Anaphylaxis underdiagnosed
A woman I know from an online allergy forum recently had a severe anaphylactic reaction involving a loss of consciousness and a drop in blood pressure, vomiting, and systemic changes in skin color, among other symptoms.
When she fainted, she fell hard enough to break the toilet. She awoke to find herself lying in a pool of water, unable to get up or help herself. She could have died if her husband had not come home a few minutes later and called 9-1-1.
The EMTs and then the emergency room doctors kept insisting that what she was experiencing could not be an allergic reaction, despite the patient's medical alert bracelet identifying her allergies and her protestations that she was certain she was experiencing an allergic reaction. Even though she told them the location of her epi-pen, they did not administer it.
When she got to the hospital the ER personnel kept telling her that passing out was not a symptom of anaphylaxis.
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The patient did not have hives, swelling or airway restriction (her unconsciousness and weakness was from the drop in blood pressure), so she did not fit the doctors' preconceptions about what a severe allergic reaction looks like. They thought her vomiting might be a sign of internal injuries from hitting the toilet when she fell, so concentrated their energy on checking for that.
They had trouble with the IV and other needle-sticks because of her collapsed veins and low blood pressure. The woman theorizes that it was the pain from all the tortuous needle sticks that got her own body pumping enough epinephrine to begin to stabilize her.
It took more than two hours before she was finally given epinephrine and antihistamines, or treated in any way for an allergic reaction.
As she said,
Unfortunately, this type of scenario is all too common. According to studies such as this one, anaphylaxis is grossly underdiagnosed. Even when anaphylaxis is correctly diagnosed, epinephrine and other lifesaving measures go unused in far too many cases.
Incidentally, the woman is allergic to corn. The item that triggered the reaction? An application of Monistat. Allergens can lurk in the most unsuspected places.
When she fainted, she fell hard enough to break the toilet. She awoke to find herself lying in a pool of water, unable to get up or help herself. She could have died if her husband had not come home a few minutes later and called 9-1-1.
The EMTs and then the emergency room doctors kept insisting that what she was experiencing could not be an allergic reaction, despite the patient's medical alert bracelet identifying her allergies and her protestations that she was certain she was experiencing an allergic reaction. Even though she told them the location of her epi-pen, they did not administer it.
When she got to the hospital the ER personnel kept telling her that passing out was not a symptom of anaphylaxis.
#############
The patient did not have hives, swelling or airway restriction (her unconsciousness and weakness was from the drop in blood pressure), so she did not fit the doctors' preconceptions about what a severe allergic reaction looks like. They thought her vomiting might be a sign of internal injuries from hitting the toilet when she fell, so concentrated their energy on checking for that.
They had trouble with the IV and other needle-sticks because of her collapsed veins and low blood pressure. The woman theorizes that it was the pain from all the tortuous needle sticks that got her own body pumping enough epinephrine to begin to stabilize her.
It took more than two hours before she was finally given epinephrine and antihistamines, or treated in any way for an allergic reaction.
As she said,
This was not a good outcome over all. Epinephrine should have been administered immediately. My husband and everyone else were so obsessed with the toilet tank and fall - thinking internal injuries - that they didn't give me epinephrine. They don't want to hear that I would have been dead from the allergic reaction before the internal injuries would have been found.She did not have internal injuries, and recovered after finally being treated for the allergic reaction.
Unfortunately, this type of scenario is all too common. According to studies such as this one, anaphylaxis is grossly underdiagnosed. Even when anaphylaxis is correctly diagnosed, epinephrine and other lifesaving measures go unused in far too many cases.
Incidentally, the woman is allergic to corn. The item that triggered the reaction? An application of Monistat. Allergens can lurk in the most unsuspected places.
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Posted by purple_kangaroo at 11:59 PM[Permanent link]
7 Comments:
What the heck do they mean, "passing out is not a symptom of anaphylaxis"??? You can't breathe, you pass out! What's so hard to imagine about that?
A little gift of hope for you for the new year...
Liz, the issue was that she was not swelling or having trouble breathing. She passed out from the drop in blood pressure.
It was the absence of swelling, hives or airway restriction that had the doctors convinced she could not possibly be having an allergic reaction. I'll edit the original post to make that a little more clear.
Thanks, Phantom. I've been following that study. It will be interesting to see whether the treatment works out long-term, and whether or not it proves to be safe and effective for people with extreme sensitivity or really severe reactions.
How frustrating is that? That poor woman. I understand that the docs and her husband would want to rule out any internal injuries, as those could also be potentially fatal, but to not heed the patient's own ideas as to what her OWN body was doing? That's just criminal!
I know what you mean about the whole "underdiagnoses" of anaphylaxis -- I had several doctors tell me that I *couldn't* be allergic to all seafood, that it must just be the iodine in shellfish. Never mind that I've had iodine placed directly on my skin with no reaction whatsoever. It's always a murky grey area when you have a less-than-typical sort of allergy. Either the medical professionals tend to dismiss your claims alltogether, or they use you as a study candidate.
I wish her good luck, and continues health. And the smae for you and yours!
Klee, yes it must have been incredibly frustrating.
It wouldn't have hurt anything or taken long for them to give her a dose of epinephrine when she first informed them that she believed she was having an allergic reaction.
yikes! that is frightening. i'm so glad that she's ok, despite all of that. i think i'd be furious w/ my husband if i told him i was having an allergic reaction and to give me the epi shot and he wouldn't.
I am the woman in the post and the thing you have to understand is that at the point I was found I was unresponsive except for screaming with fear. (Impending doom.) There was so much water due to the broken toilet tank and running water, he had no way of knowing if I was physically injured. My neck could have been broken from the fall alone.
I have NEVER had swelling with anythin g but a shot, and rarely that. My asthma (cough variant) would act up. Another reason ERs are incompetent, most don't know about cough variant asthma - and it is on the rise. The other thing that is likely to happen is my blood pressure will drop. This is the most dangerous symptom if you don't have swelling. You see, without blood pressure your blood doesn't go anywhere. No oxygen getting to the brain, and all.
I did explain to both the idiot doctor and one of the attending nurses that if you read past the first three symptoms you will see low blood pressure and even fainting. The overall incompetence shown was brilliant.
I am planning on getting with both my primary care physician and my allergist - both of whom take my allergy seriously - about this. A little education is in order in some sectors I believe.
Pax,
MLO
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