Anaphylactic Shock: A life-threatening reaction

‘A dream family vacation in island paradise Caramoan turned into a nightmare for the Trimarchi family after their seven-year-old daughter died from a jellyfish sting during an island-hopping tour,” the ABS-CBN web site reported.

The travel time from Sabitang Laya Island, where the incident happened, to the main Caramoan beach was about 30 minutes by boat.   It took another 10-minute tricycle ride before the child was taken from the beach to the hospital.

The little girl Gaia, who was described as “a gold medalist in swimming competitions in Italy,” was declared dead on arrival at the Caramoan Municipal Hospital due to serious allergic reaction.

“Her pupils were dilated, her vital signs were gone,” Dr. Minerva Aguirre, one of the hospital’s attending physicians, was quoted as saying by ABS-CBN News.

Jellyfish stings are relatively common problems for people swimming, wading or diving in seawaters. The long tentacles trailing from the jellyfish body can inject a person with venom from thousands of microscopic barbed stingers.

“Jellyfish tentacles contain microscopic barbed stingers,” the Mayo Clinic explains. “Each stinger has a tiny bulb that holds venom and a coiled, sharp-tipped tube. The jellyfish uses the venom to protect itself and kill prey.

“When you brush against a tentacle, tiny triggers on its surface release the stingers. The tube penetrates the skin and releases venom. It affects the immediate area of contact and may enter the bloodstream.”

According to the Mayo Clinic, jellyfish stings vary greatly in severity. “Most often they result in immediate pain and red, irritated marks on the skin. Some jellyfish stings may cause more whole-body [systemic] illness. And in rare cases jellyfish stings are life-threatening,” it says.

The sting can be life-threatening if it causes anaphylaxis.  The term comes from two Greek words: ana (against) and phylaxis (protection). Dr. Charles Richet coined the word in 1902 and 11 years later, he won the Nobel Prize in Medicine and Physiology for his work on anaphylaxis.

In his Nobel lecture, he explained: “Phylaxis, a word seldom used, stands in the Greek for protection.  Anaphylaxis will thus stand for the opposite. Anaphylaxis, from its Greek etymological source, therefore means that state of an organism in which it is rendered hypersensitive, instead of being protected.”

“Anaphylaxis is an acute life-threatening episode that requires immediate medical attention,” says Dr. Manmohan Yadav, a consultant allergist at Pantai Medical Center in Kuala Lumpur and author of Cause and Prevention of Allergy and Asthma.

Anaphylaxis can occur in response to almost any foreign substance.  Common triggers include venom from insect bites or stings (from bees and wasps), foods and medication.  Foods are the most common trigger in children and young adults while medications and insect bites and stings are more common in older adults.

Common triggering foods include peanuts, wheat, shellfish, fish, milk and eggs.  The most common medication that may trigger anaphylaxis are antibiotics (such as penicillin), aspirin and non-steroidal anti-inflammatory drugs (NSAIDs).

Less common causes of anaphylaxis include: physical factors, biological agents, such as semen, latex, hormonal changes; food additives, such as monosodium glutamate and food colors; and topical medications.  Physical factors such as exercise (known as exercise-induced anaphylaxis) or temperature (either hot or cold) may also act as triggers through their direct effects on mast cells.

People with atopic diseases, such as asthma, eczema or allergic rhinitis are at high risk of anaphylaxis from food, latex and radiocontrast but not injectable medications or stings.  One study in children found that 60 percent had a history of previous atopic diseases, and of those who die from anaphylaxis more than 90 percent have asthma.

“Like other allergic reactions, an anaphylactic reaction does not usually occur after the first exposure to an allergen but may occur after a subsequent exposure,” explains The Merck Manual of Medical Information.  “However, many people do not recall a first exposure.”

“It’s easier to identify anaphylactic shock if there is a known allergen,” writes Dr. John Krohmer in First Aid Manual.  “For instance, those with allergies to bee stings will usually know they’ve been stung. Sometimes, however, there is no known allergen and the victim is simply developing symptoms of anaphylaxis.”

According to the Merck manual, anaphylactic reactions begin within one to 15 minutes of exposure to the allergen.  “Rarely, reactions begin after one hour,” the manual points out.  “The heart beats quickly.  The person may feel uneasy and become agitated.  Blood pressure may fall, causing fainting.”

Other symptoms include tingling (pins-and-needles) sensations, throbbing in the ears, coughing, sneezing, hives and swelling.  Breathing may become difficult and wheezing may occur because the windpipe (upper airway) constricts or becomes swollen.

“An anaphylactic reaction may progress so rapidly that it leads to collapse, cessation of breathing, seizures and loss of consciousness within one to two hours,” the Merck manual states.  “The reaction may be fatal unless emergency treatment is given immediately.”

A medical emergency, anaphylaxis requires resuscitation measures such as airway management, supplemental oxygen, large volumes of intravenous fluids, and close monitoring. Administration of epinephrine is the treatment of choice with antihistamines and steroids often used as adjuncts.  A period of in-hospital observation for between two and 24 hours is recommended for people once they have returned to normal due to concerns of biphasic anaphylaxis.

People prone to anaphylaxis are advised to have an “allergy action plan,” and parents are advised to inform schools of their children’s allergies and what to do in case of an anaphylactic emergency.  The action plan usually includes use of epinephrine auto-injectors, the recommendation to wear a medical alert bracelet and counseling on avoidance of triggers.

What would you do if someone suffers from anaphylaxis?  First, call any of the emergency medical services in your area.  Then, ask the victim if he has an injector kit he can use.  If the victim is unconscious, you’re certain it’s an allergic reaction, and if you are trained to use the EpiPen, do so.

While waiting for the emergency response team, monitor the victim.  If needed, proceed with cardiopulmonary resuscitation (CPR).  CPR, the cornerstone of emergency medicine, is putting oxygen into the victim’s lungs by performing rescue breathing, and circulate it through the body by doing chest compressions.

“By recognizing both the early symptoms of anaphylactic shock, and the later, more dramatic symptoms, such as respiratory distress and unconsciousness, you may be able to summon emergency help for yourself, someone you love or even a perfect stranger,” the e-How Health contends.

Image Credits: WIKIPEDIA, Henrylito D. Tacio

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