Anaphylactic Shock In Austere Settings

Rourke: This article can be seen here in its original format.

In a disaster or any other situation that leaves us off the grid, we will expose ourselves to insect stings and poison ivy, as well as strange food items that we aren’t accustomed to. Allergic reactions may ensue in susceptible individuals. When we develop an allergic reaction, it might be mild or it might be severe. If severe enough, we refer to it as anaphylaxisor anaphylactic shock. Anaphylaxis is the word used for serious and rapid allergic reactions involving one or more parts of the body which can become life-threatening.
Anaphylactic reactions were first identified when researchers tried to protect dogs against a certain poison by desensitizing them with small doses. Instead of being protected, many of the dogs died suddenly the second time they got the poison. The word used for preventative protection is “PROphylaxis”. Think of a condom, also known as a prophylactic. A condom protects you from sexually transmitted diseases. The word “ANAphylaxis”, therefore, means the opposite of protection. The dog experiment allowed scientists to understand that the same can happen in humans, and had application to asthma and other immune responses.



This allergic reaction can be caused by drug exposure or pollutants, but even ordinary foods such as peanuts can be culprits. Our immune system sometimes goes haywire when it acts to protect our body from an invading substance. In extreme circumstances, a person could go into shock.
Anaphylaxis has become an timely issue in because of the increased numbers of people that are experiencing the condition. Why the increase? When medicines are the cause, the explanation is likely that we are simply using a lot of drugs these days. Why foods should be causing anaphylaxis more often, however, is more perplexing. Could pollutants be an issue? For whatever reason, allergies such as asthma, food allergies and hay fever are becoming epidemic all over the world.


The likely causes of anaphylaxis are:

• Drugs: dyes injected during x-rays, antibiotics like Penicillin, anesthetics, aspirin, ibuprofen, and even some heart and blood pressure medicines
• Foods: Nuts, fruit, seafood
• Insects stings: Bees and Yellow Jacket Wasps, especially
• Latex: rubber gloves mad of latex, especially in healthcare workers
• Exercise: often after eating
• Idiopathic: This word means “of unknown cause”; a substantial percentage of cases


Fumes from chemicals like Chlorine gas can be dangerous in their own right without causing an immune or anaphylactic reaction.




It’s important to recognize the signs and symptoms of anaphylaxis because the faster you treat it, the less likely it will be life-threatening. You may see:
• Swelling: can be generalized, but sometimes isolated to the airways or throat
• Breathing difficulty: wheezing is common as in asthmatics
• GI symptoms: diarrhea, nausea and vomiting, or abdominal pain
• Loss of consciousness: The patient may appear to have fainted
• Strange sensations on the lips or oral cavity: especially with food allergies
• Shock: Blood pressure drops, respiratory failure leading to coma and death


anaphylaxis symptoms





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Fainting is not the same thing as anaphylactic shock. You can tell the difference in several ways:
• Someone who has fainted is usually pale in color, but anaphylactic shock will often present with the patient somewhat flushed.
• The pulse in anaphylaxis is fast, but a person who has fainted will have a slow heart rate.
• Most people who have just fainted will rarely have breathing problems and rashes, but these will be very common signs and symptoms in an anaphylactic reaction.



In food allergies, victims often notice the effects very rapidly; their life may be in danger within a few minutes. People who have had a serious anaphylactic reaction should be observed overnight, as there is, on occasion, a second wave of symptoms. This can happen several hours after the exposure. Some reactions are mild and probably not anaphylaxis, but a history of mild symptoms is not a guarantee that every reaction will be that way.
Why does our immune system go awry in anaphylactic situations? Anaphylaxis happens when the body makes an antibody called immunoglobulin E (IgE for short) in response to exposure to an allergen, like food or a medication. IgE sticks to cells, which then release substances that affect blood vessels and air passages. The second time you are exposed to that allergen, these substances drop your blood pressure and cause soft tissue swelling. The airways, however, can tighten and cause respiratory difficulty.
Histamine is a substance released in this situation. Medications which counteract these ill effects are known, therefore, as antihistamines. These drugs may be helpful in mild allergic reactions, but tablets, like Benadryl, take about an hour to get into the bloodstream properly; this isn’t fast enough to save lives in serious reactions. If it’s all you have, chew the pill to get it into your system more quickly. Other antihistamines, like Claritin, come in wafers that melt on your tongue, and get into your system more quickly, although the effect is also mild.
The same cells with IgE antibodies release other substances which may cause ill effects, and antihistamines do not protect you against these. As such, we look to another medicine that is more effective: Adrenaline, known in the U.S. as Epinephrine.




The Epi-pen is the most popular of the various available injectable kits to combat anaphylaxis. It’s important to learn how to use the Epi-Penproperly. Click the link in the last sentence for a video on the subject.



You can cause more harm than good if you fail to follow the instructions. For example, Adrenaline (Epinephrine) can constrict the blood vessels if injected into a finger by mistake, and prevent adequate circulation to the digit. In rare cases, gangrene can set in. Also, remember that the Epi-Pen won’t help you if you don’t carry it with you or have it readily accessible.
Since it’s a liquid, Adrenaline (Epinephrine) will not stay effective forever. Be sure to follow the storage instructions. Although you don’t want to store it someplace that’s hot, the Epi-pen shouldn’t be kept in any situation where it could freeze, which will damage its effectiveness significantly. Store in dry, dark, cool conditions.
When is it appropriate to inject Epinephrine? An easily remembered formula is the Rule of D’s:
Definite reaction: Your patient is obviously having a major reaction, such as a large rash or difficult breathing.
Deterioration: Use the Epi-pen before the condition becomes life-threatening.
Danger: Any worsening of a reaction after a few minutes.
Imminent danger is probably most likely if your patient has difficulty breathing or has lost consciousness. If you are ever in doubt, go ahead and give the injection. The earlier you use it, the faster a person will resolve the anaphylaxis. One injection is usually enough to save a life, but have more than one handy, just in case. This is especially pertinent when you are away from your base of operations.
Some people may not be able to take Adrenaline (Epinephrine) due to chronic heart conditions or high blood pressure. Make sure that you consult with your doctor now to determine that it is safe to receive an injection. Have the medicine available, learn the signs and symptoms, and you’ll stay out of trouble.


Joe Alton, MD




Learn more about anaphylactic shock and 100 other medical issues you might encounter in a disaster in our Amazon bestselling book “The Survival Medicine Handbook“, now with over 195 5-star reviews.


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5 thoughts on “Anaphylactic Shock In Austere Settings”

  1. Almost 30 years ago, I started having frequent anaphylactic shock episodes when we moved into a new house in the country. It usually happened at night, and at least once my BP dropped completely out before I got to the hospital. I was completely unresponsive. I had to take between 100-200mg of diphenhydramine each night before bed, and that didn’t always stop it.

    The extreme itching skin and hives, the edema in the extremities, the swelling airway, fluid in the lungs, BP drop, and diarrhea. I would have it all.

    In addition to the epipen, I was allowed to have IV and airway supplies on hand. I literally got good at starting my own IV and getting the ET tube and laryngoscope ready for the paramedics when they arrived in case I wasn’t exchanging air or responsive. The 17 minutes it usually took the paramedics was too long to wait, so my prep work was important.

    Eventually allergy testing, along with some strong environmental detective work turned up that I was allergic to a particular kind of mold that was present in the house (not black mold). I was allergic to most molds.

    Why did it usually happen at night? I think because my natural steroid levels drop at night.

    We couldn’t save the situation and had to move away. Haven’t had the problem since.

    My BOB has all kinds of unusual supplies you might normally not find. But always among them is at least several different kinds of anti-histamines.

  2. Dr. Joe-thanks.Yes I have your book and have an epi pen on hand -for just in case as I am a bee keeper.Our grand
    daughter is allergic to nuts so we have a Jr epi for her also.
    Griz- wow what an ordeal.Happy u r better now. Arlene

  3. Thank you Rourke.

    Several friends carry the epi pen and my deep meds kit has about 500 benedryl tablets. Atropine is an old drug, present in mandrake, beladonna, and henbane. The Egyptians used is with wine as an anesthetic.

    Atropine is a specific palliative to organophosphate type nerve gasses which act by inhibiting acetylcholinesterase, the enzyme responsible for breakdown of acetylcholine in nerve conduction.

    I passed through Washington Regan one evening on my home south of DC and with little kiddos, reflected that they had never tasted licorice. I bought some and handed it out. I have always heard the expression ‘climbing the wall’ but that is what my little son tried to do. In fact he tore down a curtain. We loaded him up for a trip to the ER where an attendant gave him a potent and fast acting drug IV, that magic bullet for allergies, Benadryl.

    In the ‘its probably nuts category,’ I have read several opinions that many of the new allergies such as to peanuts and other environmental sensitizations are due to young kids not playing outside and being exposed to common allergies at early age… Let’s all take a break for a video game.


  4. I too carry an epi-pen, I am allergic to Bees. Much to my surprise last summer driving home with wify with windows down i got stung in the front of my neck, HOLY COW, I thought a hot burning solder iron or match stabbed in the throat. Pulled over, frantically wiped at my neck. I had this big red dot with a white swelled ring around it. But didn’t need the epi-pen. I was pretty freaked out.


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