‘Delayed’ Anaphalaxis: It’s Not Always Like TV

asthmaAnaphylaxis is a severe, life threatening reaction to an allergen.  It can happen seconds, minutes with full reaction HOURS later (2-28 hours). If left untreated, it can lead to unconsciousness or even death. Yesterday, my son Marcus had an anaphylactic reaction almost immediately after eating his lunch at school, but it was easily dismissed as an upset stomach.  Fast forward 5 hours after ingestion of an unknown allergen, he could barely breath.  Marcus has a myriad of allergies including the top 8 food allergies aka “The BIG 8” – Egg, Milk, Wheat, Soy, Shellfish, Peanuts, Tree Nuts, and Sesame.  With Marcus’ extensive allergy history, the school was very aware, on alert at all times and took every precaution to ensure his safety at school. Even so, he still had an anaphylactic attack.

TIMELINE:

12:45  Lunch (Ingestion of allergen)

1:05    Went to nurse’s office complaining of not feeling well (Listen to your child, they know their bodies, be on high alert).

1:10    Went assisted to bathroom where Marcus threw up. (First defense response as body tries to eliminate allergen from body).

M21:40    Complaining of stomach pains, went assisted to bathroom where Marcus threw up again. (Second attempt by the body to eliminate the allergen). No rash, no fever, no other symptoms at that time. After reviewing the timeline with his allergist and given Marcus’ history, this is when he would have liked the epi-pen to have been administered to prevent him from progressing to 6:10.

2:40   Picked up from school, found sleeping in the nurse’s office (body trying to slow down severity of reaction as body goes into resting state, slower blood flow, slight decrease in respiration, lower heart rate), stomach still hurting.

3:10   Still sleepy in car, arrived home from school wanting to lie down (body again trying to slow down severity of reaction as body goes into resting state, slower blood flow, slight decrease in respiration, lower heart rate)

5:15   Woke up feeling better, looking alert and perky, wanting to go to TKD with his sister. Horrible idea in hindsight, but would not have changed reaction, only timeline.

6:00  I returned to TKD for pick up and was rushed immediately to Marcus and found him with shortness of breath, looking slightly blue, and a persistent relentless cough. (Exercise increases heart rate, blood flood, GI motility pushing the allergen flow through out his body and sending a reaction systemically) – Oxygen saturation (O2 Sat) was 84 (anything above 92 is preferred). Ventolin (inhaler) administered. O2 Sat improves to 94 within minutes. Marcus has been having severe asthma attacks for the last week and I misdiagnosed his initial symptoms as such. Exercise often exacerbates Asthma, but has not for him in the past.

6:10   Cough has not subsided, slightly improved but only slightly, and I noticed flushing.  I removed his clothing to find torso covered in hives and traveling.  I immediately administered 25mg of Benadryl. I really should have hit him with an Epi-Pen at this time.

6:25   Arrived at ER with uncontrolled cough, wheezing. When the triage nurse looked up at him as we came running in, they immediately recognized the signs.  He was rushed inside where they found his blood pressure was low and his O2 Sat was 89 at admission.  Epinephrine IM administered immediately.  IV lines were started.  Fluid bolus and Solumedrol IV push administered.

7:30   First rebound reaction, followed by second rebound reaction.  Additional steroids and antihistamines administered throughout admission.

I timelined this summary to demonstrate one of the many different ways an allergen can travel through the body. It was one of Marcus’ more severe and terrifying reactions at the end of the day. We’ve all seen the TV shows, and read the horrible news articles of anaphylactic reaction.  Many of them are almost immediate reactions and while those are severe and incredibly dangerous, ‘delayed’ anaphylaxis is equally as dangerous.  As you saw in my timeline, his teacher, the school chef and the nurse were already on high alert when he threw up. At times Marcus recovered and seemed his normal self during all of this. His recent asthma exacerbation complicated things and lead us to a wrong initial diagnosis. I placed ‘delayed’ in quotations because his reaction WAS immediate, and within minutes his body was trying to eliminate the allergen from his body by vomiting — but its a symptom that can easily be dismissed. As we saw, within a few hours, his body sent out a full scale assault.

IMG_2462Doctors and nurses understand anaphylaxis, but many do not.   Ingestion of peanut or shellfish, even a bee sting, with immediate swelling and throat closure is what many identify anaphylaxis as. Sometimes there are precursors to those reactions like my son Marcus had.

  • It can happen seconds, minutes or HOURS later
  • Allergen triggers can be unknown or known
  • Visible signs and symptoms can include some or all: nausea, vomiting, skin rash, hives, shortness of breath
  • Any (2) combined whether it throwing up and hives, or throwing up twice should have you considering use of the epi-pen

A great article that explains all the different ways anaphylaxis manifests can be found at: http://www.worldallergy.org/public/allergic_diseases_center/foodallergy/.   “Certain food-allergic individuals may experience anaphylaxis only after exercise. Food-associated, exercise-induced anaphylaxis usually occurs following exercise performed 2-4 hours after eating the offending food. The offending food, or exercise alone, will not cause the reaction. Those most at risk to experience food-induced anaphylaxis include people with asthma and those who have had previous allergic reactions to the offending food.”

As a blogger, I get to share many important posts and when this happened yesterday, I knew right away that I had to share this with you. I am hoping in sharing this, that no other family has to go through what my family went through yesterday.  We were very lucky.  We were informed, prepared and incredibly careful always but it still happened. Recognize the signs, never let your guard down and be safe!