emergency food allergy

When patients with food allergy are admitted to the emergency department, the first priority is to identify signs of severe allergic reactions and inject epinephrine intramuscularly as soon as possible, rather than taking antihistamines orally and waiting for spontaneous remission or completing examinations. This is currently recognized by the global allergy community as the only first aid principle that can reduce mortality.

Last week when I was working the night shift, I met a 22-year-old young man. I had a late-night snack with a friend and took two bites of grilled squid. When I walked to the emergency room door, he was leaning on the wall and gasping for breath. He couldn't speak clearly, and he could only hold back one sentence: "Doctor, my throat feels like someone has strangled it." The exposed arms were covered with swollen wheals, and even the lips were swollen like translucent sausages. The triage nurse could tell at a glance that he had a severe allergy. He reached directly into the outermost drawer of the triage table and took out an epinephrine pen. He inserted a needle into the outer thigh through his jeans in less than 10 seconds. In less than three minutes, the young man took a deep breath and said, "I can finally take a breath." If loratadine had been given to him first, it would have taken at least half an hour for the oral medicine to take effect, and the person might have been so suffocated that he lost consciousness.

To be honest, many people’s understanding of food allergies is still limited to “a few rashes will itch for a while,” and some even think that allergies are caused by “weak immunity, and you can tolerate it after eating a few times.” This kind of thinking can really kill people. I treated an uncle in his 40s before. The first time he ate a mango, he only developed a red rash around his mouth. The itching disappeared after two days and he didn't take it seriously. The second time he was so greedy that he ate half of it. He fell down on the dining table just after eating half of it. His blood pressure could not be measured when it was delivered. It took almost an hour to rescue him. After he woke up, he was still lying on the hospital bed in a daze, saying, "It was just a little itchy last time, but it almost disappeared this time." The intensity of allergic reactions has no fixed pattern. This time it was a rash, but next time it might just be laryngeal edema or anaphylactic shock. There is no experience to speak of.

I often have family members of patients drag me and ask, "My child just has a rash and nothing else. Do I still need epinephrine?" What should I do if there are side effects? ”This really cannot be generalized. The current clinical consensus is that if you only have skin and mucosal symptoms (such as scattered rash, itching, mild lip edema), and there are no symptoms such as chest tightness, shortness of breath, tight throat, dizziness, severe abdominal pain, and vomiting, you can indeed take oral second-generation antihistamines for observation first, and do not need to give injections. But as long as respiratory, digestive tract or cardiovascular discomfort occurs, don’t worry about the side effects. The side effects of epinephrine to save severe allergies are minimal and are not worth mentioning compared with the risks of suffocation and shock. I have met the most stubborn family member. After the child ate peanut butter, his face was so swollen that he could not open his eyes. He was still crying and said, "We used to just take loratadine without injections." In the end, I called the security guard to stop him before he was given the injection. Now I am scared to think about it.

In the past five years of working in the emergency department, we have always kept three prefilled epinephrine pens in the first drawer of our triage table. They are located in front of the thermometer and tongue depressor. Whenever a patient comes in and says he feels uncomfortable after eating unfamiliar food, the first reaction is to check if there are any signs of allergies. Many people think that allergies are a trivial matter, but they do not know that food allergies are already the third most common emergency emergency in the world. Last year alone, our department received more than 170 patients with severe food allergies. Among them, 3 patients were brought to the hospital until they lost consciousness and were not saved in the end.

Of course, it doesn’t mean that if you have an allergy once, you will have to worry about it for the rest of your life. After 2 to 4 weeks when allergy symptoms have completely subsided, you can go to the allergist department for a precise allergen test, clearly write down the foods that cause allergies, and try to avoid them in the future. If you are allergic to highly allergenic foods such as peanuts and nuts, it is best to keep an epinephrine pen with you, which is much more effective than loratadine - antihistamines can only relieve the itching of rashes, but cannot save laryngeal edema and shock. This principle must be kept in mind. As for the "child desensitization" that many parents are concerned about, there is indeed an oral immune tolerance treatment plan. Children with mild to moderate allergies may slowly adapt to allergenic foods under the guidance of a doctor, but they must not try it blindly at home. Every year, parents feed their children allergy foods to "train tolerance" and eventually become emergency rescuers. Don't use their children's lives as guinea pigs.

I still remember that when the uncle who went into shock after eating mangoes was discharged from the hospital, he came to say hello to me and said that he now always has a card in his wallet with "Mango Allergy" written on the front and the phone number of the nearby emergency room printed on the back. In fact, it’s really not that troublesome. Before eating unfamiliar food, ask if there are common allergenic ingredients such as nuts and seafood. When introducing new complementary foods to your children for the first time, take a lick and observe for half an hour. People with allergies should carry first aid medicine with them. Most of the risks can be avoided. Don't wait until you go to the emergency room to regret it. It's really too late.