Epipen important with serious food allergies
Kim came to the emergency department via ambulance with complaints of passing out and an allergic reaction. She had been at a restaurant having dinner with friends when she started feeling unwell. She went to the bathroom because she suddenly felt nauseated and thought she would throw up. As she walked to the bathroom, she started to feel lightheaded. She held on to the wall as she approached the bathroom and someone walking past her figured she had just had too much to drink. She felt increasingly nauseated and walked even more quickly to the bathroom. She made it just inside the door when she vomited into the sink and then passed out hitting her head on the counter on her way down.
Unfortunately, no one else was in the bathroom at the time. After a few minutes, one of Kim’s friends realized she had not returned to the table and went to check on her. She found her sitting on the floor in the bathroom against the wall, holding her forehead where she
was bleeding from a laceration. Kim’s friend called 911 immediately and went to her side. She asked Kim if she was OK and what had happened. She noticed that Kim was labored in her breathing and was having trouble talking. Her friend put a wet, cool paper towel on her forehead when she noticed large pink welts on Kim’s skin. She recognized these welts as hives because her little brother had a history of allergies.
She asked Kim if she had any allergies, and she nodded her head yes. She asked Kim if she had eaten something she is allergic to and she shrugged her shoulders like it was a possibility. Another one of Kim’s friends came into the bathroom and was instructed to talk to the waiter to see what Kim had eaten. Within a few minutes the paramedics arrived and went into the bathroom to assess Kim. In the meantime, Kim’s friends had found out from the waiter that Kim had informed him of a shellfish allergy and wanted to make sure the pasta dish she wanted to order didn’t have any seafood in it.
The paramedics took Kim’s vital signs, put a bandage on her forehead laceration and moved her to their cot. She was displaying signs of anaphylax
is, so they immediately administered her a dose of epinephrine that they injected into her thigh muscle. They placed an IV in her arm and started an infusion of IV fluids as her blood pressure was very low, which explained why she had passed out. They gave her a dose of Benadryl and steroids through her IV and transported her to the emergency department (ED).
I saw Kim when she arrived in the ED and her symptoms had improved dramatically with the treatment provided by the paramedics. Her blood pressure had normalized and the hives on her skin were almost completely gone. She was able to tell me that she is pretty sure there was a shrimp in her food that she was allergic to. She felt a little tingling in her tongue when she first ate it and then felt quite nauseated. It wasn’t until she got to the restroom and saw the hives on her skin that she knew she was having an allergic reaction. She wanted to tell her friend to get her Epipen (which is dose of epinephrine that a patient can administer themselves in the case of an allergic reaction) from her purse, but she couldn’t get the words out.
When exposed to an allergen, the body releases histamine, which cause the symptoms we equate with an allergic reaction such as itchy, water eyes and a runny nose. Usually, the symptoms are mild and localized to one part of the body. Anaphylaxis is a severe allergic reaction, most commonly to food but can also occur with insect stings, medications and even latex. With anaphylaxis, the body’s reaction to the allergen is more severe, causes more pronounced symptoms such as swelling, wheezing, difficulty swallowing, difficulty breathing and involves many parts of the body.
Anaphylactic shock is severe anaphylaxis where blood pressure drops, bronchial tissues of the airway swell causing wheezing and shortness of breath. Vomiting, abdominal cramps, difficulty swallowing, chest tightness and hives are also symptoms seen with a severe allergic reaction. Anaphylactic shock requires immediate treatment to prevent death.
The mainstay of treatment for anaphylaxis is epinephrine. Epinephrine, also known as adrenaline, is a natural hormone and neurotransmitter in the body. Giving epinephrine as a medication causes an increase in heart rate and blood pressure, which is how it quickly reverses the low blood pressure caused by anaphylactic shock. Benadryl, an antihistamine, and steroids help to quiet down the immune response to the allergen.
Kim was prepared for an allergic rection by carrying her Epipen with her, which is a device the size of a marker that an individual can inject into themselves at the sign of a serious allergic reaction. Kim knew she had a bad reaction to shellfish and was prescribed her Epipen several years prior but had never had to use it before. People can run into serious trouble if they have an anaphylactic reaction and don’t have their Epipen with them or if they don’t recognize their symptoms and don’t or aren’t able to call for help.
It is estimated that tens of thousands of anaphylactic reactions occur annually. The risk of death among those who suffer a reaction has been estimated at about 1%, with as many as 500-1,000 deaths annually in the United States. Despite her caution in alerting the restaurant of her allergy, there was inadvertent contamination of her food with shrimp that caused Kim’s reaction. I repaired Kim’s laceration with a few sutures and after a prolonged period of observation she was able to go home. She went home on a taper of steroids and encouragement to always keep her Epipen nearby.