Confusion

[notashrimpwimp]

Last night I had a reaction that confused me.

I was having severe abdominal pain accompanied with bouts of    Along with this, I was wheezing when breathing in. I usually Epi-pen but after being told that I am too quick to Epi-pen I didn't.

Looking at the grading chart, I would say it was a 4. It really frightened me and I feel fortunate nothing else happened.

I just have this fear of using the Epi-pen too early or not early enough.

The next time this happens, should I definitely Epi-pen?

[LinksEtc]

I usually Epi-pen but after being told that I am too quick to Epi-pen I didn't.

Who told you that you are too quick to Epi?

Did you discuss this experience with your allergist?  Do you have a written allergy action plan?

I'm glad that you are ok 

[rebekahc]

Yeah, I'd say go by the chart and epi for anything more than grade I - whoever told you you were epi'ing too early is a putz.

[CMdeux]

Agreed.  Putz there would be a technical term, probably kinder than deserved under the circumstances, considering that this individual's opinion might cause you to lose your life at some point.

I'm glad that you are okay--


now, DO NOT count on a similar reaction turning out so well ever again.  

[lakeswimr]

You know that breathing difficulty = automatic epi pen.  YOu know that systemic reaction = epi pen.  I'm not sure why you are questioning this.  if your DOCTOR is telling you that these are not times to epi please fine a new doctor who specializes in food allergies.  Do you have a written emergency plan?  Is it a good one?  if so, follow it. if not then get a new doctor and a good written plan.  FAAN's plan is pretty good.  You could print that out and have your doctor sign it.  Does your allergist specialize in food allergies?  I worry about you. 

[SilverLining]

I'm also quite curious as to who said you epi to quickly.  How often have you needed it?

[notashrimpwimp]

The person who told me this was the ER doctor. She advised me to practice deep breathing when I start to feel my throat tightening.

Both allergists I went to stated that I wasn't using my Epi over much, as it is usually 4-6 months between significant episodes.

[CMdeux]

breathe deeply??   

Yeah, good advice for a panic attack, but not so much for anaphylaxis.  What, should you wait until you STOP breathing?  Or just until your heart quits on you?  I'm just curious about what would be appropriate in this physician's mind. 

Next time someone at the ER gives you that particular song and dance, whip out a copy of the technical version of the anaphylaxis grading chart and the accompanying citation (it's a Pediatrics article, and Hugh Sampson is one of the authors)... and ask exactly where THEY would advise you to administerr epinephrine in that scheme.

If you're feeling particularly saucy at that point, you could ask if they really think that they have greater expertise with food anaphylaxis than:  a) you, b) your board-certified SPECIALIST physicians, and c) the authors of that paper.

<sarcasm>
Because that must be some expertise.  GOSH.  What an opportunity for you to "learn" from a master.  </sarcasm>
 
Then point out that every study on the subject-- EVER-- shows that anaphylaxis presenting in ED/ER settings is: a) grossly mismanaged, and b) even MORE grossly under-recognized to begin with.   

[SilverLining]

breathe deeply??   

Yeah, good advice for a panic attack, but not so much for anaphylaxis.

I suspect that's what the doctor thinks is happening...a panic attack.  And for me, the deep breathing worked.  I was able to tell the difference between an allergic reaction and a panic attack because many of MINE were panic, and those that were allergic were often not anahylactic.  They were allergic reactions and the symptoms were worst BECAUSE of my anxiety.

notashrimpwimp, I knew mine were anxiety and I was able to comtrol that way.  And mine were happening daily, not a few times a year. 

[CMdeux]

Exactly.  I think that most of us probably do try applying common sense... er... before epinephrine. 

But it's pretty hard to take the advice to "breathe deeply" when breathing at all is problematic.   

[Janelle205]

Yup.  I personally love it when helpful passers-by advise me to 'take a deep breath' when I'm having an asthma attack.  It's probably a good thing that I'm too out of breath at the point to make obnoxious comments.

[notashrimpwimp]

Here's the part that gets me: she assessed me and said that I was having a severe allergic reaction with swelling in the throat, but in the future I should administer benadryl and my inhaler and then allow them to decide if I need to be epi'ed or not.

I feel confused, bewildered, and a little upset.

[hezzier]

Please don't follow that advice.  Many of us have been given bad advice from doctors who are not experts in dealing with food allergies.  If you have a good allergist, please talk to them for advice on how to treat your reactions if you are unsure what to do.  If you don't have a good allergist, then find a new one.

[rebekahc]

Here's the part that gets me: she assessed me and said that I was having a severe allergic reaction with swelling in the throat, but in the future I should administer benadryl and my inhaler and then allow them to decide if I need to be epi'ed or not.

I feel confused, bewildered, and a little upset.

Mmm hmm - PUTZ.  What's the point of an Epi autoinjector if it's not intended for the patient to use??

To quote my allergist:
The only thing proven to prevent death from anaphylaxis is early administration of epinepherine.

[rebekahc]

I found a PDF presentation on anaphylaxis geared toward teaching nurses what to look for in vaccine induced anaphylaxis.  The author states, "Since there are very few cases of fatal anaphylaxis due to vaccines, we need to extrapolate from what we know about fatal anaphylaxis due to other antigens" and includes a few really good pages with information.  Unfortunately, there are no references cited. 

A couple of the pages:

Danger signs in anaphylaxis

•Early onset after exposure to antigen
•Rapid progression
•Evidence of respiratory distress
•Evidence of hypoperfusion: eg: syncope

NOTE: Cutaneous symptoms are present in only a minority of fatal cases of anaphylaxis

Modifiable risk factors for fatal anaphylaxis

Delayed or no administration of epinephrine:
     –Early administration of ephinephrineappears to be critical for survival after severe anaphylaxis
     –A series of 30 fatal or near fatal anaphylaxis suggested that epinephrine is most effective when given in the initial 30 minutes of
       the reaction.

Upright position
     –Empty ventricle syndrome leading to pulseless electrical activity

Misdiagnosis

Unwitnessed

www.bccdc.ca/NR/rdonlyres/...A6E8.../1GustafsonAnaphylaxis.pdf