Scary patients

Allergist are always being made fun of because the lifestyle is good and people think the patients aren’t very sick. Not so! At least about the patients. Yesterday, I saw two patients with life-threatening allergic disease.

The first was a nice man of 35, a businessman in Pittsburgh. When younger he had noted some trouble breathing after eating crab, so he avoided it. Then in December, he was visiting family in New York and they went out to lunch at a Chinese seafood restaurant. He ate a variety of fish and shellfish and drank about 1/2 a beer. Soon after starting he felt unwell. He stood up and immediately vomited and fainted. He was unresponsive. 911 was called and he was rushed to an emergency room where he was treated with epinephrine, steroids, fluids and benadryl with complete resolution of his symptoms. Presumably he had an anaphylactic reaction to fish or shellfish which he eats infrequently. As part of his job he travels frequently to Asia, including China. Imagine what might have happened if he had been eating alone, or in his hotel room. I sent off tests and prescribed him an Epi-Pen (self-injectable epinephrine) along with recommending strict avoidance of all fish and shellfish (at least until the tests come back) and getting a Medic-alert bracelet.

The second was even scarier. A teenage girl I’d seen a year ago with mild asthma. The only thing unusual was that her symptoms seemed to get worse quickly, but she’d only had one hospital admission a couple years ago and an ER visit just before seeing me. I did allergy testing which showed her allergic to many things (cat, dog, molds, pollens). I sent her on her way with an inhaled steroid and said to follow up in a few months. She never did, but often they don’t. She did well on the medicine for a while then stopped taking it because she thought she didn’t need it. Thursday night she went to a friend’s house and the friend had a dog. She got home and had trouble breathing. She told her mom she couldn’t walk upstairs to get her medicine and then that she thought her heart was going to stop. By the time the EMT’s got there they had to bag her (use a bag and mask over her mouth and nose to get air into her lungs) and she got intubated in the ED and was still “tubed” when I saw her. Scary

A certain subset of asthmatics is what we call brittle. They may not have daily symptoms, but they go down hill fast. Of course you don’t really know who they are until something like this happens. She was a lucky one. EMS got there in <5 minutes and she’ll be fine. Unfortunately there is no way to know when this might happen again. Hopefully, the patient and mom will understand the need for daily medicines to fight the inflammation in her lungs a bit better.