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
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
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
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.
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
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?
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
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
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.
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
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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