Allergy-Prone People Advised on Fast Relief in Simple Kit

A college coed allergic to peanuts dropped dead after eating chili at a restaurant, unaware that it contained the nuts.

A 57-year-old man died after he was stung repeatedly while trying to trap a swarm of bees. He was so allergic that one or two stings would have killed him.

A chronic alcoholic knew that he was allergic to shellfish, but ate crab salad in a late-night refrigerator raid. He passed out and died before help arrived.

The deaths were due to anaphylaxis, the most severe allergic reaction.

But underlying that, none of the victims carried the stimulant epinephrine, which counteracts anaphylaxis if injected immediately after symptoms start.

New studies indicate that many people prone to anaphylaxis don’t carry epinephrine injection kits at all times, even though it can save their lives and the kits are easily available by prescription for $5 to $30.

“If you had an episode of anaphylaxis, you’re likely to have another,” said Dr. Bruce Wolf, a Nashville allergist. “Because this reaction can be fatal, you need to have epinephrine.”

Attack Can Kill

Anaphylaxis can kill by causing shock--a heart- and breath-stopping sudden loss of blood pressure--or by swelling victims’ throats so they suffocate.

Epinephrine maintains blood pressure and decreases swelling. It also fights less deadly symptoms, including hives, flushing, itching, headache, runny nose, asthma and shortness of breath, sneezing, anxiety, uterine or stomach cramps, nausea, vomiting, diarrhea, abdominal bloating and fainting.

Dr. Deborah Birx, an allergist at Walter Reed Army Medical Center in Washington, suffered anaphylaxis aboard an airplane after eating kiwi fruit while flying to an allergists’ convention in California.

“First my heart started racing, then I felt lightheaded. That’s when I started feeling terrified. Then I had difficulty swallowing, and felt that if I swallowed, I wouldn’t be able to breathe again.”

Flight attendants had epinephrine on board but it did not fully stop her allergic reaction, so the plane made an emergency landing in Omaha, where Birx’s reaction finally abated at a hospital.

Variety of Sources

Each year, anaphylaxis kills up to 50 Americans stung by bees, yellow jackets, wasps, hornets or fire ants; about 1,000 allergic to penicillin, and another 1,000 allergic to dyes injected during certain X-ray procedures, said Dr. Michael A. Kaliner, chief of the allergic diseases section at the National Institute of Allergy and Infectious Diseases.

In addition, Dr. John Yunginger of the Mayo Clinic estimated, anaphylaxis annually kills five to eight Americans allergic to nuts, shellfish, eggs, seeds and other foods, although fewer than a dozen deaths have been documented.

Other causes are food additives such as sulfites; allergy shots; snake venom; animal bites; extreme doses of pollen; blood products, and drugs. Among those are antibiotics and heart medications, vaccines, vitamins, hydrocortisone, anesthetics, aspirin, acetaminophen, codeine and other painkillers.

Nearly 200,000 hospitalized patients a year suffer medicine-induced anaphylaxis and 50,000 more are hospitalized because of reactions, according to the American Academy of Allergy and Immunology. Kaliner believes those figures are high.

Incidence Calculated

Kaliner estimated that 1 in 2,500 to 1 in 10,000 anaphylactic episodes are fatal. Dr. Tim Sullivan, head of allergy and immunology at the University of Texas Southwestern Medical Center, contended that those figures include mild allergic reactions he does not consider anaphylaxis. Sullivan said up to 10% of people hospitalized with severe anaphylaxis die.

The anaphylaxis deaths of the coed and the alcoholic were among eight food-induced deaths studied by Yunginger and his colleagues.

“In no case was epinephrine administered before or immediately after onset of symptoms,” they reported to the American Academy of Allergy and Immunology. The bee-sting victim also did not carry epinephrine, authorities said.

Wolf and Dr. Phil Lieberman, another Tennessee allergist, surveyed 89 allergic patients who had suffered anaphylaxis and found that among those who responded, “only 50% kept epinephrine with them despite being warned to do so. . . . Patients either forget or ignore these admonitions.”

Patricia Hutcheson and colleagues at St. Louis University Medical Center surveyed 76 patients with insect-sting anaphylaxis who were treated with epinephrine in hospital emergency rooms.

“We found that 82% had not received any advice on the avoidance of insects, 71% had not received a prescription for an epinephrine kit and 44% did not receive advice to consult an allergist,” she wrote. “More effort must be made toward educating emergency room personnel about preventive measures.”

Kaliner said epinephrine kits should be carried by anyone who has had an anaphylactic episode, but not by everyone with allergies. They also should be carried by those prone to severe asthma attacks and those allergic to sulfites, peanuts and shellfish, said Dr. Ronald Simon, an allergist at UC San Diego’s Scripps Clinic and Research Foundation.

Should Carry Kit

Kaliner said people who might need epinephrine should carry one kit and keep others in the home, car and office. Those whose throats swell during anaphylaxis should carry an epinephrine inhaler to avoid suffocating.

The simplest kit to use is the EpiPen, a preloaded, push-button syringe that looks like a fountain pen and costs $20 to $30. The Anakit, $17 to $22, is a preloaded conventional syringe. Finally, consumers can buy glass ampules of epinephrine for about $5, and load their own 20- to 50-cent syringe.

Epinephrine speeds the heart; it can cause heart attack, heart failure or deadly abnormal heart rhythms in people with heart disease. Kaliner said these people should inject half the normal dose if they suffer anaphylaxis.

His advice to people prone to anaphylaxis is simple: “If symptoms begin, take both an antihistamine (preferably in quickly absorbed liquid form) and epinephrine. Then get yourself to a hospital.”