anaphylaxis

Can Peanut Allergies Be Cured?

/ Jordyn Redwood / Leave a comment

There are few things that make me nervous in the ER anymore. After spending twenty plus years in nursing, I’ve seen and handled most everything.

One exception is peanut allergies. When a patient signs in with that complaint it is emergent because of the concern of anaphylaxis which I posted about here. There is a point of no return when it comes to an allergic reaction where the patient will die despite all efforts. 
The other question becomes just how do we protect these children? An Epi-pen should be kept with these children at all times. For one, some parents won’t do this. Also, parents are uncomfortable giving these injections. 
Another reaction is to create a peanut-free environment. In reality, I don’t know how feasible this is. Peanuts and peanut products are prolific and I feel like this gives parents a false sense of security. 
Recently, researchers developed a study to see if they could inhibit the body’s response in a peanut allergy. They gave small but increasing amounts of peanut protein along with a probiotic every day for eighteen months. The test group was split in half with half of the participants receiving a placebo that looked and smelled like the treatment. On the last day of the study, the participants were given a double dose of peanut protein with the probiotic. Twenty-six of the twenty-nine children didn’t have an allergic reaction whereas only two of twenty-eight in the placebo group demonstrated the same.
Of this group on non-reactors, after a two-five week period of being peanut free, they were retested and twenty-three of twenty-five still had no reaction.
Over time, it is possible for the body to build up tolerance but this method has been found to be twenty-times more effective.
The next step is to see how long this effect will last. Will it be a cure?
It might be too early to tell but it might well be a very good step in the right direction. 
Would you try this for your child if they had a peanut allergy?

Allergic Reaction: Dianna Benson

/ Jordyn Redwood / Leave a comment

I always love it when friend and author Dianna Benson stops by! Dianna is a talented writer and has two treats for you today– a new novel, Persephone’s Fugitive, is releasing. I was blessed to have the opportunity to read and endorse this novel. Two, she is giving a factually based fictional account of an EMS call dealing with a severe allergic reaction called anaphylaxis.

Welcome back, Dianna!

“EMS 6, allergic reaction, at 123 Main Street.”

At 7:40 Christmas night, my partner and I flip on the lights and sirens and race our ambulance toward 123 Main Street. En route, my partner reads off details of our dispatched call on our dashboard laptop.

“Twenty-year-old female. Respiratory arrest.”

I grab the radio. “This is EMS 6, requesting assistance on our anaphylaxis call. Copy?”

“Copy EMS 6. FD 14 is en route.”
    
Once we roll up on scene, several people wave us into the two-story home, their faces contorted in panic. As we hear sirens from an approaching fire truck, we rush our loaded stretcher inside the front door and toward the young lifeless body lying on the tiled kitchen floor, cyanosis around her lips.

I notice our patient’s chest is motionless, and I don’t feel or hear any air moving out of her mouth or nose.

“What is her name?” I ask no one in particular in the crowd of about a dozen surrounding us.

“Ally,” several voices answer.

“Ally?” I rub my knuckles over her sternum.

“Unresponsive,” I inform my partner, who’s yanking out a BVM (bag-valve mask), other airway equipment, and the med box.

I feel for a carotid pulse on her flushed neck. “Rapid and weak,” I say to my partner. We share a look of understanding—our patient is headed for cardiac arrest. Our interventions must be quick and efficient.

“What happened here?” I again ask the room full of people as I press the mask over my patient’s mouth and nose with my left hand in the E/C formation. With my right, I squeeze the football-sized bag every five seconds to oxygenate the young woman’s system. Her chest rises and falls with every squeeze, indicating her airway isn’t blocked by swelling or any foreign object.

“She was eating and started coughing, and said her chest is all tight,” a hysterical woman answered, suddenly kneeling next to me. “She was itchy all over, had trouble breathing, hives on her back.” 

I face the middle-aged woman, tears flowing out of her eyes and down her cheeks. “Are you her mother?”    

“Yes. She was severely allergic to peanuts when she was little but out grew it or whatever.”

As I continue bagging, my partner pushes epinephrine IM (intermuscular) then inserts an IV into our patient’s left arm for med access and fluid replacement. A fire crew of four men darts into the house.

Without an exchange of words, I hand one of the firefighters the BVM, and two of them take over bagging. One presses a tight seal over the mouth and nose, the other squeezes the bag.
   

“Hand me our monitor,” I ask the firefighter closest to our cardiac monitor. He and the fourth guy assist me in hooking up a twelve led ECG to our patient’s four limbs and chest.

I study the monitor for our patient’s vital signs, looking for indications of imminent anaphylactic shock and cardiac arrest. “BP 80/52. Pulse 134. SPO2 86%. Normal sinus heart rhythm.”

“Uh-huh,” my partner says, letting me know he heard my report of the grave vital signs.

I hand him diphenhydramine and methylprednisolone to administer into the IV line.

“Does Ally have any medical conditions or take any medications for anything?” I ask the mother.

“No. Nothing.” 

We add Benadryl to the line then attach a little bag of Pepcid to the IV set up. Following up with those meds, we add Solu-medrol.

In scanning the kitchen, I spot several whole pies ready to be served, remnants of T-Bone steaks and empty lobster tails on multiple dirty plates. “Did she eat any nuts tonight?” I ask the mother to keep her occupied.  

“Nothing any of us ate tonight contains nuts.” The mother points over her shoulder. “We haven’t eaten any pie yet, but none of them has nuts.”
     
“Has she ever eaten lobster before tonight?” I ask while digging into our airway bag.
 
“Once. Couple of months ago and loved it.”

“It was probably the lobster. The second encounter with an allergen is when an allergic reaction occurs.” I turn to my partner. “Let’s intubate.”

“Uh-huh.”

I’m readying the intubation equipment when Ally jerks to a conscious state, coughing and rolling on to her side, shoving the mask away from her face.

“Guess she didn’t want to be intubated,” one firefighter whispers near my ear, not out of humor but relief, a feeling I share. 

“Ally? Hi.” I grab a non-rebreather mask. “You suffered a severe allergic reaction. You need oxygen.”

She nods, rolling to lie on her back again. Her mother squeezes her hand, pats her forearm.

“Bummer, I know, but we gotta take you to the hospital to be monitored overnight.” After turning the portable O2 tank on to 15 liters per minute, I strap the non-rebreather to Ally’s face. “Just breathe normally and relax. You’re doing fine. We’ve got you, Ally.” I smile at her.

The firefighters lift her weak body onto our stretcher; I study the monitor. “BP 96/60. Pulse 118. SPO2 92%,” I say to my partner.

“That’s what I want to hear,” he responds in a relief matching my wide smile.

You can read more posts done on allergic reactions/anaphylaxis here, here, and here.


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Dianna T. Benson is the award-winning and international bestselling author of The Hidden Son and Final Trimester. Persephone’s Fugitive is her third release. An EMT and a HazMat and FEMA Operative since 2005, Dianna authentically implements her medical and rescue experience and knowledge into all her suspense novels. She lives in North Carolina with her husband and their three children. www.diannatbenson.com


Author Question: Death by Bee Sting

/ Jordyn Redwood / 1 Comment

Amie Asks:

My character is allergic to bees. The villains plan on using bee venom to make her death look like an accident if they need to. Is there any drug that would mimic bee venom, or will I need to use actual bees?

Jordyn Says:

There is no drug that I’m aware of that would mimic bee venom so I think you’re going to need to use the real thing. You could just have the killer trap a bee against her body so it actually stings her versus trying to gather bee venom and try to inject her with it. 

What actually kills a person if they are allergic to bees is not the bee venom itself– it’s the body’s response to the bee venom and the response it mounts is called anaphylaxis.

I think I should point out the difference between an allergic reaction and anaphylaxis. An allergic reaction is a localized response (I get stung by a bee and my whole arm swells up) or a skin rash.

Anaphylaxis is a multi-system reaction due to massive histamine release that leads to capillary leaking, massive swelling and edema. Anaphylaxis is defined as having two or more body systems involved reacting to the substance and can be two or more of the following.

Skin: Hives.
Gastrointestinal: Vomiting or diarrhea.
Respiratory: This would include anything from the mouth to the lungs. Lip swelling. Tongue is swelling. Itchy, scratchy throat. Thick feeling to the throat. Difficulty swallowing. Drooling. Wheezing in the lungs. Low oxygen levels.
Cardiovascular: Increased heart rate and low blood pressure.

When we treat anaphylaxis– each treatment is designed to stop the reaction. The more body systems involved, the more life threatening the reaction is. 

#1 Drug given: Epinephrine via an intramuscular injection. Why not IV? An IV dose in a conscious person could cause enough coronary artery vasoconstriction to give the person a heart attack.
#2 Drug: Inhaled Albuterol IF the person is wheezing. 
#3 Drug: A Steroid. If the person has multiple system involvement (particularly respiratory or cardiovascular) then this will be given IV. If not, then an oral dose is okay.
#4 Drug: Benadryl or diphenhydramine. This blocks one form of the histamine being release (H1 blocker). IV if sick, otherwise by mouth. 
#5 Drug: An antacid like Zantac or Pepcid. This blocks the other form of histamine being released (H2 blocker). And same here, too– IV if sick, otherwise orally.

Patients with anaphylaxis are monitored for 8-12 hours after medications are given. Patients who require more than one dose of IM epi may be admitted to the hospital. The reason is that when the medication wears off we want to ensure the reaction doesn’t come back. Patients will go home with a script for an Epi Pen (or renewal script), a steroid for three days and then H2 blocker for three days.

If you’re interested in more information– here is a post I did on food allergies. 

Author Question: Death by Food Allergy

/ Jordyn Redwood / Leave a comment

Sally asks:

My villain is going to kill his wife. She has a severe peanut allergy. My initial plan was for him to put peanut oil in a salad dressing, one that needs to be shaken to combine the oil and other ingredients. He also damages her epi pen. He does this right before he leaves town for business in order to give himself an alibi.

Using Epi Pen

He’s a professional athlete so news of his wife’s death will make media outlets like ESPN. I want initial news reports to say that it doesn’t seem to be foul play, even though it is.

Does that work?

Jordyn Says:

The cause of death would be anaphylaxis. That’s how the person would die. Basically, an allergy causes a huge histamine release that can lead to cardiovascular collapse– difficulty breathing, low blood pressure, increased heart rate (tachycardia.) The reaction can get to the point where it can lead to death.

This is what your character would die from. So– the ME would be able to determine that the patient had an anaphylactic reaction. How easy it would be to pinpoint the exact cause of the reaction may be harder.

My follow-up question to Sally was: What’s to prevent the character from calling 911?

Death by allergic reaction does take a while. There is not set amount of time and my guess is it could be fairly expedient– perhaps 30 minutes for a person who is highly sensitive.

This is where the setting would come into play. In a city– the EMS response time should be 2-6 minutes. However, in the country where there may be only volunteer response, it feasibly could take 30 or more minutes.

The photo from this piece comes from a great article about whether or not to use epi pens.

Some free nursing advice for you here today– if you are a parent or adult and the thought comes to your mind– “Hmm– should I use the epi-pen?” Then yes, you should. Don’t wait. Don’t question it. Give it and either call 911 or go straight to the ER.

The issue with anaphylaxis is that it can spiral to a point where we cannot reverse the reaction and you may die. However, I’ve not yet seen a person die from giving themselves a single epi injection when perhaps they didn’t need it.

We’d rather monitor you alive for several hours than tell your family you’ll no longer be with them. 

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Sally Bradley has worked for two publishers, writing sales and marketing materials, sorting through the slush pile, and proofreading and editing fiction. She has a BA in English and a love for perfecting novels, whether it’s her work or the work of others. A judge in fiction contests, Sally is a member of ACFW, The Christian PEN, and the Christian Editor Network. She runs Bradley Writing and Editing Services from her home outside Kansas City. A mother of three, Sally is married to a pastor who moonlights as a small-town cop.