Why You Need to Know More Than An ER Doc

This post was inspired by a conversation with some great people who work for an amazing allergy-related social profit organization Canada. At one point, we discussed the misconceptions and misinformation that even some medical professionals have about anaphylaxis. I've certainly been told some odd and incorrect things by people with an M.D. after their names:

1. If you administer your auto-injector, you don't need to go to the ER. FALSE! It's not magic. It just buys you time. Many people need additional medications, including more epinephrine. You are literally risking your life if you don't call an ambulance and head to the hospital.
2. Vomit the food back up and you'll be fine. VERY FALSE! If your throat is closing up, you risk choking or aspirating on your own vomit, making the situation even worse.
3. The third issue was that a paediatric doctor I know didn't know how to use an injector in practice and so injected it and let go immediately. While any amount of epinephrine is better than none, hold down that auto-injector for up to 10 seconds. The pressure also helps prevent silly amounts of bleeding.

So, that discussion led to my quick grievance about the lack of an anaphylaxis protocol in ERs. I have mentioned this before and firmly believe that anyone at risk of anaphylaxis should come up with an ER plan in conjunction with their immunologist or allergist. That plan should be communicated to friends and family in case the person is not able to communicate. Put it on paper and keep it in your allergy kit.

The reason behind this is because ER doctors have done everything from give me salbutomol and nothing else (my asthma does not act up during an anaphylactic attack) to giving me a diphenhydramine drip and then discharging me after two hours even though I was still symptomatic. The recommended minimum is four hours and there was no mention of taking diphenhydramine or watching for secondary reactions for 24-72 hours. One doctor rudely asked me what I wanted him to do while my throat was closing up and no medication had been administered by ER staff. I show no external signs of anaphylaxis; so, this may explain some of the oddities I've experienced, but there's definitely no good excuse.

Despite all of that, I do not blame ER doctors. They're unfathomably busy and have to deal with such a myriad of conditions and patients. Mistakes happen, but not because doctors are reckless or don't care. They happen because they may not have enough specific training (consider the likelihood of knowing every disease and its treatment in the world. Gregory House M.D. is fictionally crazy after all.) or because areas like ERs and ORs involve a lot of people, responsibilities, stress and various, ever-changing situations. If a doctor has a patient crashing in one room, the girl whose face isn't swollen and looks just fine will not seem like a priority, even if she should be triaged as though she is.

Specific steps need to be taken upon admittance and post-care. Doctors also need to realize that anaphylaxis does not look the same in everyone. Even the same patient can react differently at different times. Just as there are now checklists for ORs to ensure that protocols exist and are followed (developed by WHO), I would like to see protocols developed for the ER. This takes a lot of the guesswork away from already busy individuals who should be the poster adults for multi-tasking. Where there is uncertainty, there are errors. Too many people died from asthma attacks in Ontario before proper triage and treatment protocols were developed. So, let's take away the uncertainty.

I will not delve into my opinions of what that protocol should look like, because I am not a medical professional. However, should this post be read by some hospital administrator somewhere, please make a plan. If I know what it should like, your staff can draft it pretty quickly. If you have anaphylaxis or care for someone who has it, make a plan with your immunologist. I'd like to say you can trust an ER doctor with this, but it's just not a certainty.

Lessons to Learn from Anaphylaxis Deaths

Every time I hear about another death from food allergies, I am horrified, sad and take it as another reminder to be vigilant. I just read an article about Diallo Robbins-Brinson who passed away in Atlanta this past Monday. My intent here is not to be critical. My intent is to point out what must be learned from this.

Allergies are not a fixed thing. Personally, my food allergies developed over almost a decade and within that time, some came and went a few times. Even now, in my 30s, I have some that may have disappeared and I'm careful to eat a variety of foods and never become dependant on one thing should I develop another allergy. I also know a handful of people who developed allergies in their 20s and they had no history of allergies, personal or familial. If you are allergic to anything, you unfortunately must assume that you can develop other allergies.

The other point is that in the article, it stated that according to his mother, Robbins-Brinson was "so accustomed to avoiding peanuts, Diallo no longer carried an Epi-Pen". It's pretty obvious why this horrifies me. Sorry to use that word twice, but that's what it is - horror. I am very accustomed to avoiding eggs, dairy, certain nuts and shellfish, but under no circumstances would I not carry two EpiPens with me. If I didn't have my EpiPen (I always have my EpiPen), I wouldn't eat.

Complacency and comfort are things allergic people can never afford to be. Not ever. We can never get accustomed to being safe. We're just not. We can live our lives normally and be positive and optimistic (and we should be), but no matter what, we have to be critical and be prepared for the worst.

Once again, I am not criticizing the family at all. This was an undiagnosed allergy and I can certainly understand why Robbins-Brinson did everything the way he did. I've written before about how I can feel "too safe" when I'm staying with friends and family.

What I am saying is that parents and caregivers should have frank discussions with their child's/teen's immunologist and their child/teen. For adults, being older doesn't mean you're wiser and it certainly doesn't mean you can stop an anaphylactic attack. If any doctors are reading this, you need to be a lot more frank with your patients. A little bit of fear is not a bad thing if it makes someone carry an EpiPen or wear a MedicAlert bracelet. I'll admit that a horror story about a freshman who was force-fed eggs during university initiation and suffered severe anaphylaxis was what it took for me to become so vigilant about my own health years ago.

I would love to see an awareness campaign about always carrying epinephrine auto-injectors developed by a social profit allergy organization and funded by the makers of epinephrine auto-injectors. It worked for seatbealts.

So, please learn the lessons here. Allergies change and under no circumstances should anyone with allergies or asthma be without an epinephrine auto-injector or medical bracelet. It's just not worth it.