I’m sad to report that last week a dear young 35 year old friend passed away suddenly in his apartment after suffering what was supposedly a severe anaphylactic shock.
Personally, I a a bit skeptical of this story (b/c I knew him well and he was unaware of any allergies over his 25 years) and he lived on a high floor in an urban apartment (Toronto) so unlikely to come across things like spiders etc.
I know this isn’t a lot of info to go on but given the lack of previous allergies, the urban environment and severity of the reaction, are there any obvious allergens that could have likely caused his sudden death (leaving him without even time to get an ambience?).
I know he was also depressed and have slight suspicions the allergy story was provide by his family to cover up a suicide but would be grateful for some factual possibilities here.
Any airbornes: mold, pollen, some components of perfume (which includes air fresheners and suchlike)…
Having it come from as far as another apartment seems unlikely, but some people with food allergies can get the allergy from the scent of the food, depending on which specific mollecule is the trigger (it’s got to be one that’s part of the smell); they don’t need to eat it.
I guess my question is are these things, while possible, extremely rare for a personally-health 35 year old in an urban environment with no history of allergies? And would they kick in so fast that he couldn’t call for help?
Either the answer is, this is much more common than I had anticipated, this is extremely incredibly rare, or it’s so unusual that perhaps it’s the family covering for what we knew was his obvious depression.
I had a severe anaphylactic reaction to, well, nothing. At first the doctors thought it was exercise induced, but that didn’t pan out. Sometimes the immune system just goes nuts.
Anaphylaxis is rare, but becoming more common. Risk factors include a previous history of anaphylaxis, a family history of anaphylaxis, a history of asthma, but you can suffer anaphylaxis in the absence of any of these. And idiopathic anaphylaxis - for which no cause is ever identified - is a thing.
Although anaphylaxis is life-threatening, most victims do in fact recover, even if untreated.
The fact that fatal anaphylaxis in the absence of risk factors happens only rarely doesn’t mean that it didn’t happen to your friend; it does happen to some people, and why should your friend not be one of them? This doesn’t have to be a common thing for it to happen to your friend; he just has to be unlucky. One abstract that I found by googling suggests “an age-related predisposition to fatal outcomes in teenagers and adults to the fourth decade of life”, which your friend was squarely in the middle of.
Could he call for help? Yes, but he might not realise what was happening, especially if he had no history and so no awareness of anaphylaxis. And, if he does call for help, it won’t necessarily arrive in time.
Well, if you really want to know, look at his death certificate. They are generally public documents, and anyone can go to the appropriate government office and view them. Or look it up online here. Death Certificates can be falsified, but it takes a family with enough pull with a doctor to persuade him to do so.
Was there an autopsy done? Here in Minnesota, a healthy 35-year-old dying alone, not under any medical care and without obvious causes would almost always require an autopsy by the coroners office. Is that true for Canada? It’s much harder to falsify/obfuscate a death certificate when an autopsy is done.
Latex is a big one. If he suddenly decided washing-up gloves would be a good idea, he may well have been wrong. There are any number of cleaning products, soaps, lotions, etc. he could have bought and not realized they had some allergen in them. Or he could have developed a new allergy he didn’t know he had.
My question is, why do you care so much? Your query has a tone of demand to it, as if you have a right to know. You don’t.
The first sign of allergy often is difficulty breathing which, if you’re not familiar with it (so, if you have no previous history of allergies), can be mistaken for a cold. Your sinus and throat swell and close up: a little child may just go into a “try to breathe” mode, but someone older is likely to panic once they realize this is beyond a cold. How would he call for help? Screaming or using the phone are right out; you’d need the presence of mind to go get a neighbor.
And yes, anaphilactic shock kicks in very quickly, and yes, it is possible to go into anaphilactic shock the first time you encounter an allergen/have a noticeable reaction to it. Several people including my niece would likely be dead if SiL-the-GP didn’t always carry epis and hadn’t happened to be around when they got hit; only one of them had a previous history of mild allergies.
It happened to me at about 12 or 13. In the middle of the night I got up to go to the toilet and collapsed. Next thing I new it was the next day and I was in hospital. My parents had heard me collapse and called an ambulance. The story, as I heard it later, was that my throat was almost swollen shut and, had the drugs not worked by the time I got to the hospital, I was having some surgical intervention. Oddly, my doctor never made any effort to identify the agent that caused it. I think the idea was that if it happened again, we may have some idea of the cause and it may be worth investigating. It never did and never was.
Fatal anaphylaxis is rare to the one to three in ten million rate but no clear cause is second to medications as the trigger.
Yes suicide is much more common. Yes we still live in a world in which some families would want to not have a death by suicide known. But rare things do rarely happen and it would be an odd story to make up.
My daughter had an anaphylactic reaction to a number of bee stings. Neither she nor any other member of her family has had any allergies before or since. It was her first week in college before classes started and they engaged in bonding exercises one of which involved rolling down a hill. She got stung several times and went into shock. She carried an epi-pen for a number of years after, but finally gave it up.
His previous lack of known allergies isn't much to go on either. Most people have no idea they are allergic to something until they are exposed to the allergen for the first time. This will usually prompt them to take the tests to identify them.
Secondly, there are many adult-onset allergies which your friend may not have exhibited any previous symptoms. Tree nuts, eggs, and shellfish are all known to develop in some adults who were previously unaffected.
As someone who is anaphylactic to tree nuts, particularly cashews and pistachios, I can tell you, it sets in fast, especially once it hits your bloodstream. There’s not a lot of time to self-administer Benadryl, an Epi-pen, or call 911 before your airway closes… and that’s if you realize what’s happening to you.
You can also develop an allergy to something that you are exposed to too much, too. I’m allergic to basil, which is rare. I could eat it for the first 18+ years of my life but after washing tomato sauce coated pots and pans in the dining hall for hours at a time, several nights a week for months as a college freshman, suddenly started breaking out into hives, which I still get after accidental skin contact with a surface with even a nearly invisible amount on it. I haven’t dared eating anything containing it for 20 years because I got hives in my mouth and in my throat the last time I did…From what little have been able to find on the topic over-exposure is usually how this allergy is acquired.
And why couldn’t there be a bee or other insect in a closed up apartment? I got stung by the same hornet twice, once outside and then a couple of hours later in my bedroom after it apparently had hung onto my clothes or hair for long enough to come in with me despite me thinking I’d shaken it off outside.