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Anaphylaxis and Meniere's Disease

 

Over the last 8 years, it has become increasingly apparent that Meniere’s is not a disease. “Something” is irritating or putting pressure on your balance and or hearing nerve(s). What it is is unknown until start to you investigate.


The very same thing happens, but in a much more serious way when “something” invades your entire body (not just one localized area as in the inner ear). In this local area you have a balance nerve and a hearing nerve: one “set” for each ear. Your balance nerve “gives” symptoms ranging from lightheadedness and dizziness to drop attacks and anything in between. Your hearing nerve gives symptoms to do with a complete lack of hearing to horrible disabling noises…and, again, anything in between. It all depends on the intensity of the “intruder”. In each case, there has to be an intruder. So I always teach people to look for the underlying cause(s). There has to be one or more. Your body is continually trying to protect you. Always! Naturally! In the case of an anaphylactic reaction, the body is trying to protect you from a systemic invasion. In the inner ear, it is trying to protect you from a localized invader.


Let me give you an example. If you are allergic to peanuts, by trial and error you have learned to avoid them. You know your body’s protection will give you a huge reaction. (Anaphylaxis) In the inner ear, the very same reaction occurs. Your body is trying to protect you again, by letting you become aware of something not right in it. In this case, by giving you symptoms to get your attention. And once again, there is an underlying cause.


A healthy body isn’t nearly as impacted by this kind of invasion as an unhealthy one. Get healthy! Work WITH your body. Don’t shut down its defense mechanisms with anti-inflammatories and antihistamines. Repair it with a healthy lifestyle and it will keep you going for a long time…and know it’s never too late to educate yourself…and to apply this knowledge.


Anaphylaxis represents a “state of protection”. Essentially that means your body is protecting you against something that has just entered it. Something that will upset the wellbeing of your entire body. We are not talking about a little cut or a bruised elbow. This can be a life threatening situation.


Let’s explore what anaphylaxis is by looking at some a) definitions, b) possible causes, c) signs and symptoms (seeing how your body reacts naturally), and d) some treatment options. I will conclude with my thoughts about possible prevention. Please keep in mind we are exploring anaphylaxis: not allergies. I’ll also share a couple of my own experiences to illustrate the heart-racing situations. The more you know, the more helpful you can be, if the situation ever came up. Even just reading my experiences will help you be more practical. You will be amazed at your capabilities if you have the slightest idea how to help in an emergency! This kind of emergency truly is an emergency. So a tiny bit of insight can be of tremendous value. Please make sure you do NOT use this information for anything more than just a learning experience.


This is an extremely complex situation, so please don’t assume anything. But I want to simplify it to make it understandable. Hence do NOT use it for class presentations unless you can speak about it in your own words. I will add links to helpful sites. Do investigate this more if you read anything that might impact your family. I am also gearing this information more towards adults. Children have their own challenges. I am not a nurse who has ever specialized in pediatrics for any length of time. So what I will be discussing is meant for an adult: not an infant or child. Their bodies react differently and in most cases, much more quickly. Also their doses of emergency drugs will be different.


Before we can go further you need to understand some terms or phrases that are always related to anaphylaxis. In order for you to see the bigger picture, let’s define your immune system, an allergy, an allergic reaction, an allergen, an antigen, and an antibody. They all sound very similar, and that is why it’s so important to understand what each means. They all come into play with this “allergic” condition.


Your immune system is your body’s natural protection: it’s the overall defense mechanism. It reacts automatically and it reacts because it doesn’t like things that are not natural to it. It works “behind the scenes” all the time to keep you healthy. It allows certain things, but reacts to others, sometimes “irrationally”. If your body is healthy, it can withstand many more intruders than an unhealthy body. It’s strong enough to handle these intruders. It doesn’t like them because they could harm you in many ways, so it does its best to keep them out. The ones it can’t keep out, it reacts by trying to wash them out. That is the inflammatory process at work.


Compare your immune system to a complex alarm system with many sections in your home. It recognizes certain people and allows them the freedom of the house. It disallows other situations and sets off the alarm. But please realize that your body is much more complicated than your home alarm. This is a simplification for illustration purposes only.


An allergy is a frequent, recognized, tested or suspected condition in which a certain element (intruder) brings about a certain unwanted body reaction. An allergic reaction is the actual activity in which this allergy (condition) plays out. Your immune system is equipped to react to any intruders by bringing in processes (inflammatory process) and its own chemicals to overcome (render harmless) or neutralize them. The intruder is called an antigen and it is a foreign substance, often a protein. It may be a substance from the environment (such as chemicals, bacteria, viruses, or pollen) or formed within the body (such as bacterial toxins or tissue cells). So an allergic reaction is the result of an allergen entering your body. It is this reaction that tells you something isn’t right and needs to be checked out.


In another very simplistic explanation, the body realizes it will come up against this allergen frequently, so it creates guards to deal with the intruders, but only a specific guard per specific intruder. That guard is called an antibody. Thus the next time you encounter this allergen, there is already some defense mechanism (antibody) available. The body doesn’t have to work so hard to get rid of it. This is what allergy shots are based on. This is being desensitized: not being so strongly affected by things such as pollen or dust or hair dander. In essence it acclimatizes the intruder to the body. Each type of antibody is unique and defends the body against only one specific type of antigen.


For our purposes, the antigen and the allergen are both intruders which cause the body to activate its immune response. In the medical field, there is a difference. Histamines and antihistamines are chemicals that are very involved in this type of reaction. Histamine is released by the body as the allergen intrudes. As already mentioned the body tries to set up preventative measures. And this is often the release of histamine. But an antihistamine is a chemical that the medical community has produced to react to this reaction. Often the histamine itself might cause a problem, so it is “quietened” to reduce that effect. Without going into too much detail here, steroids are used to create this reaction. Essentially by giving this type of drug, you are preventing the body’s own defense mechanisms from doing their job. But this is all part of the medical model of treatment. Some examples of antihistamines are Benadryl and diphenhydramine; and corticosteroids, such as prednisone. These may be given to further reduce symptoms. If you are using these types of drugs, I would encourage you to have regular liver testing done. I would also suggest you find alternatives to their long-term use. You should do your own in-depth research. Link defining allergies
http://www.nlm.nih.gov/medlineplus/ency/article/000844.htm


The reason I want you to understand this whole process of reactions, is because while this is the body’s normal reaction to an intruder, sometimes it reacts very quickly and very seriously. That is called anaphylaxis. Sometimes, exposure to what is normally a harmless substance or intruder, such as pollen, causes the immune system to react as if the substance is very harmful. The body will shut down if the intruder isn’t given certain chemicals (drugs) to render this reaction harmless. You might think this is an overreaction of the body to an intruder, but as it presents such a strong and life-threatening reaction, it is crucial to recognize it. And recognize it quickly! This is all done automatically by your body.


Have you ever sought out medical help and been asked about “allergies”? It’s an automatic reaction with nurses, and I would imagine it’s the same with many other health care professionals. (I catch myself asking people this in a general conversation! It’s second nature to me.) Allergies are not a problem until you are exposed to the culprit, and your body has already determined it doesn’t want it in you. Then it sends a very clear message. “Get it out of here”! Often you aren’t even aware that something unusual or potentially harmful is brewing, until you can’t breathe and feel panicky!


People often already know their allergies. No health care provider would give them anything related to that allergy. I am sure you are aware of the problems some people have with sulfa drugs and penicillin. Many people wear bracelets announcing them and know all the antidotes to prevent further body damage by carrying certain drugs at all times such as Epi-kits.


What does an anaphylactic reaction “look like”? Here are the signs and symptoms. As nurses we are taught to pay attention to people from the time of an injection to about 15 to 20 minutes later. But the reaction can be slow in coming. Symptoms develop rapidly, often within seconds or minutes, but sometimes, they take up to four hours after the allergen has been introduced. Then it’s hard to recall what had gone before. Respiratory symptoms include difficulty breathing, wheezing, abnormal (high-pitched) breathing sounds, nasal congestion, and a cough. If you analyze those, you will recognize they are the outcome of fluid in the respiratory tract. And that area only wants air. So in essence, you would be drowning.


Circulatory symptoms include confusion, slurred speech, rapid or weak pulse, blueness of the skin (cyanosis), including the lips or nail beds, fainting, light-headedness, dizziness, anxiety, sensation of feeling the heart beat (palpitations). Here we are dealing with a lack of oxygen going to vital centers. And when you can’t have an adequate amount of blood with fresh oxygen (oxygenated) being exchanged for blood carrying unwanted carbon dioxide (a waste product), it will result in these symptoms. Integumentary (skin) symptoms include hives, generalized itching, skin redness. This is the histamines at work. Lastly, gastrointestinal symptoms include nausea, vomiting, diarrhea, and abdominal pain or cramping.
http://www.nlm.nih.gov/medlineplus/ency/imagepages/19316.htm


Essentially, anaphylaxis can cause a dangerous drop in blood pressure, and decrease blood flow in the body, especially to the brain, heart, and lungs. Symptoms occur within minutes to two hours after contact with the allergy-causing substance, but in rare instances may occur up to four hours later. Anaphylactic reactions can be mild to life-threatening. Near the end, I will mention another type of reaction that can be mistaken for an anaphylactic reaction. It is called a vasovagal reaction.


How does your body protect you? The immune system normally responds to harmful substances such as bacteria, viruses and toxins by producing symptoms such as runny nose and congestion, post-nasal drip and sore throat, and itchy ears and eyes. This is an inflammatory effort to wash away the toxins that have been created. An allergic reaction can produce the same symptoms in response to substances that are generally harmless, like dust, dander or pollen. The sensitive immune system produces antibodies to these allergens, which cause chemicals called histamines to be released into the bloodstream. These often cause itching, swelling of affected tissues, mucus production, hives, rashes, and other symptoms. Symptoms vary in severity from person to person, and from exposure to exposure.


What are common causes of anaphylaxis? What could “give” you an anaphylactic reaction?


Many, many people are affected by foods. If you have any allergies, get in the habit of reading all labels, all the time. Prepare your meals from “scratch”. Strict avoidance of the allergen is necessary to avoid a severe reaction. Ask questions about ingredients and preparation methods when eating out. The Food Allergy & Anaphylaxis Network
http://www.foodallergy.org/anaphylaxis.html


If you have any allergies: real or suspected, make a note of them. Anaphylactic reactions to medication will typically occur within an hour after taking the drug, However reactions may occur several hours later. It is estimated that up to 10 percent of the population may be at risk for allergic reactions to medications.


Please note, according to literature from The American Academy of Allergy, Asthma & Immunology, "The chances of developing an allergic reaction may be increased if the drug is given frequently, in large doses, or by injection rather than by pill. The most important factor may be an inherited genetic tendency of the immune system to develop allergies. Contrary to popular myth, however, a family history of allergy to a specific drug does not mean that a patient has an increased chance of reacting to the same drug." Please read and understand the information in the insert that comes along from your pharmacist. Do you have any sinus problems? Could they be a result of an allergic reaction to a drug you are now taking? Ever thought of that before?
http://www.aaaai.org/patients/publicedmat/tips/recurrentinfections.stm


Other possible causes for an anaphylactic reaction or episode can be insect stings in which the chemicals are the problem. (Wasps are nasty.) Latex in “plastic” or rubber items, dust mites, molds, and animal dander are also common causes of allergic reactions. We ignore many signs our body shares with us because it is more convenient to do that: this could be a serious mistake.


Treatment! This is every health care professional’s nightmare! This is why we ask so many questions. Anaphylaxis is an emergency condition requiring immediate medical attention. And if you are getting your flu shot in the local grocery store, help might be minutes away. You may feel “put upon” by the nurse refusing to give you a flu shot or a hepatitis inoculation, but in their professional assessment, you might be a poor candidate. They have to weigh the consequences very quickly. Don’t argue. This decision is made with your best interest in mind. I am always amazed as to how nonchalant people are in signing up for flu shots. This is an invasive procedure and you may have an allergy to some of the ingredients: yet you feel inconvenienced when I, as the nurse, brings this to your attention. Nothing you put into your body is without risk. I don’t see the humor in administering adrenalin on the grocery floor waiting for an ambulance. Please be very open discussing your potential allergies when asked. I get nervous when parents say no to allergies for their young children in order to have a flu shot and the child is looking at the parent. They know. I digress.


Pretend you are alone at home and you suspect someone is having an anaphylactic reaction. Your regular physical assessment must include the airway, breathing, and circulation. And don’t they all stem from the suspected anaphylactic reactions? If you recall, the signs and symptoms: they match these areas to be checked. (ABC: airway, breathing, circulation) If needed, CPR would be initiated. Call 911. Have someone stay with the person in case more help is needed. A health professional will give an Epinephrine injection immediately. This opens the airways and raises the blood pressure by constricting blood vessels. Many people with known severe allergic reactions may carry an Epi-Pen or other allergy kit. Please offer to stay with them if you know they are having problem. (You have no idea how much moral support is appreciated!). In rare cases, emergency interventions by paramedics or physicians may include placing a tube through the nose or mouth into the airway (windpipe). This is known as an endotracheal intubation. Sometimes emergency surgery to open a space directly into the trachea and to place a breathing tube may have to be done. This will be done in an Emergency Room. The usual treatment for shock including intravenous fluids and medications to support the heart and circulatory system will automatically be started. A common translation for anaphylactic shock is “bloodless shock”. The body reacts to any shock when it presents itself.


When I was a very green nurse, I was called to a neighbour’s home. Her children couldn’t wake her up. In front of her on the table lay several pill bottles and a few pills. I called her doctor (…this was before 911 was available). He called the ambulance and then rushed over from his office. All arrived at the same time, and recognized her as a chronic alcoholic on many meds. They couldn’t wake her either. It’s hard to distinguish when someone is having trouble breathing. We had her on the floor by the time everyone arrived and her breathing was already better. But everyone felt she was in a serious enough a condition to need further hospitalization. Don’t take any chances! I want to share another story. A few years ago, one of my associates in our hospital was stung by a wasp. Her sister rushed her to a local doctor’s office. He was a brand new grad and had his new “bag” close by. It contained one vial of adrenalin! (Epinephrine) By this time she was already loosing consciousness. They got her to the hospital five minutes away. There they worked on her for the next six hours. Being “one of us” as a staff member made the situation a bit eerie. She then went to ICU overnight and was released the next day. She was very lucky to be alive! This happens very fast and it needs to be recognized for the emergency it is.


A vasovagal reaction is sometimes confused or mistaken for an anaphylactic reaction. Again, nurses are trained to recognize the difference. And again, it takes practice and speed to do this. Basically it is a reaction to the procedure rather than the chemical “stirring up” of the ingredients of the “intruder” I am sure you have heard of people fainting at the sight of needles or blood. Some faint when the needle is actually put into their body. It happens within the first few minutes after the injection. Although this too is an unwanted reaction, it is much more “welcome” by a health care provider than an anaphylactic reaction. In giving flu shots, nurses experience this one more frequently and deal with it in a much more “relaxed” manner. I recall a very busy evening flu clinic in a huge warehouse. There was a lot of goofiness going on and no one was really being serious about the injections. Suddenly I heard loud crash. “My last injection” had passed out and was caught between two chairs. He was very large. It took some maneuvering to get him on to the floor. (I always make my patients sit down for the injection and for a couple of minutes after it.) We ended the evening in a very subdued manner. One more short story. If you instinctively know you don’t want this injection, don’t have it. I had a grandfather who passed out three times in ten minutes (from one injection!). His granddaughter had challenged him to a flu shot! He didn’t want to tell her that while in the army, he passed out each time he was given an injection. Eventually they gave him only when he lay down! He didn’t want her to find out he was a sissy! Pride goeth before a fall, and in this case, three falls. Use some common sense.


What is the difference between these situations? In a vasovagal reaction, the person looses momentary consciousness, or just feels very faint (lightheaded). Their pulse is weak and they are often cool to the touch. Here is a good site to learn more.
http://www.hrspatients.org/patients/signs_symptoms/fainting/default.asp


We put cool, moist cloths on people’s foreheads or the back of their necks. We get them to take deep breaths. This usually lasts a few minutes and the person is fine. Always, the nurse will take a respiration, pulse, and blood pressure reading. These are excellent indicators of their state of health at that moment.


While this is not a life-threatening moment, this condition is NOT something to be ignored. I find many people gloss over this. I feel very strongly that something is causing this reaction. It just doesn’t happen for no reason. High blood pressure (hypertension) is well addressed by the medical community. I feel that low blood pressure (hypotension) is equally important yet mostly ignored. Treatment for this is usually not as dramatic as calling 911, but I feel the person should not drive themselves home. They also need to be more aware of this reaction and investigate its possible underlying cause, and get treatment. Drugs and other chemicals may be the cause. If blood doesn’t circulate to the brain, and subsequently, to the lungs, isn’t that reason for alarm? I think so. Don’t ignore this condition. Make sure it is written into your health record.


Once you have received treatment for an anaphylactic reaction and have been looked after for a minimum of six hours within reach of medical help, you must do some reviews. You have to find out what caused the episode. It may happen again, with less favorable consequences. Don’t play silly games with yourself and ignore this.


Can you prevent anaphylaxis? First ask yourself why does your body want to protect you? That is its nature and it will go to amazing lengths to accomplish it. If you look after your body, it will look after you. Good partnership. How do you look after it? BY not bombarding it with all sorts of chemicals, be they prescribed and or recreation drugs, cigarettes, drugs, additives in foods, diet products, etc. The list is long and you have been exposed to it for quite a while now. But the warnings are very real and true. The more chemicals you take in, the more possible chances you have to be “mismatched” and have a reaction. Pray that it is not an anaphylactic one. They are scary for all concerned. The only way to rebuild your body’s defenses is through nutrition: not drugs or chemicals. It all points to the immune system. Is yours overworked and undernourished? Would it not make sense to strengthen it as much as possible? How do you know it’s not strong? By having these reactions when most people do not. Incidentally, this might be a good time for you to renew and upgrade your CPR certificate. A little knowledge can increase your confidence immeasurably.

 

By Karin Henderson - Nurse, Retired.

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