By Dr. Paul Ehrlich
The 2019 new year brought heartbreak to a South Brooklyn family as an 11-year old boy died after reacting to the smell of fish being cooked in his home. As described by the New York Daily News, the family hooked him up to a “medical device”, and when that didn’t help they called 911. While the medical device wasn’t identified, I suspected that it might have been a nebulizer pointing to a history of asthma. A later report in the New York Post confirmed that he did have asthma, and also a fish allergy.
This tragedy is a reminder of the dangers of poorly controlled asthma more than a food allergy story. When the small airways are inflamed, the space through which the air flows is reduced. When a new trigger further shrinks the diameter due to mucous and swelling, the volume plummets. When the airways belong to a child, there just isn’t that much room to constrict.
Years ago I was asked to consult with the health authorities of a Caribbean country on the rapid increase in the incidence of asthma. We concluded that it was because people had shifted away from cooling their homes using natural air exchange and the installation of air conditioners, which trapped the allergens. This problem of reduced access to fresh air is also a problem in cold weather. In the winter months with windows shut, environmental allergens such as dust mite and cockroach are trapped in the home. Lungs become “twitchy” as the English put it. As a kind of double jeopardy, this condition can be exacerbated by breathing cold winter air.
Thus, the airways are primed for exposure to airborne allergens, in this case fish.`The literature contains examples of incidents like this, usually when people wander through a food court where shrimp are being boiled, or in restaurants. Roasting peanuts are another known trigger if being roasted in commercial quantities.
Every death is a tragedy, but it is also a warning. Respiratory anaphylaxis can be thought of as an asthma attack triggered via the blood. Control your asthma. Know your triggers. And minimize your exposures. In addition you can’t control environments where the odors are secondary to what others might be doing, such as cooking obviously but also sanding or spray painting. These irritants can also trigger an attack. If your child is susceptible to these, asthma control is the first line of defense. If a patient is using albuterol frequently, the asthma is not controlled.
Regardless, be sure to have an epinephrine auto-injector like the Auvi-Q, Epi-Pen, or one of the generics readily available. Epinephrine is both a Beta 1 agonist and a Beta 2 agonist. That is, it treats the respiratory system the way albuterol does for an asthma exacerbation (Beta 2), as well as the heart (Beta 1)–crucial for correcting plummeting blood pressure from anaphylaxis. It was the go-to treatment for asthma exacerbations before albuterol was developed.
Illustrations from Asthma Allergies Children: a parent’s guide