Yup. And in general I don’t second guess a doctor who has actually spoken with the patient in person. So I’m dealing with a hypothetical.
As a hypothetical: there are no pills that will help in an actual emergency, even if having some gives you a feeling of being prepared.
The hypothetical IOW as described second hand by the OP, including general allergy symptoms, eye swelling, and asthma symptoms/“light respiratory distress” beginning within a few hours of exposure, would leave me, as someone with some medical knowledge and not easily scared, scared for my wife until it was proven that there was no IgE mediated cause to an ingredient in that dish that she might be exposed to again.
If a doctor told my wife there was no reason for me to be scared and some pills would be enough to be prepared for a future emergency I insist that my wife see someone else.
True, EpiPen use is not indicated for sneezing at a buffet; it is indicated if even past relatively mild IgE mediated reaction is proven and there are any of the symptoms I listed. The next episode may be a fatal one.
Epi is underused. That’s not my opinion. It’s well documented.
Too many incorrectly believe it is not necessarily to use it for the episode, and/or are needlessly scared to use it.
And too many doctors drop the ball:
Criteria BTW:
TABLE I. Clinical criteria for diagnosing anaphylaxis
Anaphylaxis is highly likely when any one of the following 3 criteria are fulfilled:
Sampson et al 393
Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (eg, generalized hives, pruritus or flushing, swollen lips-tongue-uvula)
AND AT LEAST ONE OF THE FOLLOWING
a. Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
b. Reduced BP or associated symptoms of end-organ dysfunction (eg, hypotonia [collapse], syncope, incontinence)
Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours):
a. Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula) b. Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
c. Reduced BP or associated symptoms (eg, hypotonia [collapse], syncope, incontinence)
d. Persistent gastrointestinal symptoms (eg, crampy abdominal pain, vomiting)
Reduced BP after exposure to known allergen for that patient (minutes to several hours):
a. Infants and children: low systolic BP (age specific) or greater than 30% decrease in systolic BP*
b. Adults: systolic BP of less than 90 mm Hg or greater than 30% decrease from that person’s baseline
PEF, Peak expiratory flow; BP, blood pressure.
*Low systolic blood pressure for children is defined as less than 70 mm Hg from 1 month to 1 year, less than (70 mm Hg 1 [2 3 age]) from 1 to 10 years, and less than 90 mm Hg from 11 to 17 years.
Please do not even remotely suggest to anyone that waiting until the need is obvious is appropriate.
Unless there’s a doctor nearby how is the average person supposed to know the obvious signs of severe anaphylactic shock and death?
I have found strangers even a medically trained individual was not prepared to actually apply my glucose rescue pen., when needed.
The hero in these situations are not around, usually. Even an informed family member may be reluctant.
Counting on this is futile pursuit.
I’m not going around watching every diner in a restaurant and it’s not likely anyone else is. Their phones are much more interesting.
Good luck in the wild getting help. No one wants a lawsuit.
You’re your own best advocate. If you can’t be, have someone with you.
The OP didn’t know and it was his wife. That’s why he posted here. With a very important question. Looks like they have their answer.
I realize your coming to this from a Doctors POV. The average person has not read the paper you cited, nor is going to. I’m sorry that’s just how it is.
Dramamine is also an antihistamine, but not the same one that’s in Benadryl.
I wouldn’t recommend artificially inducing vomiting, because of the risk of aspiration. A person in anaphylaxis already has a compromised airway; don’t mess things up further! They don’t even recommend doing this for children who have gotten into something they shouldn’t have.
p.s. This says that the 8-chlorotheophylline moiety (molecular side chain) has an effect on the vestibular system, i.e. the motion-sickness producing area in the inner ear.
Both of these. Epi scares me. It’s an extremely potent drug that has profound effects on the cardiovascular system, and I don’t like to think of it being given without a clear indication.
BUT . . . the thing that’s most likely to kill someone is not getting their epi soon enough. (Thank you for the linked article, DSeid.) If you wait until you can check off a whole list of symptoms, it may well be too late.
Oral antihistamines are great for mild reactions with a slow progression, but the OP describes a situation involving unspecified “major allergy symptoms” facial swelling and respiratory distress. That’s scary right there. Add to that the fact that many people’s reactions worsen with subsequent exposures, and this is someone who should always have immediate access to epi.
Maybe they should of ask the doctor for the script on it.
I’m of the opinion a strong cup of black coffee may have helped her if she had stopped consuming the fish.
If this is truly her first episode and she’s never had a scare before her doctor might have been being on less is more side of things.
Until she has further evidence, I could trust that.
Again, if she had needed it and had the pen, take the shot. Without fail. I suspect the cruise medical care has them on board.
I’m honestly not sure what you are talking about now Beck but it has nothing to do with anything I wrote.
I am not advocating strangers giving strangers epinephrine. All though in emergencies I am not against such.
I am reacting to the misinformation that an antihistamine is any sort of treatment for an actual serious, as in could progress to life threatening, allergic reaction. It is not.
I am reacting to the misinformation that someone who carries an EpiPen for identified risk should have reluctance to use it unless the severity of the reaction is already obvious.
I am pointing out as a matter of an FQ level response that it sounds like the event of the OP (considered as a hypothetical given second hand history and all) meets current criteria for anaphylaxis, albeit a mild self resolving episode this time. As a hypothetical.
And sharing my humble opinion about what I’d be doing if I was in the place of the OP in that hypothetical.
I didn’t know my my gall bladder was failing and got sick after eating pistachios. Lot of vomiting and then sat on the toilet. Pretty violent reaction for a couple hours.
I gave away the rest of my pistachios. Pretty sure I can’t eat them since surgery. No cashews either. I still eat almonds in small portions.
I loved them for my entire life but can’t process fatty foods anymore.
Another snack that suddenly made me ill (before my diagnosis) was Mike & Ike candy. It’s gelatin based. Fortunately I had only eaten half a box. But felt like throwing up for over an hour. I haven’t bought them again either.
Surgery has made me careful with many fatty foods. I can only eat small portions once in awhile.
I’m posting as a warning because people won’t know they have gall bladder stones until they get sick and have sharp pain.
They are closely related compounds but the stimulant is not something separate added to the bottle. It is part of the molecule. Attached. It gets metabolized into separate bits.
No, they are not. Please stop spreading misinformation.
Beck, that will NOT stop a severe, fast-acting allergic reaction. That is terrible advice.
I’ve had two anaphylactic reactions that landed me in the ER. Symptoms can progress extremely fast. The only sure thing is an epi-pen.
It’s actually pretty rare for transportation services to have them on board. That is not something to rely on.
I’m not advocating doing such a thing but I’d be willing to inject someone in anaphylaxis with and epi-pen or equivalent. I’ve been on the other side, it’s effing scary and painful. I’ve read the package insert with all the scary warnings and they are sobering, but so is not being able to breathe.
I don’t think this incident was severe as all that. If it had been the OP would’ve said so.
As to strangers giving Epi-pen or Glucose rescue or any other treatment, I meant the average person is not gonna know when or if they should. And if you’re in serious trouble all you can hope for is they don’t video you and post it on YouTube or TikTok.
If a person needs these remedies it’s incumbent on themselves or close loved ones to know the signs.
So the idea, if you’re not a doctor yourself, you’ll even know to give your own self a shot. Unless you learn. Hopefully not the hard way.
I know what diabetic ketoacidosis and low glucose looks like and I’d still be trepidatious to approach someone who looks as tho’ they’re in jeopardy.
So if you don’t know, your loved one doesn’t know and strangers don’t know, care or are just scared. What’s a person to do?
I still think Benadryl and Dramamine are similar enough to help in mild allergic symptoms. And black coffee can help. I’ve seen it.
Again, if you have serious allergies and have a pen. Avoid your allergens, and take the dang shot if it’s necessary.
Well again, the assessment of this as a mild anaphylactic event is hypothetical based on second hand description, it appears the dermatologist? did not think it was, and the general message is yours to dismiss if you want.
But that general message remains: the next event after a “mild” anaphylactic event that self resolved can be rapid and severe; epinephrine, given as early as possible once the signs of anaphylaxis are identified, even if they are mild at that time, is the treatment. Care for a suspected risk of anaphylaxis should include identification of the allergen if possible, prescription of an epinephrine auto injector, and education on when and how to use it.
Sorry to continue this hijack, but I want to understand this. My understanding is that Benadryl is diphenhydramine bonded to a salt. Dramamine is diphenhydramine bonded to 8-chlorotheophylline. In the body, they both dissociate to diphenhydramine (the antihistamine) plus something else, which is inert in the case of Benadryl, or is a stimulant in the case of Dramamine. Is that all correct? If so, it seems rather pedantic to insist that they are different drugs. They are just different ways of administering diphenhydramine, which is the actual drug (ignoring the stimulant effects of Dramamine), and both would be equally effective as an antihistamine. Is this right?
Dramamine breaks down into active diphenhydramine plus the theophylline product, which are bound ironically. And yes Benadryl is diphenhydramine HCl, also bound ironically. I was thinking it was more a “prodrug” but that is not correct looking into it more.
It’s like saying the bandaid that’s good for a papercut is also useful in the case of amputation. No, it’s not.
So, please, please, just admit you don’t know in this case and don’t give that advice for severe allergic reactions. If there’s no epi-pen around call 911, don’t fap around with Dramamine or black coffee. If the person has an epi encourage them to use it. If they can’t - reasons can include eyes swollen shut, fingers swollen, continual vomiting, unconscious, whatever - read the instructions on the pen then inject them in the thigh. You don’t even have to remove clothing first, the needle will go through it. Speed is of the essence if they are at the point they can’t do it themselves.
Epi-pens are not hard to use, they’re designed that way. They come with a “trainer” so you (or a loved one or good friend or whomever) can practice giving you the shot without actually giving you the shot. There are instructions on the epi-pen itself.
If the person is having a severe enough reaction that they can’t do this themselves if someone else around them doesn’t do it they will die.
Getting a pen isn’t always as easy as it should be. I’ve had insurance companies push back (one asserted that since I hadn’t had any serious reactions for 10 years I didn’t need it anymore. Um… no, the immune system is not that forgetful. Unfortunately for me.) Out of pocket for awhile they were running $1800 which was prohibitive for the poor. I’ve encountered doctors reluctant to write a script for them. I think if you’ve had an anaphylactic episode you should get the dang things for free but perhaps I am biased.
On top of that - you can’t reliably avoid an allergen if you don’t know what it is. There’s a tendency to latch on to “the obvious” and not look further but that could potentially kill someone. What if the person in the OP isn’t allergic to fish but to, say, onions used in the sauce? Or tomatoes in the salad served alongside the fish? There they go, avoiding the fish but the next time they eat pasta in red sauce they wind up in the hospital or worse.
… or she was the only one who mentioned/noticed being stung.
Bee stings are not always extremely painful. I’ve been stung several times and some of them were worse than others. On the other hand, someone that allergic to bee venom would tend to be hyper-aware as they couldn’t afford to miss even a single sting.