Anaphylaxis can cause great anxiety. This is perfectly understandable, of course, and even justified. Survivors have, after all, experienced a brush with death. Knowing what caused the anaphylaxis will help to allay fear, for you can take precautions to avoid it in the future. But spare a thought for those with idiopathic anaphylaxis – they do not know what to do, or what to avoid. They have to wait for another episode to get another clue. If idiopathic attacks are frequent the patient should be offered continuous oral steroids to help ward off the attacks.
I advise my patients to face their fear in the following manner, and this applies to all forms of anaphylaxis. Firstly, acknowledge that your fear is perfectly rational. You have good cause to be afraid. Now construct a small cabinet in your mind. Place the trigger, together with your fear of the trigger, into the cabinet. Alongside it, place your supply of preloaded adrenaline. Now you can close the door, and keep the fear compartmentalised. As long as you have your adrenaline, you have every chance of survival. Even patients with idiopathic anaphylaxis can derive some comfort from this.
Acute anaphylaxis is usually a straightforward diagnosis. However, the clinical presentations of anaphylaxis are varied. In the extreme, anaphylaxis may present as a sudden loss of consciousness without the telltale signs of allergy. This is a challenge for doctors, for they must now consider the possibility of anaphylaxis in any unconscious patient. Other confusing presentations may include vomiting and bloody diarrhoea. Who would expect these to be allergic in origin when they are so often caused by other disorders? Similarly, sudden airway obstruction may be mistaken for choking, and anaphylactic asthma may be treated as ‘ordinary’ asthma. So, as you can see, it is more likely that anaphylaxis will be underdiagnosed than overdiagnosed.
A word about panic attacks and pseudo-anaphylaxis
Panic attacks are episodes of severe anxiety, in which patients experience a whole range of physical and mental symptoms. The attack starts with a feeling of impending doom, and progresses to a thumping heartbeat, shortness of breath, chest pain, light-headedness, pins and needles, and a feeling of faintness. Nobody dies from a panic attack.
Admittedly, some panic symptoms also occur in anaphylaxis. However, the attending doctor can distinguish the severe systemic collapse of anaphylaxis from the feeling of systemic collapse that accompanies panic. Some patients, unfortunately become obsessed, with the notion that they have anaphylaxis, not panic, and no amount of reassurance from the allergist can convince them otherwise. That’s a pity, because these patients are obviously suffering and they are not getting (or accepting) the most appropriate treatment. Rather, they spend their time going from one panic attack to another, all the time searching for an anaphylactic trigger that does not exist.