Understanding allergy and anaphylactic shock can save life
On a Wednesday night, 18th of September, I was awakened twice by itch on my face. On both instances, I just scratched off and went back to sleep. In the morning, I again felt the itch on my face but just scratched it off and went straight to shower. When I was getting ready for work, I looked at the mirror and got shocked. My face was scary! Rashes were all over and I felt like my face was deformed.
I took a tablet of my over-the-counter medicine Cetirizine and notified the office that I will be late. I just need to wait for the medicine to take effect. However after about 30 minutes, I feel a reverse effect. Instead of the rashes subsiding, I felt a few were coming out on my neck area. That was not a good sign. Cetirizine is not working. It used to work fine but I guess the allergens have already spread out that Cetirizine can no longer combat. The medicine is only for once a day so I can not take another pill.
Decades ago when I first had allergy attack this bad, I was advised to be very conscious about it as it can cause suffocation. I did not pay attention to the medical term back then. Now that simple Cetirizine does not work, I had to see a doctor. I ran to the clinic that is nearest from our area. I told them that Cetirizine is not working and I was prescribed with Bilaxten. I asked if it is stronger than what I took and the doctor said yes. She warned me that it can make me drowsy and sleepy. That was the same warning that I had with Cetirizine when I first had it but is no longer the case after years of using it. I guess my body got immune to it. Since this will be my first time to take Bilaxten, I don't want to take the risk of going to work. I notified them that I will eventually be absent for the day.
The doctor also warned me about the possible suffocation which she reffered to as anaphylaxis or anaphylactic shock. So that is the medical term. You may wonder why and how can allergy cause suffocation. This is how the doctor described it in layman's term:
Even if the rashes stop spreading outside on the skin but allergens in the body are still active, the allergens could be spreading across the internal organs. And if the internal organs swell because of the rashes, it can block breathing passage. That can be lethal.
Back to the doctors's warning which she also clearly stated on my medical certificate, I have to rush for emergency in a hospital if I feel difficulty in breathing.
I went back home and waited for Bilaxten to take effect. The spread of the rashes stopped so I hoped that will be it. After about two hours, the rashes were not subsiding and I felt my chest was getting heavy. I thought it is just in my head and had the courage to wait for three more hours. However, my chest was getting heavier. No, it is not just in my head. My breathing is getting harder. And the rashes start to spread out again. It looks like Bilaxten has only slowed the allergens down but not totally stooped them.
I had to go to the hospital in an early evening. I rushed to the emergency room. Upon seeing my face, a nurse immediately know what to do. He wrote on a piece of paper and asked me to have my HMO card approved at the other counter. When I got back to the emergency room, the nurse pointed me to a seat and I waited for a while. Another nurse came with a hep-lock and syringe. As I have expected. I will have a shot again. I had like this twice in about the last fifteen years. Here's to my third.
The nurse asked me to get inside a room near the emergency room counter and lie down.
"Why are you putting me to bed? I am not getting admitted. I will go home after the shot."
"Yes, ma'am. You will go home. It is just that you need to be stable in bed as the medicine can make you drowsy."
Yes, the shot will really make me drowsy. I remember when I first had it, the doctor did not want me to go home. She said they have to admit me for at least eight hours. I had to convince them that my residence is just five minutes away and I am sure I am not yet asleep by when I get home. I won. I was telling the truth anyway.
The nurse went out to get something. I laid on the bed and saw this moon over me.
"Oh, no. This is not an operating room, is it?" I asked myself.
The nurse came back and started to work on the hep-lock. Then he eventually pushed a vial of diphenhydramine. He told me to lie down for about 20 minutes and I was like, "Darn! I could fell asleep by that time."
I woke up and sat on the bed the moment the nurse walked out of the room. These hospital tools were in my view.
My vision was as clear as what my phone camera lens has taken but the world was swaying. Yes, that is one effect of diphenhydramine. It can make the patient drowsy and sleepy, far more stronger than Cetirizine and Bilaxten. But I can not fell asleep. I am not spending the night in a hospital. I fought the sleepiness real hard. Thanks to my phone that somehow entertained me. It was either I play Soduko or take photos of non-sense-to-me items in the room, including the wall clock to my left on the wall. At least that was easy to read as I was getting blurry vision reading my watch.
When the clock hits more than 20 minutes passed, I stood up and felt the world under my feet. It is stable so far. I got out of the room, went to the nurse station and asked that I'll be discharged. The two nurses who attended to me earlier asked if I am sure that I can manage. I said yes.
I went to work the following day, Friday. My colleagues can still notice rashes on my face on a closer look. I thought it will eventually go away and just shrugged it off. That was until the afternoon.
It was past five o'clock and I squeezed in a meeting that was not scheduled. We were just halfway through the meeting when I feel my face itchy and flaring. I touched my cheeks and there were few swells.
"My face is flaring again." I said to no one in particular.
"Yes! I think you need to go and see a doctor," my colleague answered. I did not want to go. I wanted to finish the work day which ends at 6:00 o'clock, just less than 30 minutes to go. However when I rushed to the washroom to see my face on the mirror, I am starting to look like not myself. It was worse than that on the photo above. My whole face was so red. I ran to the pantry to get water where my other colleagues saw my face. They were all pushing me out to the nearest hospital which is just minutes away.
"Yeah, I need to go to the hospital but not there," I answered and referring to the one near our office.
"With how my face is getting worse, they might insist that I will be admitted and I don't want to stay overnight in a hospital away from home. I'd rather bring myself to the hospital near my residence," I explained. But we know how far that is considering the traffic jam during rush hour like this when it is time to go home for most workers.
I booked a car and was lucky to immediately get one. Estimated travel time stated on the booking app was 59 minutes. On our way, I tried to calm down. I was thinking that the worsening yesterday took several hours so there is plenty of time to reach the hospital without getting tragic. However, I was fooling myself. I felt my face getting thicker by the minute. The swelling was worsening so fast. Halfway to the hospital, my chest started getting heavier. Darn! There goes the warning for difficulty in breathing.
I was not sure if the driver was noticing what's happening with me at the back seat but maybe not specially that it started to get dark and I did not turn the light on. I told him to do what he can to get around the traffic jam because I am not visiting a patient in the hospital. I am bringing myself to the emergency room.
"Ha? Why, what's going on?" He asked.
"You may not notice but I am having an allergy attack. My face is swelling so bad and my breating is getting difficult."
"Okay, ma'am. I'll do my best." Indeed, I can see he was doing what he can to overtake other vehicles along the way.
We reached the hospital after around an hour of travel. Exactly what the booking app has estimated.
I thanked the driver and jumped out of the car. When I entered the emergency room, the nurse asked what happened. I said my allergy has gone far worse than when I was here last night. One of the staff who saw me last night exclaimed, "Ay, oo nga!" Yes, it indeed got worse!
The doctor asked me to enumerate what I ate the whole day.
"White bread with milk in the morning. Rice, pork and mung beans for lunch. Banana cue for mid-afternoon snack. I eat all of those without having allergy."
"Is there fish added to the mung beans?"
"I don't know. I did not cook it."
"I suspect it could have fish ingredients in it that triggered the allergens."
"But I also eat fish and other seafoods without having allergy."
"Whatever caused your allergy at the start may not be known. But since you already have allergens in your system, any triggers, even if you take them without starting allergy, will aggravate the spread of allergens in the body."
I just nodded.
"Were you given prescription last night for take-home medicine?" He continued.
"No. I was just given a shot and discharged afterwards," I answered. He kept quiet.
The nurse asked if I have HMO card. I handed it to him while mentioning that it is the same card I used last night. He asked the doctor, "I wonder if this will still be approved when she already used it last night for the same case."
Darn! So I need to worry about payments first before I get treated? I did not say a word though.
The doctor said it should be okay because it will be a different diagnosis. Last night, what they put on my papers was hypersensitivity. This time, the doctor was saying anaphylaxis. Those are still related because anaphylaxis is worsening of the hypersensitivity. The HMO can argue that I should have been treated well last night and can accuse me of not following doctor's advice so it got worse. Thus they can decline the use of my card.
I was hoping that my cardwill not be declined while a medical technician was taking my vital statistics. I looked at that speedometer-like gadget but never learned how to read it so I asked.
"What's my blood pressure today?"
"One forty over seventy."
"One forty? I never had that. Why is my BP rising? What does allergy have to do with it?"
My normal blood pressure reading is 110/70. I once had 120/70 but that was just once and the doctor was saying it is still within normal range. One forty is towards the borderline of having hypertension.
The doctor answered, "It's okay. I think you're just stressed out while traveling to here. We will check your BP again later when you have calmed down." That was a consolation.
I crossed my fingers as I brought the card and the small slip of paper from the nurse to the information desk to have my HMO card approved. Approval was not as easy as last night. This time, the person on the line from the HMO asked for the information officer to hand the phone to me. She asked what happened. I answered plainly.
"My face is swelling so bad that started just this afternoon and my breathing starts to get heavy."
She did not ask further and just said it's okay. Use of my card for this case is approved. Halleluiah!
I went back to the emergency room and a different nurse led me to what was labeled as isolation room.
"Why are you isolating me?" I am not contagious! I wanted to add.
"No, ma'am. It's just that this is the only room available here in the emergency area."
I waited for a while then the first nurse who tended to me earlier came with two syringes.
"You're giving me two shots this time. I had only one last night," I commented.
"Four shots all in all, ma'am."
"Four shots!?!" I thought I jumped on the bed.
"Two for steroids and another two for diphenhydramine."
I got just one shot of diphenhydramine last night and that is to combat allergens from spreading out into other parts of the body. Now I get steroids. That is for the terrible swelling of my face. How do I know? That is because they use steroids in facial care centers to stop starting pimples or acne from swelling further and bursting out.
He stuck the syringes one on each of my upper arms. He then fixed the hep-lock on the same arm where the hep-lock was attached last night. He just picked the other side this time.
He said he will be back and turned away. With the diphenhydramine shots, I guess. The moment he stepped out of the door, I began shaking. My heart was pumping so hard. I was pulpitating. I put my arm in the air and saw the tremor. I do not know what it is but I can not be having a heart attack!
I exclaimed when the nurse appeared by the door.
"Why am I shaking and pulpitating so bad? I don't have heart problems!"
"That's the effect of the med I gave you earlier. It is normal. It will eventually subside."
"The effect is that fast? Like in just few minutes and I feel like the world is shaking?"
"Yes, ma'am. It's okay."
You could have told me the impact of the steroid, I wanted to exclaim at him. He pushed two syringes of diphenhydramine through the hep-lock and asked me to lie down.
With the thought of two syringes of diphenhydramine, I was not sure if I can still fight the drowsiness effect. I have given in to the possibility of spending the night in the hospital but I was amused with myself that I was still conscious after almost an hour.
I got out of the bed and walked around the room. It was good. I was able to roam without feeling the danger that I will sway or stumble. I can walk straight. I paused and gauged myself if I can take myself home. So far, I was confident that I will not drop along the way. I was sure that I will reach home with all my senses intact.
The nurse's back was towards me when I got out of the room. I called for attention and the nurse turned around. I said I wanna go home. He asked if I will be okay on my own. I said yes. He got my papers and stapled a brown sheet before handing to me. A list of allowable and prohibited foods for persons with allergy. I eat all of those that are not allowed without having allergy. How come?
"I eat all of these that are not allowed but none of them triggered allergy. How come I have to worry about them now?" I asked the doctor.
"Your allergy could have been triggered by the weather as allergens can be carried in the air. Since you already have the allergens in your body, any allergen reactor like those foods to avoid in the list can aggravate the spread of it in your body," he explained. I just nodded.
I went through the list again and, aha! The pineapple is the culprit! Every Friday, our HR has this what they call as Friday treat when they provide fruits for everyone to share. Since I just picked a small slice, I apparently neglected that I ate pineapple and forgot mentioning it to the doctor earlier.
The doctor asked few questions before discharging me.
"Last night, didn't they give you that list of foods to avoid?"
"How about prescription for take-home medicine? You should still continue your medication for a week." He asked this earlier.
"No. I was not given the list of foods to avoid and I was not prescribed of anything for maintenance." I was given the list of foods to avoid when I first had a diphenhydranine shot more than ten years ago. I do not recall any of them until this time.
The doctor suddenly looked timid. I thought he felt ashamed of how I was treated last night.
"I am sorry for that. Maybe last night was toxic in the emergency room that is why they forgot those things."
I wanted to answer, "No. Things were actually quiet here last night. The thing is, the doctor on duty never checked up on me. She was just sitting on the side and letting the nurses take care of me. She never even said a word to me." Instead, I just said "Okay."
He handed me the prescription slip and told me to stop taking the Bilaxten since it is not effective on me.
"What a waste," I thought because I already bought good for five days. How much more if I bought all that was prescribed for fourteen days?
Oral diphenhydramine meds for five days and Loratadine for seven days. The doctor explained that the oral diphenhydramine should be taken before bed time because it can make me drowsy while the Loratadine is okay in the morning.
Just to be sure, I still asked, "you mean Loratadine does not have the drowsy effect?"
Oh my... if only the doctor on duty last night gave me all these pieces of advice and the prescription then I wouldn't be here again this time.
The doctor continued his pieces of advice. "You already have allergens in your system so you have to be very very careful. Avoid those prohibited foods in at least a week."
I really appreciated the way how the doctor treated me this time. I thanked him and started my way out. I forgot to have my blood pressure be taken again.
On the way home, I already concluded that all my foods on stock are in the "avoid" list including milk which is my best friend to go to when I do not cook and do not want to eat outside. A glass of milk will be enough. It's too bad now. I can't have it. I wonder what I can eat without allergen reactors.
On the weekend following all these drama, I went for groceries and wondered what I should buy. For the first time, I got very conscious of the foods I pick. I checked allergen information of all food I touched and was surprised to realized that almost all have allergen information.
Even a soda cracker which I thought is bland and no complicated ingredient has this disclaimer.
Processed on the same facility that handles milk, peanuts, sesame and soy.
With all those allergen information on almost every processed food that I check, I realized how allergy can be lethal. I also realized now that even eating can be so lonely if you have very limited options.
I have never been such conscious about foods to eat until I got into such rushing myself twice in two consecutive days to the emergency room. I may be not afraid to die but that does not mean that I'll just die without helping and taking care of myself.
I buy fruits but I never bought as many as a basket in one go until this incident too. I may need to go back to the market more often as I know the fruits will be gone in a short while. I will depend on them more often now.
About one week before all of these drama happened, I was also awakened by an itch on my face. I scratched my face and felt a small lump. At that point I was on my senses to think that it was a start of allergy attack so I took a Cetirizine pill and went back to bed. I woke up fine the following day. If only I had given the same attention to the itch that woke me up twice this time, I should have taken the pill and not allow the allergens to have more time to spread out. I wouldn't be going through all these ordeals. If only...
So how does one manage an allergy and avoid getting into the anaphylactic shock condition? I got few tips below.
If you know you have allergy and know the cause, the best medicine is prevention. Stay away from the cause of your allergy.
If you know that you have allergy but do not know the cause, like in my case, keep an over-the-counter antihistamine with you all the time. The moment you feel like an allergy attack is starting with just one or two rash spots, take the medicine immediately. Do not just shrug it off like I did. Take note of the dosage though. Most antihistamine dosage is only once a day. Do not overdose if you think the first one did not take effect. As all drug advertisement disclaimers say, "If symptoms persists, consult a doctor."
If your allergy attack has gone worse to multiple rashes and affected fairly wide area of your body (like that on my face on the photo above), over-the-counter medicines may no longer work. You may need the diphenhydramine shot. In this case, you have to see a doctor.
Know as much as possible the allergen reactors and avoid them when you already have allergy attack, at least in a week as the doctor has advised.
Be conscious of how your food is prepared. You may think that it does not have allergen reactors in the ingredients but it could have been prepared in tools or utensils that got in touch with allergen reactors.
Back to when you do not know the cause of your allergy, consult an allergologist or allergy specialist. This was what the doctor who prescribed me the Bilaxten has advised (which I have been trying to schedule for weeks but it is so hard to make appointment with an allergologist as there are only few of them).
Getting to know your existing illness and being conscious not to trigger or aggrevate it can save your life.
Stay healthy and happy!
Disclaimer: I am not a medical professional. Everything that I have written on this post is just my opinion and based on my personal experience. Nothing on this post should be taken as professional medical advice. If you think you have the symptoms of allergy, you should consult a medical professional.
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