Deadly Ignorance

This is one of a series of several posts discussing issues that complicate the diagnosis of allergies. The summary and index of the series can be found here.

Problem: Even life-threatening anaphylactic reactions are likely to be discounted or misdiagnosed.

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Issues with allergy testing and doctors' attitudes toward atopic patients are bad enough when the patient is experiencing only bothersome symptoms. But these problems become truly dangerous in the midst of a life-threatening anaphylactic reaction.

Too many doctors and emergency personnel have an appallingly poor understanding of allergic reactions.

One woman recently had a severe anaphylactic reaction involving loss of consciousness, drop in blood pressure, vomiting, and systemic changes in skin color, among other symptoms. When she woke up she could not get up off the floor to get help, and could have died if her husband had not come home a few minutes later.

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 allergy alert bracelet 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.

It took more than two hours before she was finally given epinephrine and antihistamines, or treated in any way for an allergic reaction. You can read her comments under my earlier post telling her story here (her username is MLO).

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.

A few weeks ago I had a clear anaphylactic reaction to a particular food. This happened after multiple occasions of less severe but increasingly obvious allergic reactions to that food. There were no other possible causes for the reaction at that time.

Within seconds of ingesting the food I had severe itching and tingling of the mouth and throat, all-over body itching, tightness of the throat, difficulty swallowing, hoarseness and coughing, among other symptoms also including dizziness, rapid heartbeat, swelling eyelids and immediate intestinal distress.

A liquid antihistamine helped significantly within about 10 minutes of the dose, suggesting that the reaction was indeed histamine-related.

Perhaps because months earlier I had tested "negative" to that food (the welt was only 4/7), my allergist didn't seem to believe I could really be allergic to that food. He wouldn't even see me about the reaction, although he could call in a prescription for an epi-pen "if I really wanted him to, even though he didn't think it was necessary."

He added that if I wanted to, we could do a skin-prick test at some point in the unspecified future "to see if I was really allergic to it."

I suspect that if the skin test came back negative, he would tell me to go ahead and eat it.

If I ever went back to see him again, that is.