It was a common topic of conversation. Nobody could figure out why she went back to the same “smoke spot” after being stung several times, and none of us could even recall seeing a bee behind the building.
I’ve been stung by bees several times in my life. They sure hurt IME!
I tend to react less to honey bee stings than mosquito bites - from the standpoint of swelling and later itching and pain. The initial stab does hurt worse when done by bees For me. Very much a case of YMMV.
Spoiled fish can develop high levels of histamine, and a person who eats it can have a reaction that mimics an allergic reaction. This happened to one of my employees. Her friends took her to the ED and she was fine, but there was a lot of unpleasantness between eating the fish and recovering.
A very good point. In the case as described by the OP though there was more respiratory involvement and no reported gut symptoms, whereas your link notes scombroid rarely involves the respiratory system and commonly involves the gut. Also the link notes commonly others eating the same dish would be likely effected as well. One expects the OP would have shared that fact.
Very good point. We are just back from the Caribbean. My gf is still itchy with weeping areas from mosquito bites. For me, a mosquito bite is intensely itchy for a bit, then it is gone. She sprays with DEET, I don’t bother.
Sure, but the O.P. specifically asked about this. It’s right there in the thread title. One can assume the post above yours was responding to the original question.
… which I dunno if it was really answered?
Let’s say vomiting can be induced by the gag reflex (finger down the throat) to avoid all the side effects of emetics mentioned upthread … would that still be the best thing for someone in a situation similar to the OP’s wife to do?
No.
I mentioned upthread that the amount of the allergen eliminated by inducing vomiting can’t be counted on, and that - most of all - if there is ANY chance of the person losing consciousness, vomiting is the last thing you want. Even if she remained conscious, but the airway swelling worsened, vomiting could be a big problem.
My employee was the only person who got sick that day. My guess is that it’s fairly common for one piece of fish to go bad (it’s on the outside, sitting in a warmer spot, that fish had a slightly higher concentration of histadine, whatever. My guess is that’s just harder to prove, rather than being unusual.
I really like several of those fish, and sometimes notice that a piece of fish “tastes itchy”. I taste them gingerly, since my employee’s experience. (Unlike an allergic reaction, which can be triggered by a tiny dose, scromboid poisoning is very dose-dependant.
It’s too bad the OP didn’t snag the leftover dish to test for that, as well as to determine what other allergens might have been in it.
Getting even a tiny amount of an allergen into the airway sounds like an incredibly bad idea. But ianad.
Thinking about it, that would of course avoid the toxic effects of various emetics like ipecac (if you could even get it anymore) or the dangerous old standby of drinking heavily salted water.
Would it also eliminate the problems associated with decreasing consciousness or increasing respiratory problems? Does the vomiting stop immediately after the fingers-in-throat thing? Or does the stomach remain “touchy” and prone to regurgitation for a while?
I’ve never tried this method or been present when someone else tried. Does it even work for everyone? My impression was that a lot of people just gagged and drooled, but didn’t bring anything up.
I need to learn more.
As I understand it, there just aren’t any situations where it is medically recommended to induce vomiting before admission to professional medical care.
I think it used to be recommended for certain types of poisoning etc, but nowadays the advice is just to seek immediate medical attention. Emergency medical people might do something that is equivalent to inducing vomiting, such as gastric lavage, but if they do, they are doing it in a controlled setting where the patient’s airway can be protected and resources and methods are at hand to attend to any adverse outcomes.
Getting back to epi pens and antihistamines:
If there’s an epi pen around, and someone appears to be suffering anaphylaxis, the epi pen is the best choice.
But in my wilderness first aid class, the instructor said that even if you have an epi pen, it may not last long enough to get the victim to an emergency department (wilderness, after all) and said you should ALSO give the person an antihistamine, which can help hold the reaction in check. I discussed it with my PCP who agreed that antihistamines are helpful in treating anaphylaxis.
And once, when i was on an island that wasn’t exactly wilderness, but also was more than an hour from an ED, a woman had a scary reaction to a bee sting. There were no epi pens on the island. I offered her some Benadryl, which she took. When she returned from visiting the ED, she thanked me for the Benadryl and said the ED doctor thought that had saved her life.
So i have three sources (wilderness first aid instructor and two doctors) who claim that antihistamines are helpful, if an epi pen isn’t available.
As FQ that’s the closest we can get: it is not part of recommended care. My guess remains that there is more risk of harm than benefit but that is informed opinion not a factual answer. And if in doubt do not risk causing more harm.
Yes the article I linked to bemoans the fact that physicians who really should know better are part of the problem.
FQ level answer though remains: antihistamines can be an adjunct to the epinephrine injection and can help with minor allergic symptoms without signs of anaphylaxis and at lower risk to become such, but are not effective for anaphylaxis. That is absolutely clear from all official guidelines.
Antihistamines can definitely be helpful, but their effect is primarily in preventing a reaction. Or in preventing it from getting worse. They block histamine receptor sites in the body and interfere with the vasodilation or bronchoconstriction (and GI effects) that the histamine might otherwise cause.
But when those things have already happened, antihistamines will not quickly reverse them. You need epinephrine for that.
I remember once asking an E.R. doc if I should’ve given Benadryl in addition to epi in a particular instance, and he said it would be like (performing a certain bodily function) in the ocean.
In the case where you don’t have epi and DO have an an oral antihistamine, what have you got to lose? (Unless the person is too far gone to swallow safely or known to be allergic to the antihistamine, etc, etc.)
Bottom line: If the reaction is severe, don’t waste time with Benadryl if there’s epi on hand.
Generally, inducing vomiting is not recommended. On the other hand, if you body decides that it’s going to vomit out the offending allergen, there’s little you can do to prevent it.
The two times I had anaphylaxis I received 0.3 mg epinephrine (adult epi-pen dose), 120 mg solu-medrol (steroid to reduce inflammation and immune reactions), and 100 mg diphenhydramine (generic Benadryl). But the epinephrine was done first, and the rest was also via injection meaning it’s going to take effect a LOT faster than if you take a pill. So yes, Benadryl has a role to play but it should not be considered the first, best, and primary treatment.
So… if I had access to neither an epi-pen or emergency medical care sure, I’d take Benadryl…but it would be a race between it taking effect and my severe allergy killing me. Not a scenario I ever want to play out in real life, thank you very much.
I think it’s the epinephrine that keeps you alive long enough for the steroid and antihistamine to really kick in and cut down the reaction but I am not a doctor, just someone with some severe allergies.
Oh - and both times I was vomiting during the reaction (really, the body seemed to be trying to dump the warp core out of every orifice, it was a lot of bodily fluids flying around). Didn’t seem to do a damn thing about slowing it down, much less reversing it. I wouldn’t rely on that, either, and then there’s the risk of inhaling the vomit and so forth already covered.
I don’t think throwing up will do anything beneficial based on my admittedly limited and anecdotal experience.
The amount of allergen required to trigger an allergic reaction is typically pretty tiny, and if you ingested a whole meal of it, it just seems very unlikely that you would expel it completely enough to make a difference.
Yes, antihistamines are a useful adjunct.
To keep this FQ level here are the 2020 official guidelines.
Note:
It is a good thing to help the person feel less itchy but preventing blood pressure collapse and airways closing off needs the epi. There is not good evidence for steroid use but that is not evidence of lack; given little risk of harm it is still often used.
Inducing vomiting may cause harm. No guideline advises it. I would strongly recommend against it. I do not however have solid evidence for that opinion.
Epi-Pens are like Narcan in that people who carry them should not hope to need them, and if they are used, 911 should also be called.
Did you mean “ionically”?
In a wilderness or other emergency situation, if things got really dire, an antihistamine could probably be administered rectally (or TBH vaginally if the victim is a woman and you’re really squeamish). Phenergan (promethazine) is a prescription antihistamine that is also a very potent anti-nausea med, and commonly dispensed as suppositories.