Friday, February 8, 2013

Lesson Seven: Allergies

Lesson Seven: Do NOT flirt with Anna Falacksis

Or, as medical dabblers know her better, anaphylaxis.
Anaphylaxis is the body’s sudden allergic reaction which leads to disseminated (that means all over) swelling, redness, and itching. If the “all-over” part includes in your airway, you’ll feel a tightening in your throat, maybe a tickle, you might be coughing for no reason, wheezing, and eventually, it’ll swell up to the point where you can’t breathe.

Untreated, you will die. As my gunnery sergeant used to say, remember this, you’ll see this material again.

What’s happening is, your body has just come into contact with some substance (in, say, peanuts, strawberries, shellfish, or bee venom, for example) that it really doesn’t like.

A host of things happen. I’ll spare you the medicalese long explanation, but remember that this chain of events is all part of what’s known as “the histamine response” your body goes through. It makes the cell walls of your blood vessels more fluid-permeable. When blood and fluid leave the blood stream and soak into surrounding tissues, those tissues get swollen and red. Other mechanisms take place which leads to itchiness.

The swelling around your airway can shut down your trachea worse than Christmas traffic at the international airport, and the loss of circulating volume of fluids (i.e. blood) can be so sudden and severe that you go into shock. One or both of these will activate your life insurance policy if you don’t get to a hospital, preferably via 9-1-1 ambulance.

Okay, allergies “BAD”, but what am *I* supposed to do?

Well, since you asked:
Not “some antibiotic, I can’t remember the name...” Find out the name. See an allergist to do a sensitivity panel to check for specifics. Memorize it. Write it down. Wear it on an MedicAlert bracelet or neckchain. Write in on a Post-It you stick to the back of your driver’s license.

2) With food items, be an SS Camp Guard about not eating it. We’re talking about your life, after all.
I once dated a girl who was allergic to MSG. We were getting dinner at a Chinese restaurant (her choice) which advertised “No MSG.” She asked when ordering, and was again assured “No MSG.” She then said, “Well, if there is, I’ll die right here on the dining room floor.” Whereupon the waiter hemmed and thought, and suggested she might want to try something far less likely to contain the offending substance. That’s the level of persistence I’m talking about.

I’m not a pharmacist nor a doctor. Consult yours. Many people are in the habit of carrying Benadryl (diphenhydramine) along with either an Ana-kit or an EpiPen. Many ERs give OTC H2 blockers like Zantac, Pepcid, etc. as well. I repeat for the record I’m not prescribing anything here. But let’s go over why you, in consultation with your doctor, might decide some or all of these things are a good idea.

Benadryl is an antihistamine. Remember that “histamine response” involved in anaphylaxis? Well, there you go. It can decrease the speed or severity of the response.

Zantac/Pepcid/etc.? Guess what...Zantac etc. blocks certain body processes which release acid into your digestion. But wonder of wonders, it (and similar-family OTC drugs) also block the same allergic response cycle that’s possibly trying to kill you.

Ana-Kits and EpiPens are both injected forms of Epinephrine (that’s adrenaline, in other words) which can also help with things, especially if airway swelling is involved. Both require a prescription to have and carry.
The Anakit is a small kit with syringe which contains two doses, that you inject yourself with. You push one dose, and if necessary, twist the plunger and push the second dose.
The EpiPen is modeled on the military’s Chemical Warfare injectors. It’s the size of a Magic Marker pen. You pop off the cap, press the “hot” end to a large muscle, like your thigh, and it auto-injects you.

Both from familiarity with the idea from my military days, and the fact that most people won’t be able to inject themselves, the EpiPen is probably a better idea for most folks. YMMV.

* If you have potentially life-threatening allergies, consult your doctor and carry the medicines agreed upon, at all times and places. And replace them when they expire. No excuses.

* Use of any medications will not “cure” you. It ONLY BUYS YOU TIME TO GET TO THE ER.

If you’ve used Benadryl, Zantac, and/or prescription epinephrine, and have any doubt about or reason to suspect that you may continue to have an allergic response, your next step is either to a friend/relative’s ER-bound car seat, or to the phone to dial 9-1-1 for an ambulance ride.

Also, be aware that everyone is different. To get an allergy generally requires sensitization. That could be the first time you ate shellfish, or got stung. Subsequent re-exposure to the offending substance can produce increased responses, in both speed and severity. It can be gradual. Or the second one could kill you.

The speed of the response in subsequent cases may give you an idea of what to expect. Some people may be allergic to certain seafoods, but the response may be so mild that it’s worth the discomfort, and slow enough that they needn’t take any measures other than an OTC med. Other people might turn lobster-red in a few minutes, be coughing and wheezing, and need immediate emergency care. Still others may pass out within minutes from airway swelling, require immediate paramedic response and field airway support and medication, just to survive.

I don’t know which type you are, and you probably don’t either. Which is why you should take the precautions listed, and not flirt with sudden death, whether it’s you, a loved one, or a friend.

If you’re going to ignore this, I can send you my info to be listed as your life insurance beneficiary.

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