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*Note* This is NOT a substitute for medical care. If you are suffering from anaphylaxis shock, call 911 immediately. Seek medical attention. I'm only posting this information if medical attention is not readily available and an epipen is not enough. As a person who is routinely outside and away from civilization, I realize I need to be thoroughly prepared. Also, I am NOT a medical doctor. I am a research scientist, the PhD kind. When it comes to dying while waiting around for medical attention or doing it myself, I'll do it myself. Also, some info has been updated after a visit from my allergist. *Updated again after a visit with my allergist on 1/22/2009 noted in green.
First, call 911. Go to the emergency room. Get off the internet and take care of yourself. You should only be reading this after you have recovered from an episode and want to learn more. Like I said, this is only intended for situations where you cannot get immediate medical attention. Personally, if I cannot get medical attention within 30 minutes, I'm going to the routine. From past experience, I have about 15 minutes before I go into shock. Get medical attention first. Don't make me say it again. This is life-threatening.
What is Anaphylaxis Shock? - click here for more info on anaphylaxis shock.
Some background: I learned the hard way that I was allergic to fire ants in 2003 when I was mowing the backyard. A tiny ant bit me on the hand, and I didn't think anything of it. I went inside and took a shower. 20 minutes later, I started to break out in hives and my throat started to close. Severe headaches ensued, and I popped some benadryls quickly. After a visit to my allergist, he confirmed that I was a level 3. His advice was to start venom therapy and to move up North where there are no fire ants. I vowed to never do yard work again. Every time I do yard work, some terrible accident occurs.
After five years without a bite, I was walking around the Texas Reds Fest (June 08) with Mouse getting ready to go home when I felt the pinch of a single fire ant on my second toe. Wonderful. My doctor had called earlier in the week and told me that I was now a level 4 on the rast test. Immediately, my hands started to swell. I found the nearest police officer and asked for EMS. This was not going to be pretty. By the time EMS got to me, my throat at started to close and hives started to appear. Standard procedure would be to use an epipen, but my symptoms were much more severe than the first time. In addition to my throat closing, I began to hyperventilate because that's what I do when I can't breathe. I try to breathe harder! I also experienced shaking, jerking, teeth chattering, restlessness, headache, and chest pains. Also, these symptoms I experienced were not in my control; it is as if I could not physically try to breathe slower or hold still. The shaking and jerking made putting in an IV difficult. The paramedics had given me (all injected, ouch), benadryl (2 doses), epinephrine, and steroids. The combination wasn't enough, so off to the ER we go. By the time I got to there, I was as "red as an apple" according to the doctor on duty. I was also given pepcid intravenously while at the ER. After a couple of hours, I looked well enough to go home. My good friend, Valerie Reiss, took care of the dogs and took me home. Thanks, Val!
Let's just say that feeling like the life was being choked out of you and not having motor control is probably not the best feeling in the world. Anyways, here's my personal instructional guide. Again, this is not meant to replace medical attention. Do this at your own risk.
Note about building immunity: People who are highly allergic can only hope to build immunity to 3-5 individual ants. I go into shock from just a single ant. If you get stung by more than a few, you might need to go ahead and inject multiple epipens. They should be given 30 mins apart. Epi-pens are only to buy you time to get to medical attention.
Hardware (I carry these with me all the time - all the pills in a one-dose container):
1. Epipen - This is by prescription only. Your doctor should have showed you how to use this. This is only supposed to buy you some time until medical attention arrives.
2. Benadryl - I use the cheap stuff (now comes in dissolvable strips). Ideally, you would want this injected. But take what you can get.
3. Prednisone - This is by prescription only. I happen to have some that was given to my dog and some prescribed to myself (20 mg per dose). Again, if it was life and death, I don't care where it comes from. Occasionally, patients will experience another anaphlyaxis episode 4-6 hours after the first episode without re-exposure. The corticosteriod shot prevents the second episode. In this case, I'm using prednisone.
4. Pepcid - This is to reduce redness and help facilitate the effects of the antihistamines. It will make you not look like an apple. My allergists think that this is not that effective anyways but still standard practice.
5. Cortizone10 - hydrocortisone cream to apply to the site of the bite (if it was from a bite).
6. Arnica - I swear by this stuff. This is for bruising or trauma. This should be used once you have come out of shock. This is only secondary.
First step: You should use your Epipen. You should have practiced using one in your doctor's office. Hint: It goes in your thigh, not in your heart Pulp Fiction style. You should be calling 911 right now. They may advise you to take another Epipen dose if your symptoms are worsening. My allergist recommends taking one immediately, and another 10 minutes after if the symptoms are not any better. Hence, I always have at least two in the vehicle at all times, and I always carry at least one in my purse.
Side effects: You will get the jitters and the shakes. I had no motor control. You may also experience headache, nausea, and rapid heart rate. The good news is that these symptoms won't last more than 30 minutes, and they aren't as bad as death. You may also feel run down for several days. If the effects of the epi have worn off and you still have not received medical attention, you may be advised by 911 to take another dose.
Scary News: According to a recent study, 30% of people do not carry their epipens with then, 30% are carrying expired epipens, and 30% of pediatricians do not know how to use an epipen. Carry it, always. Get your allergist to write you refills for epipens so you can always have un-expired ones to carry.
Step 2: Pop a recommended dosage of Benadryl (2-3 pills). Do this quickly before your throat starts to close up! Remember that oral drugs will take longer for the body to utilize than injected drugs. My allergists says that most people will die before the oral medications are even digested, but you might be one of the lucky ones that happens stay alive long enough for it to work. I'd take it. This also comes in dissolvable strips now. I'm not sure if it will work any faster. Worth a try though. Side effects: You will feel groggy and sleepy.
Step 3: Take 1 dosage of Prednisone. Steroid drugs are supposed to be taken in a very specific fashion. However, when it comes to life or death, you must decide if you can wait for medical attention. I hate taking prednisone or other steroids due to the side effects, but you have to do what you have to do. Ideally, medical staff would inject you with corticosteroids. Prednisone is the second best option next to nothing. Occasionally, patients will experience another anaphlyaxis episode 4-6 hours after the first episode without re-exposure. The corticosteriod shot prevents the second episode. In this case, I'm using prednisone. Side effects: Weight gain, muscle aches, joint pain, edema are all possible. Five days later, I still hurt. There are other long-term side effects. You might get this prescribed after your shock incident, but I wouldn't take them, and my allergist doesn't recommend it either. Anaphylaxis shock is acute and does not need to be treated after the incident.
Step 4: Take a single dose of Pepcid. This will reduce swelling and help facilitate the antihistamine's effect. By this point, medical attention should have arrived. If not, you either hiked too far, live too far in the country, camped too far in the boonies, or need to repeat steps 1, 2, and 3. Emergency dispatch may advise you to follow other orders.
Step 5: Once your symptoms have begun to subside, you can apply Cortizone 10 or any other hydrocortizone cream to the bite site (if it was insect bite related). This will help reduce swelling and itching.
Step 6: Once you are out of shock, you can also take Arnica orally or apply it topically to trauma sites. I have bruises from my IV site and injection sites as well as places that I bruised when I had no motor control. I swear by Arnica. I used it during my ankle surgery. Wonderful stuff. I came home bruised and covered with electrodes. You can see a bruise on my inner forearm and on my wrist from trauma when I had no motor skills.
Step 7: Be glad you're still alive. 400 people die of anaphylaxis shock yearly in the United States. Good Luck!
Tags: fire ants anaphylaxis shock epipen peanuts seafood bee wasp