiopathic angioedema.  I have a pretty limited understanding of the mechanics of it.  It causes your body to mimic anaphylaxis, with no trigger - it just happens.

    In 1998, I began having serious allergic problems (hives for 2 years, sudden tracheal spasms, swelling) and one day in 1999 it all happened together, and I went to the hospital in what appeared to be anaphylactic shock.  

    And went to the hospital 2 or 3 times a week in that condition for months.  I was retired on disability by Big State U.; I worked in Admissions, and it doesn't give the best impression to applicants and their parents to have a staff member being wheeled out with shouting EMTs regularly.

    In this condition, allergy tests are useless, since the results change literally from day to day.  Allergy shots have no effect.  The first treatment given was prednisone.  It didn't work;  I gained sixty pounds, my brain went on vacation, and the incidents continued.

    I was very lucky.  A doctor doing a six-month placement  at Jefferson in Philly until his position at the Cleveland Clinic opened up had a theory about antihistamines: people can take a lot more than had previously been believed, and did I want to be his guinea pig?  Did I?  It took a year to wean me off the prednisone (I was home sick for two and a half years) and to learn how to stay awake with the antihistamine load, but it worked.  I haven't had an incident since 2000.

    I still carry my Epipen, and I still have liquid Benadryl (in the disgusting Bubble Gum flavor) in the house, but I live a normal life thanks to his theories.

    If anybody else out there has these symptoms - constant attacks of 'anaphylaxis' that can't be diagnosed or treated - tell your allergist or immunologist to call the Cleveland Clinic adult allergy & immunology department.  They know how to treat this.

    "Republicans are poor losers and worse winners." - My grandmother, sometime in the early 1960s

    by escapee on Mon May 28, 2012 at 06:52:35 AM PDT

  •  I had an ugly reaction (5+ / 0-)

    once to chiquita bananas. It was a long time ago they had just started selling them in Germany. My mother bought them cause they were so nice looking and I loved bananas.
    They reaction was almost immediate starting with itching, then hives and swelling of my lips and eyes. After about 30 minutes all my joints hurt and I couldn't stand or walk. I never had any breathing problems through this whole ordeal. About 4 hours later the swelling went down and the pain stopped.
    The worst of it was I had to cancel my date with the hottest guy of the school. I was 16yo, what can I say. :)

    El pueblo unido jamás será vencido. The people united will never be defeated

    by mint julep on Mon May 28, 2012 at 06:54:42 AM PDT

  •  this is fascinating to me because I have (3+ / 0-)

    developed anaphylactic-level allergies with neurological auto-immune disorder. I had a general "well, my immune system is off-filter" understanding of why I would suddenly be allergic to things I've never been allergic to. I didn't really understand the connection between neuropathies - both peripheral and central - and allergies. I'm not sure I really understand it, still, but reading that histamines are neurotransmitters gives me a better sense.

    Thank you.

    Now, if only we could reverse it so that I can return to joyfully eating nuts. Alas.

    •  We are just now beginning to (0+ / 0-)

      understand this area.  Our understanding is increasing exponentially, but we are in only the crawling stage now.

      Warmest regards,

      Doc

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Mon May 28, 2012 at 06:39:32 PM PDT

      [ Parent ]

  •  Hey, Doc! WRT corn allergies ... (1+ / 0-)
    Recommended by:
    Translator

    In recent (past 5-7) years I've met several people with various sorts of allergic reactions to corn & corn products, which got me to wondering about GMOs.

    Is it possible that there is undetected / unreported / covered-up genetic contamination of corn destined for human consumption, and that these allergic reactions are in fact due to compounds such as the Bt toxin?

    •  This is controversial. (1+ / 0-)
      Recommended by:
      WereBear Walker

      With a highly refined product like corn starch it is unlikely that foreign proteins are involved, but we have lots more to learn.

      Warmest regards,

      Doc

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Mon May 28, 2012 at 06:50:58 PM PDT

      [ Parent ]

  •  I have experienced this (1+ / 0-)
    Recommended by:
    Translator

    And always make sure to have an epipen handy!

    Where ignorance is our master, there is no possibility of real peace. - Dalai Lama

    by kimoconnor on Mon May 28, 2012 at 10:47:31 AM PDT

  •  Liquid Benadryl belongs in every first aid kit and (1+ / 0-)
    Recommended by:
    Translator

    I give it to new Moms at baby showers, and I take time to explain it to them before they need it.  Twenty years ago my four-year-old broke out in hives, one of which became a continuous welt that went around her whole torso. Of course it was 10:30 at night when it started and nearly eleven when my hubby had to run out to the drugstore...we got some in her just as she was starting to get upset and have a hard time breathing and it was all okay.

    Meanwhile, I never let her have raspberries again for several years as she had eaten half a carton just before this. Years later I read that raspberries, like grapes, often have sulfites on them for a preservative.

    Another time, an adult friend of mine began to have a reaction to unexpected sulfites and luckily she had explained to me once that her type of reaction was physical but also emotional, and that when she felt like she couldn't breathe she also felt very antisocial and had a tendency to go avoid people. I caught her behaving strangely at a luncheon once (had to go find her in an unoccupied area of the building as a matter of fact) and she was struggling to breathe.

    •  Reactions to sulfites are not (1+ / 0-)
      Recommended by:
      nuclear winter solstice

      uncommon and usually present in folks prone to asthma.  Anaphylactic reactions are uncommon but not unknown.  Sulfites are usually used on dried, not fresh, fruit to preserve color.  They are also common in wine, so be careful.

      Warmest regards,

      Doc

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Mon May 28, 2012 at 07:02:53 PM PDT

      [ Parent ]

  •  Tipped and rec'd. (4+ / 0-)
    Recommended by:
    Avila, Translator, amsterdam, basquebob

    I guess I'm partially returning from my TTFN from last week.

    I see this good diary and its comments do not mention "tracheotomy."  If you're about to die because your throat is swollen from anaphylaxis, somebody needs to plunge a knife (a clean scalpel is, of course, preferred, but any knife will do) into the front of your throat to open the trachea!

    Otherwise, you DIE.

    This almost happened to me a few years back, when I had an anaphylactic reaction to a prescribed blood pressure medication--throat swelled up, could hardly breathe for hours, almost died.

    The father of one my employees died from this.  He was given a pill by his doctor in a country in Africa.  He immediately went into this kind of shock. He drove himself to a nearby emergency clinic. They said:  sorry, can't help, doctors are on lunch break.  He died in the waiting room from asphyxiation.  Anybody around could have saved him by cutting a hole in his throat, while his heart was still beating.

    •  I always keep my pocket knife (1+ / 0-)
      Recommended by:
      Timaeus

      razor sharp, and I was prepared to save her life with it.  I did not mention it in the piece because very few nonmedical persons know where to cut and that something hollow needs to be handy.  But I was ready to do it.

      Warmest regards,

      Doc

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Mon May 28, 2012 at 07:05:00 PM PDT

      [ Parent ]

  •  THANK YOU for this (1+ / 0-)
    Recommended by:
    Translator

    I live under the threat of anaphylaxis due to bee stings and penicillin.   I wear a Medic-Alert bracelet about it.  And have to carry an epi pen.

    Been there, done that.  Very scary.  I've been told "next time" I only get about 4 minutes, unless I have the epi pen and 9-1-1.  

    But I never understood the physiology of the anaphylactic shock syndrome.  Thanks for the education.  

    And thank God you were home next door when you were called!  Glad it worked out so well.  :)

    "I'm glad I don't know how it feels to vote to withhold basic human rights from someone else." DavidW-DKos

    by sockpuppet on Mon May 28, 2012 at 06:58:10 PM PDT

    •  You are very austute! (1+ / 0-)
      Recommended by:
      sockpuppet

      I am not a believer (but I rarely talk about it, I am NOT one of those offensive atheists who ridicule people of faith!).  However, as I have played this over and over in my mind, and I even used the term Providence in the piece, it does seem sort of miraculous that everything just fell into place for me to save her life.  One or two more things like that might make me reconsider.

      Please consider these factors!

      What if I had not been home, next door?

      What if they had hesitated to call me?

      What if I had no diphenhydramine?

      What if her beau had been there (I would not have gotten a call, and by they way he never came to see her Saturday after the event)?

      What if she had not trusted me enough to take the drugs that I brought?

      What if her trachea was so swollen that she could not swallow the medicine due to pressure on her esophagus?

      There are a thousand million other factors involved, and everything added up to the fact that her mum calling me, me knowing what to do, and having the lifesaving drugs that I do not even take has allowed her life today.

      I am incredibly thankful that she is still with us.

      Warmest regards,

      Doc

       

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Mon May 28, 2012 at 07:13:24 PM PDT

      [ Parent ]

      •  Miraculous providence (1+ / 0-)
        Recommended by:
        Translator
        However, as I have played this over and over in my mind, and I even used the term Providence in the piece, it does seem sort of miraculous that everything just fell into place for me to save her life.  One or two more things like that might make me reconsider.
        Well, as someone who has had "one or two more things like that,"  things that are just too many coincidences to be ignored, I think you might need to get used to it. ;)

        I call it, "being on Angel Duty".   When you get The Call, sometimes you'll recognize it, but usually you'll realize it in the aftermath.  It's very cool, either way, when it happens.  :)

        You were tapped for Angel Duty!   It'll happen again.   Watch for it.  

        "I'm glad I don't know how it feels to vote to withhold basic human rights from someone else." DavidW-DKos

        by sockpuppet on Mon May 28, 2012 at 07:37:41 PM PDT

        [ Parent ]

  •  I take loratidine (Claritin) for chronic rhinitis (1+ / 0-)
    Recommended by:
    Translator

    - is this also an effective emergency treatment for anaphylaxis, or should I get some Benadryl as a precaution?

    I once had bronchitis with asthma-like symptoms (relieved by prescribed theophylline) and once reacted to eating mixed  nuts with dramatic swelling of the soft palate, which got me an ambulance ride.

    There's no such thing as a free market!

    by Albanius on Mon May 28, 2012 at 11:30:32 PM PDT

    •  The research (1+ / 0-)
      Recommended by:
      Albanius

      that I have done overwhelmingly mentions diphenhydramine.  It is a very good inverse agonist for H1 receptors and is the drug of choice.  It is cheap and safe, too.

      Perhaps the biggest advantage is that it is absorbed and becomes active within a few minutes rather than an hour or so.

      Warmest regards,

      Doc

      I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

      by Translator on Tue May 29, 2012 at 06:20:58 AM PDT

      [ Parent ]

      •  This diary may save additonal lives, thx much - nt (1+ / 0-)
        Recommended by:
        Translator

        There's no such thing as a free market!

        by Albanius on Tue May 29, 2012 at 10:46:38 AM PDT

        [ Parent ]

        •  Thank you for the kind words! (1+ / 0-)
          Recommended by:
          Albanius

          I do try to be helpful as well as informative.  And thanks to your comment and my reply, I just hit the magic 100 comments!

          Warmest regards,

          Doc

          I would rather die from the acute effects of a broken heart than from the chronic effects of an empty heart. Copyright, Dr. David W. Smith, 2011

          by Translator on Tue May 29, 2012 at 04:40:38 PM PDT

          [ Parent ]

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