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  • Anaphylaxis

    The most explosive, immediate, and obvious reactions are mediated by basophil and mast cell degranulation. Anaphylaxis is a whole-body emergency involving multiple systems. The triggers are food proteins, drugs that attach to proteins inside the body, bee or wasp stings and occasionally other allergens. Histamine is the first mediator released by mast cells, often in massive amounts. The largest concentrations of mast cells are in the skin, lungs, and the gastrointestinal tract.

    Lieberman' estimated the incidence of anaphylaxis in the United States, based on episodes of food, drug, latex, and stinging insect hypersensitivity. He suggested that between 1.24% and 16.8% of the US population is at risk of anaphylaxis. Approximately 0.002% of these are at risk for a fatal reaction. The foods most commonly associated with anaphylaxis are cow's milk, eggs, wheat, shrimp, fish, peanuts and other nuts.

    The drugs that trigger anaphylaxis include penicillin, aspirin, anti-arthritic drugs, morphine, radio contrast dyes, and anesthetics. Insect bites especially wasp and bee stings do cause fatal anaphylaxis. A physician died, for example, on the golf course 20 minutes after a wasp bit him on the nose. He had an old epipen injector (adrenalin) in his golf bag, but the injection did not save him. The risk of life-threatening anaphylactic reactions to insect stings increases with age. Adrenalin supplies should be fresh and a second dose is often required.

    An anaphylactic attack may begin with hives, shortness of breath, wheezing and a feeling of impending doom. The major features are bronchoconstriction, edema, with increased capillary permeability and rapid movement of water from blood to tissue spaces leading to hypovolemic shock. Symptoms include angioedema, asthma, urticaria, flushing, pruritus, rhinorrhea, tachycardia, hypotension, vomiting, diarrhea and abdominal pain. A woman in her late 20's described the following anaphylactic reaction: "My teeth started tingling and the inside of my throat was itchy...my palms got red and swollen. I felt light-headed and agitated. My heart started to race...by the time I got to the emergency my entire body had broken out in a rash and my feet were so swollen my boots wouldn't come off. But things got worse as soon as I walked in...I couldn't breathe and I began to panic. I felt I was going to die. The doctor in charge was very short with me. He told me to get a hold of myself, that I was just making things worse, but I was out of control. I was terrified and wanted to pass out but couldn't."

    By-standers and even physicians may not appreciate the gravity of the allergic crisis. Immediate treatment with injected adrenalin, antihistamine, steroids and life support may be necessary to rescue the anaphylaxis victim. The second, late phase of anaphylaxis can develop into a prolonged illness if left untreated. The initial immune response recruits other immune responses. Anaphylaxis is unpredictable and is probably not caused by a single mechanism. Lethal events include:

    1. tongue and throat swelling, obstructing the upper airway

    2. severe asthma and/or lung swelling with failure of respiration

    3. shock – water moves from blood into tissue spaces

    4. heart rhythm abnormalities and cardiac arrest

    Sudden death occurs rarely and randomly as a tragic consequence of eating a reactive food, often in a restaurant. The actual trigger for anaphylaxis is seldom known with any certainty, although often a single agent such as traces of peanut oil in a salad or dessert may be blamed, usually with no proof. Previous occurrences of severe asthma attacks, whole-body hives, local swelling reactions of the tongue, throat, and face; general swelling of the extremities and sudden onset of breathing difficulty suggest increased risk of life-threatening anaphylaxis. Sampson et al reported on 13 children and adolescents with fatal and near-fatal food anaphylaxis. All 13 had asthma with previous serious reactions to food - peanuts (4), nuts (6), cow’s milk (2), and egg (1). The six patients who died had itching or tingling in the mouth, tightness of the throat, irritability, abdominal pain or vomiting within 3 to 30 minutes of eating the food. None of the fatalities had self-injected epinephrine. All of the survivors received epinephrine within 30 minutes of the onset of symptoms. Anaphylaxis was rapidly progressive and uniphasic in 7 patients and biphasic in 3 who had early oral and abdominal symptoms followed by a 1-2 hour remission, followed by increasing respiratory symptoms, hypotension, and death. Three children who survived had a protracted course requiring ventilatory support and treatment with vasopressors for 3 to 21 days after the onset. This report emphasizes the potential severity of food reactions and the importance of prompt administration of epinephrine.

    Anaphylaxis can be triggered by exertion after eating certain foods and may be responsible for sudden deaths in healthy athletes as well as people with known asthma and food allergy who exercise with unaccustomed vigor. Allergy patients are cautioned to exercise in gradually graded increments, watch food intake before athletic events, and avoid sudden, unaccustomed exertion. In one patient wheat was the sensitizing food, and anaphylaxis began with exertion 40 minutes following ingestion. The patient, a 42 year-old man, developed generalized urticaria and loss of consciousness playing tennis following a meal of wheat bread and tea. His symptoms were reproduced and studied. His reactive pattern began with itching during exertion, followed by hand swelling, and generalized redness, and then hives broke out. He experienced drowsiness and shortness of breath. Within minutes he would lose consciousness. Studies of this pattern of reactivity showed elevated blood levels of histamine and an increase in blood acidity. The oral intake of sodium bicarbonate (3.0 grams) taken before exertion was successful in blocking this severe reactivity. Another case-report described wheat allergy as a trigger for exercise-induce anaphylaxis in an 18 year old girl; one hour after lunch she exercised and developed urticaria, abdominal pain, diarrhea and dyspnea. Two further episodes occasioned a challenged study which confirmed the wheat reactivity and showed that sodium cromoglycate blocked the reaction.

    ( Neugut AI, Ghatak AT, Miller RL. Anaphylaxis in the United States: an investigation into its epidemiology. Arch Intern Med. 001;161:15-21)


    • Discussions of Environmental Science and Human Ecology were developed by Environmed Research Inc. Sechelt, B.C. Canada. Online Topics were developed from two books,

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      Air and Breathing helps you understand breathing, respiratory diseases, air quality issues, airborne infections and other causes of breathing disorders. You will find detailed information about the respiratory tract, atmosphere, air pollution, airborne infection, air quality allergy, lung diseases and airborne hazards at home.

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      In the book, The Environment, you will find detailed information about the weather, climate change, soils, forests, energy sources, oceans, the atmosphere, air pollution, climate change, air quality and the politics of the environment. The Environment is available as a Printed book or as an eBook Edition for download.

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      The Author Stephen J. Gislason MD

      Food Causes

      Not all respiratory diseases are caused by airborne pathogens. If asthma, bronchitis and/or nose sinus congestion is chronic or attacks occur frequently in all seasons and are not related to airborne exposure, then consider delayed pattern food allergy as the cause and do diet revision using the Alpha Nutrition Program.

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      • Discussions of Environmental Science and Human Ecology were developed by Environmed Research Inc. Sechelt, B.C. Canada. Online Topics were developed from two books,
        Air and Breathing and The Environment.

      • Air and Breathing helps you understand breathing, respiratory diseases, air quality issues, airborne infections and other causes of breathing disorders. You will find detailed information about the respiratory tract, atmosphere, air pollution, airborne infection, air quality allergy, lung diseases and airborne hazards at home.
        2018 edition 106 pages.
        Air and Breathing eBook Edition for Download.

        The Environment

        In the book, The Environment, you will find detailed information about the weather, climate change, soils, forests, energy sources, oceans, the atmosphere, air pollution, climate change, air quality and the politics of the environment. The Environment is available as a Printed book or as an eBook Edition for download.

          Download The Environment as an eBook

        The Author Stephen J. Gislason MD

        Food Causes

        Not all respiratory diseases are caused by airborne pathogens. If asthma, bronchitis and/or nose sinus congestion is chronic or attacks occur frequently in all seasons and are not related to airborne exposure, then consider delayed pattern food allergy as the cause and do diet revision using the Alpha Nutrition Program.

        Alpha Education Book Orders

        Click Add to Cart buttons to begin an order for mail delivery (US and Canada). All books can be downloaded as PDF files. Click the Download buttons to order eBooks for download. Pay by Pay Pal for immediate download. Click the book titles (center column) to read topics from each book.

        Print Books Read Topics Download
        Alpha Nutrition Program
        Aching and Fatigue
        Air and Breathing
          Alpha Nutrition Cooking
        Alcohol Problems 
        Gluten Problems 
        Managing Diabetes 2
          Eating and Weight
        Skin Disease
        Feeding Children
          Human Brain
        Food Allergy
        Digestive Disorders
          Food Choices
        Heart & Arterial Disease
          Immunology Notes
        Inflammatory Arthritis
        Nutrition Notes

        Google Search Alpha Online

         
        Alpha Online

        alpha online

        Alpha Online is a Web Site developed by Environmed Research Inc. Sechelt, B.C., Canada. Online Since 1995. Orders for printed books, eBooks and nutrient formulas are placed at Alpha Online. Alpha Nutrition is a registered trademark of Environmed Research Inc.