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Shock horror: Anaphylaxis

Plenty of other things could have killed me over the years: stress, high blood pressure, liver disease due to heavy drinking, injuries sustained in misjudged pub fights due to heavy drinking, my wife garnishing my food with shards of glass due to my heavy drinking. But not this – surely I couldn’t be dying from an allergic reaction?

Bar hay fever, I had never shown intolerance towards any-thing. In fact, I had always had a slight disdain for people who said they were allergic to wheat or milk or peanuts or shellfish. Yet here I was in A&E, with a nurse massaging my thigh, preparing it for a shot of adrenalin two hours after I had been eating cockles. I had a steroid drip in one arm and an oxygen mask on.

“This may hurt a little.”

“Uhthonemine,” I said, meaning I don’t mind. Speaking properly had become a problem: my tongue was several times its usual size and my lips had taken over my face, which was decorated in an exotic-looking rash. It took immense concentration and will to swallow.

Adrenalin and steroids – and, indeed, doctors – are wonderful things, and after seven hours under observation I had recovered sufficiently to be released. But the diagnosis from the on-duty doctor was chilling: I had experienced anaphylactic shock, an acute severe reaction to an allergen, and if I had delayed coming to the hospital, it could well have killed me.

There are around 10 deaths a year in which anaphylaxis is cited as a contributing cause. Worryingly, this rate has doubled in the last two years. The most well-known food cause is peanuts, though others include eggs, milk and shellfish. And it isn’t just food: latex, insect stings and certain drugs can all provoke a reaction. “In a recent incident,” Vicky Fields from the Anaphylaxis Campaign told me, “one of our members was walking down a supermarket aisle and reacted severely to rubber car mats on display.”

In my case, the culprit remained in the shadows. I had just finished a course of penicillin, so perhaps I had reacted to that. The cockles I had eaten an hour or so before could have been the cause, but I ate them regularly and with impunity, so perhaps not. Perhaps it was a combination of the two, although it is possible to develop an allergy towards a substance that one had previously been immune to. “Theoretically, anything could be the cause,” were the doctor’s parting words.

The information I received from the on-duty doctor and, later, my GP was understandably vague, but instinct told me it would be wise to avoid shellfish and penicillin. I had steroids to calm any rashes and was prescribed two EpiPens (self-administered adrenalin shots) in case I experienced another life-threatening reaction.

The adrenalin is supposed to allow you 15 to 20 minutes to get to hospital. Without it, it is possible to die within a few minutes. Naturally, after my release I forgot to take my EpiPens when I went out. I tended to come out in a rash every time I took a brisk walk, but it would vanish an hour or so after wolfing down a handful of steroids. After a week, I had pretty much let slip from my mind that I had anaphylaxis. I was fond of shellfish, but it wasn’t going to impact dramatically on my life if I had to avoid it. So, too, penicillin; in the back of my mind was the thought that I would get ill again and it may be a slight problem finding a suitable antibiotic, but, again, it didn’t cause me too much concern.

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Then I had another severe reaction. At the dog end of a long, hot bath, I felt my lips begin to tingle and felt – well, just odd. I got out of the bath and looked in the mirror. A ghoul stared back: I looked massively unwell, my eyes were sunken, my lips had ballooned, I had an alarming number of hives on my forehead, hands and feet, on top of the now-standard all-over rash. I needed to cool down and splashed water over my face and neck, but quickly realised I was on the verge of collapse. As soon as I lay down, I felt the need to cool off again and stumbled back to the bathroom. This zigzagging continued for 10 minutes, and then I started to panic. I became incredibly, unusually scared, as if something very terrible was going to happen. This sense of doom, I discovered, is not uncommon when having a reaction. I asked my wife to call an ambulance, because I felt like I was about to pass out and couldn’t remember at what point to use my EpiPen.

As long as my breathing wasn’t too laboured, my wife was told, there was no need to go into hospital or inject myself with adrenalin. My blood pressure had dropped, so I just had to lie down and take it, my thoughts alternating between the pedestrian and the chaotic. All night, my body felt foreign, as if made up entirely of right angles. It took two days for the hives and my lips to reduce this time.

More than anything, this second episode was frustrating. If I could be allergic to a bath, surely I could be allergic to anything? “These reactions,” my GP told me, “could have no obvious trigger.” Splendid. So it’s not necessarily shellfish? “Not necessarily; you could try a prawn, but have your EpiPen handy.” Double splendid.

Severe allergy is thought to affect more than 1 million people in Britain. Studies show that allergies as a whole are increasing, so it follows that extreme reactions will rise also. No one knows why, although one theory is the hygiene hypothesis – essentially, better hygiene, and the use of vaccines and antibiotics do not allow our immune systems to develop properly. Consequently, they end up attacking other, harmless things, such as proteins in food. “To put it in very simple terms,” says Jonathan Brostoff, professor of allergy and environmental health at King’s College, “it could be that we are becoming too clean.”

Or it may be because we are being exposed to substances that are relatively new to us. Sesame has become a familiar food item in the UK only recently (in hummus, say, or oriental cooking), and as such sesame allergy is increasing. The increase in latex allergy, too, appears to be related to an increase in contact: a Royal College of Physicians report says that 8 per cent of health workers have an allergy to latex rubber.

Yet allergy services in the UK are desperately stretched or, in some places, non-existent. Vicky Fields says research is the obvious way forward. “Our guess is that anaphylaxis will be the last to be solved as it is at the most severe end. The Government needs to pay attention to the lack of allergy centres and expertise in the area. The rise in NHS services has certainly not kept pace with the rise in allergies.”

Despite a six-week wait, I managed to get an appointment with a specialist, to see if the underlying cause for my anaphylaxis could be found. It couldn’t. A pinprick test, where solutions of different fish and shellfish were placed on the skin, showed no reaction. The specialist told me it could be a combination of food and exercise, that the penicillin had primed my immune system to react in unusual ways to foreign bodies, or that there is – and I was expecting this – “perhaps no discernable cause”.

I am still waiting for the results of a blood test for a shellfish or penicillin allergy. In the meantime, it is a case of being more aware of what I am putting into my body, keeping vigorous exercise to a minimum and having character-building cold baths. Minor changes aside, I am determined not to let it impinge on my quality of life, because although my dinner may not be, I like to think the world is still my oyster.

This entry was posted on Tuesday, July 17th, 2007 at 7:10 pm and is filed under Flonase Top News. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.