October 22, 2013

Treatment of Anaphylaxis/Immunotherapy Reactions

Avalanche Management
Well, now I know what "for treatment" means. Two weeks ago I was supposed to have turned the car around and gone back 'for treatment." Today, when I really wanted a lozenge shortly after my triple-venom shots, I was taken to the back "for treatment."

Treatment involves an injection into the thigh of adrenalin (Epinephrine) to constrict your veins and halt the allergic reaction while keeping your airways open. The reaction is an inflammatory response, so they also give you a steroid. Then they administer antihistamines to control the histamine symptoms, in my case a drippy nose, phlegmy throat and bloodshot eyes. Tagamet is an H2 receptor blocker while Zyrtec (and the Claritin I took before heading to get my venom shots) is an H1 receptor blocker. They like to cover all bases, because some histamines will affect your ability to breathe and others will affect your heart, or stomach or….

This all takes a couple of hours. They have to continually monitor your vitals. The adrenalin will at first cause a fast heart rate and a spike in blood pressure. A nurse will check your vitals every 30 minutes or so, looking for an abating of symptoms with leveling out of blood pressure and heart rate. If your symptom are abating but your vitals don't correspond, then something is wrong. (That was the case when I was at the UC in April. The bloodshot eyes and hives had improved but my pulse was still high.) When I was deemed stable, I was released. And again, I'm not allowed any more venom shots until the doctor reviews my case.

Colorado Allergy and Asthma Centers definitely handles systemic reactions a little differently than Rocky Mountain Urgent Care. The latter didn't send me home with any pills like I got today. The white one is Zyrtec but the others, I'm not sure which is which. The Tagamet I was given at Urgent Care was green. The third pill is Prednisone. I do know what they're for, though. It's the same drill: an H1 antihistamine, an H2 antihistamine, and a steroid, to prevent late-phase anaphylaxis.

Have you ever seen footage of an avalanche? Did you notice the little snowballs and layer of fluff that wafts down the mountain before the whole shelf just lets loose? The doses help to manage the snowballs and fluff, to prevent an avalanche – Late-Phase Anaphylaxis – and keep you out of the ER.

Keep in mind that many avalanches start under the surface, and entire mountainsides of snow let loose without any indicators. Anaphylaxis is no different. For some reason I thought to myself, "a little wheeze is okay" and that I should watch for signs of increase. But that's the wrong way to think; anaphylaxis is not like a snowball that grows. Like an avalanche, it can just let loose in the blink of an eye.


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