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Anaphylaxis, aura of doom.

August 16, 2007

Matthew Vasey, MD



Our nations' obsession with fear evoking thought is all around us, from television shows, to movies, to newspapers, to sports, to education, to presidential campaign trails, and now even on NYJSM.com. As if there are not enough things to fear out there, the world of Allergy brings to us one of the most feared medical emergencies in the form of a life-threatening allergic response, called anaphylaxis. Anaphylaxis results from an environmental allergen exposed to an immune cell in the body, IgE. (7) Immunoglobin E, which might as well as stand for Emergency in this instance, although it does not, triggers a series of events evoking what is interpreted by the individual as an "aura of doom". (3)

The four main types of stimuli that can produce anaphylactic shock are food, drugs, latex and insect stings. These four subgroups show anywhere from 1.21% to 15.04% , or somewhere between 3.29 million to 40.9 million of the US population are at risk of anaphylaxis. (1)

Looking more closely at the food sub group, studies have found the particular types of foods most commonly implicated in anaphylactic presentations in the western culture to be peanuts and tree nuts, (2,5,6,8,9) fish (eg, cod, whitefish), and shellfish (shrimp, lobster, crab, scallops, oyster) (4). Happy endings require prompt recognition by either the person experiencing anaphylaxis or knowledgeable onlookers, followed by seeking management from healthcare professionals by placing a call to 911. A person experiencing repeat anaphylaxis, maybe carrying an Epipen (Click here for "how to use" video) which should be given immediately, even before the 911 call, epinephrine can help to temporarily delay the life threatening constriction of the airway. Should life saving measures be required in the meantime someone with Basic Life Support (Click here to find out about getting certified) certification can help, if you are all alone with someone requiring life saving measures waiting for help, try to stay calm and remember to monitor the ABC's, an open and functional AIRWAY, BREATHING in order to provide the lungs with oxygen and CIRCULATION of blood via a pulse.

Given the multi-organ system failure that results in anaphylaxis, there are many things that can happen. Itching and swelling of lips and tongue with a metallic taste, skin redness, rash, swelling, goose bumps, abdominal pain, vomiting "stringy" mucus, diarrhea, throat tightness, difficulty swallowing, difficulty talking with hoarseness, itchy ear canals, shortness of breath, difficulty breathing, chest tightness, wheezing, itchy nose, runny nose, sneezing, feeling faint, fainting, chest pain, swelling and redness of the eyes, tearing, women may experience lower back pain and uterine contractions, hence . . . aura of "doom", that doesn't need to be "doom". (3)

REFERENCES:
1. Alfred Neugut, AI., Anita T. Ghatak, MPH; Rachel L. Miller, MD Anaphylaxis in the United States An Investigation Into Its Epidemiology Arch Intern Med. 2001;161:15-21
2. Bock SA, Munoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol.2001; 107 :191 -193
3. Hugh A. Sampson, MD. Anaphylaxis and Emergency Treatment PEDIATRICS Vol. 111 No. 6 June 2003, pp. 1601-1608
4. Kemp SF, Lockey RF, Wolf BL, Lieberman P. Anaphylaxis: a review of 266 cases. Arch Intern Med.1995; 155 :1749 -1754
5. Pumphrey RSH, Stanworth SJ. The clinical spectrum of anaphylaxis in north-west England. Clin Exp Allergy.1996; 26 :1364 -1370
6. Sampson HA, Mendelson LM, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med.1992; 327 :380 -384
7. Stephen F. Kemp MDa and Richard F. Lockey MDb Anaphylaxis: A review of causes and mechanisms Volume 110, Issue 3, September 2002, Pages 341-348
8. Yocum MW, Khan DA. Assessment of patients who have experienced anaphylaxis: a 3-year survey. Mayo Clin Proc.1994; 69 :16 -23
9. Yunginger JW, Sweeney KG, Sturner WQ, et al. Fatal food-induced anaphylaxis. JAMA.1988; 260 :1450 -1452

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