Anaphylaxis: Understanding Deadly Allergies
The Key to Dealing with Anaphylaxis and Anaphylactic Reactions is to First Understand Them
Most people know anaphylaxis is a dangerous and potentially deadly allergic reaction, but the understanding rarely goes beyond that point, unless you are someone who suffers from these allergies. I am such a person; my normal triggers are any tree nut and a number of antibiotics, but I can have a reaction with no clear trigger at all.
This is apparently what happened last Friday; my nine-year-old daughter, Isella, decided I had been at my desk far too long and insisted we go for a walk. During our walk, we stopped at the store for a treat, buying a candy bar to share. Because I am so hypersensitive to even a hint of tree nut, I went through the usual precautions: checked the ingredients, checked the package for any warnings, and even inspected the chocolate bar before enjoying my half.
I didn’t even make it two blocks before the familiar warning signs of a severe reaction hit. I felt the tingling sensation in my tongue and the burning in my ears. I could feel the heat climbing through my lungs and down my limbs, along with the swelling of my throat as it became difficult to breathe. I do not carry a purse, and never have; however, I almost always have my medication tucked in a pocket. This time I didn’t think to grab it as I was heading out the door with my daughter; we were still a quarter-mile from our home and I was in a full-blown anaphylactic episode.
I have always made sure my children were aware of my allergies, and what they needed to do if I ever went into anaphylactic shock: Don’t panic. Help me get epinephrine in my system as quickly as possible. Watch for signs of respiratory arrest. She followed all the steps except calling for an ambulance; she contacted my husband instead. However, her ability to recognize the signs and do what she needed to do helped me recover from what could have potentially been a fatal occurrence. I will also never, ever leave the house without my medicine again.
Allergies vs. Anaphylaxis
Many people suffer from allergies and sensitivities. Some metals can cause reactions on the skin, and hay fever is the bane of springtime for a good part of the population. Rashes, hives, watery eyes and congestion are all signs of an allergic reaction. There are several medications, both prescription and over the counter, to help people combat mild to severe allergies.
However, anaphylaxis is different because of the severity of the reaction; all anaphylactic reactions are allergic reactions, but not all allergic reactions are anaphylactic reactions. Anaphylaxis attacks the whole body, and while a mild to severe allergic reaction can cause quite a bit of discomfort, anaphylactic shock can be life threatening. Most people know what triggers their allergic reactions, but an anaphylactic reaction can occur with no apparent trigger at all.
This is what happened to me; while I have no doubt that something about the candy bar sent me into shock, I will never know what specifically caused such a severe reaction. I am so highly sensitive to pecans and hazelnuts that even contact with them can trigger an episode, and walking through a walnut grove creates the same response in me that is experienced by people with severe hay fever.
What Causes Anaphylactic Allergies?
Allergies are really nothing more than the immune system’s response to what it considers a threatening invader, like pollen, bee venom, or certain foods. For whatever reason, a body’s natural immune response goes into defense mode against this perceived threat, and the person develops an allergy. With an anaphylactic allergy, the immune system shifts into hyperdrive.
There are actually two types of anaphylactic reactions. One is true anaphylaxis, which happens after a person has already become sensitized through previous contact to the trigger. An anaphylactoid reaction does not require previous sensitization to the allergen, and can happen with first contact. In my case, since I cannot isolate the trigger for my last episode, it could have either been anaphylactic or anaphylactoid; however, it doesn’t really matter, because the outcome for both is the same and both are life threatening occurrences.
Anaphylactic Allergies on the Rise
Understanding deadly anaphylactic allergies is important because of the increase in such allergies among children. My allergies are hereditary; my grandmother and uncle both suffered severe allergies to antibiotics, and I do as well. I have a hyperactive immune system, as did they, and all three of us had some sort of autoimmune disorder. My grandmother and uncle had Hashimoto’s Thyroiditis, and my uncle, Thom Pilkinton, developed Guillain-Barré after a bout with swine flu in 2009. This syndrome was a contributing factor in his death in 2011. I also developed Guillain-Barré after coming down with chicken pox, shingles and a strep rash right before my 41st birthday. The combination of the three forced my immune system to overload, triggering Guillain-Barré. While I recovered, I still suffer unexplained pain on occasion, and the episode also created allergies I hadn’t had before.
I am naturally predisposed to anaphylactic allergies, but what about children who do not share a heredity such as mine? There has been a significant rise in the number of children who suffer severe allergies. In 1997, 3.4 percent of children possessed food allergies. By 2011, that number had climbed to 5.1 percent. Skin allergies in children under 18 rose over that same time period from 7.4 percent to 12.5 percent.
What is even more interesting are the demographics surrounding the rise in allergies; children in lower-income homes are more likely to develop skin allergies, but children from affluent homes are more likely to develop food allergies. Data has shown the higher the income, the higher the prevalence of allergies. Children born in the United States are also more prone to allergies than those born outside the U.S., leading some to speculate that children born in other countries may be exposed to more diseases, allowing immunity defenses to build appropriately.
While scientists have yet to come up with a definitive explanation for the sudden increase in allergies, including the life threatening anaphylactic allergies, among children, one explanation gaining popularity is the too-clean-for-our-own-good theory. Every day, television ads bombard the public with the need to completely sanitize a home to keep it healthy, but some researchers say this may be counterproductive, instead doing more harm than good.
A paper published in The Journal of Allergy and Clinical Immunology spoke of children raised in Indiana’s Amish country. These children are often raised on farms and are exposed to different types of bacteria and other immunity stimulants. In turn, these children have lower instances of allergy and asthma than children without that exposure. Basically, just like our brains, our immune systems need stimulants to develop properly, and when those stimulants are removed, the immune system looks for something, anything, to allow it to develop. It is still important to keep a clean environment for kids, but indiscriminately using antibacterial soap and keeping a home so clean your socks squeak may negatively impact the development of a child’s immune system.
New research also suggests that the immune system can be “retrained” as well. Certain therapies expose the individual to small amounts of the allergen until the body no longer recognizes it as a threat. The goal of this type of immunotherapy is to stop what is known as the Atopic March, or the natural progression of an allergy from mild to severe.
Handling an Anaphylactic Episode
Whatever the reason for the increase, anaphylactic allergies pose a real problem for both sufferers and schools and businesses, which have to accommodate people with life threatening allergies. When I was in school, there usually were not special accommodations for those students. I learned early on to not eat the treats brought for birthdays and Christmas, and I usually brought my own lunch to school.
Now schools often have peanut-free areas, children who bring peanut butter sandwiches to school end up leaving them in the office because someone in the class is allergic, and homemade treats are discouraged. Children carry epinephrine as regularly as their backpacks. Restaurants provide allergy menus, and many food companies have dedicated peanut and tree nut free production lines.
No matter the level of care taken by someone with an anaphylactic allergy, though, reactions are going to happen, and full-blown anaphylactic shock can be fatal. Anaphylactic shock can cause swelling of the throat, which constricts the airway. It can also cause a person’s blood pressure to drop, along with paranoia, dizziness, and extreme pain. It is important to note that anaphylactic reactions vary from person to person (for instance, I rarely break out in hives), and from incident to incident for the same person. Anaphylaxis can happen immediately, or delay up to an hour after the offending intruder enters the body; the quicker the reaction, the more intense the severity.
The most important thing to do if someone is even suspected of anaphylaxis is to call for medical help. Even if epinephrine is available; an epinephrine injection only lasts for about 20 minutes, but an anaphylaxis can recur, sometimes as late as a day or two later. Not only that, but epinephrine has its own side effects, and if not administered correctly, can be as dangerous as the reaction.
People who suffer from anaphylaxis, and those around them, need to understand that anaphylactic shock is a trauma to the system, and recovery takes time. Exhaustion, pain and sore throats are not uncommon during the recovery process; I have had my fair share of anaphylactic reactions, and have been in full blown anaphylactic shock at least seven times in the past 20 years. Recovery for me has been different each time; one episode left me unable to talk for three days. It is pretty normal for me to live on oatmeal and grits until my throat recovers, that is if I have an appetite at all. I can sleep for a day or two after, and this last bout caused a pleurisy type pain to shoot through my lungs; two days later it still hurts occasionally to breathe.
The Key to Handling Anaphylactic Allergies is to Understand Them
Whether we admit it, anaphylaxis controls people’s lives, and the lives of our families. We plan where to eat, we question servers at every restaurant, we read labels judiciously, and we stay away from the treats brought by well-meaning students and coworkers. Even with all our planning, though, something as mundane as eating a candy bar can prove to be quite an adventure, as can the ice cream treat that you asked about and were told was safe, yet found out it contained hazelnuts, or the delicious cheesecake you realize too late had a crust made out of pecans.
My family deals with my anaphylaxis by making a joke out of it; it helps them cope and understand, while not diminishing the reality of my deadly allergies. We also have my children checked regularly for potential allergies, but fortunately, neither has shown an indication toward developing them. Meanwhile, they all know what to do if I show even a hint of an anaphylactic reaction.
As for me, I have learned my lesson. My epinephrine is now like an American Express card – I will not leave home without it.
Commentary By Heather Pilkinton