By Dr. Paul Ehrlich
At a recent food allergy support group meeting, a Mom raised the subject of when to inject epinephrine. She spoke with alarm of watching her child vomit, to which I responded, “I like vomiting” to the uncomfortable amusement of some of those present.
Let me explain:
Seeing a child throw up is upsetting. We all know how it feels, and we don’t like it. Certainly, a prolonged episode can be unhealthy, leading to dehydration and other problems. But vomiting is nature’s first aid. It has undoubtedly saved the lives of innumerable college students on weekends over many years, and it has served food allergic patients as well by “getting rid” of the allergenic food. Apart from the rejection, there’s also the fact that vomiting is accompanied by a jolt of the body’s own epinephrine, aka adrenalin, which is, after all, what an epinephrine injection does. This is the so-called fight-or-flight response.
As we explain in our book, “epinephrine works by stimulating the release of both beta-1 and beta-2 neurotransmitters, and thus is known as a beta-agonist. Beta-1 neurotransmitters constrict the blood vessels and increase the tone of the arteries, raising blood pressure, which is desirable because of loss of fluid from the blood during anaphylaxis. Not only are vital organs deprived of oxygen when blood pressure goes down, but also the blood vessels themselves leak, much in the way the joints in your hot water pipes will leak if the pump fails because they depend on pressure to keep all the seals tight. Beta-2 relaxes the smooth bronchial muscles and opens up constricted airways, which allows the patient suffering from anaphylactic shock to breathe.”
Below are the various areas and systems in the body which must be evaluated with allergic reactions leading up to anaphylaxis:
One or more of the following:
LUNG: Short of breath, wheeze, repetitive cough
HEART: Pale, blue, faint, weak pulse, dizzy, confused
THROAT: Tight, hoarse, trouble breathing/swallowing
MOUTH: Obstructive swelling (tongue and/or lips)
SKIN: Many hives over body
Or combination of symptoms from different body areas:
SKIN: Hives, itchy rashes, swelling (e.g., eyes, lips)
GUT: Vomiting, crampy pain
So vomiting by itself is not sufficient in evaluating the seriousness of an allergic reaction. Regardless, even a brief episode of vomiting carries the risk of aspirating—inhaling–the stomach contents into the lungs. Therefore, one walks a fine line.