Anaphylaxis Posing as Asthma

In the 2011 Special Edition of Allergy & Asthma Today by the Allergy & Asthma Network Mothers of Asthmatics, there was an article titled, "When Anaphylaxis Looks Like Asthma".  The article shared the heart-breaking stories of Sabrina Shannon and Emily Vonder Meulen, who died after suffering what appeared to be severe asthma attacks, yet turned out to be anaphylactic reactions to accidental food allergen exposures.

As I wrote in one of my previous posts, my daughter had an anaphylactic reaction, after eating a few corn muffins that I made with flax seed in it (I was unaware of her severe flax allergy at the time), when she was 3 weeks shy of her second birthday.  The thing is, I had no idea that what was what was happening to her.  We are so incredibly lucky that she survived the reaction, and I wanted to take the time to go over the events of that incident, as a learning experience for others.

I was about 5 months into life as a "food allergy mom", getting used to baking with substitutes and such, and trying out new recipes.  Since my daughter was highly allergic to egg, I was trying out one of the options, which was flax seed.  I had tried it once before, in a cupcake and it made the cupcake nice and fluffy.  I thought it made my daughter a little itchy, but I wasn't entirely sure, so we were going to give it another try in a batch of corn muffins.  My daughter thought they were delicious and gobbled down a few mini-muffins.

A little while later, she threw up her corn muffins all over me.  (Thanks, as always, to Facebook, for helping me keep track of the history...here was my status update from that moment: "Well, I think it's safe to say that Morgan's sick...she threw up copious amounts of corn muffins, all over me...I think giving birth shut off my gag-reflex, because it didn't faze me one bit...")  That was at around 6:30 p.m.  By around 8:30 p.m. I was posting on Facebook that she was all smiles.

Then, there's another post from me around 11:00 p.m. about some random news article, which reminded me that I was up, messing around on the computer.  That's when the memories came back to me...

We have (and still use) a baby monitor and even without it, I could hear with my "Mommy ears" the most unsettling noise, coming from my daughter's room.  I could hear an odd sound in her breathing.  She was making this "kuh" sound.  It reminded me of the sound my mother would make (a heavy smoker and NOT the sound I wanted to hear from my precious baby).  She sounded like she was having a little trouble breathing, so I went in to check on her.  I got my husband up and we both went in there and turned on the lights.

She was sleepy, but usually if I had come in there, she would have wanted to talk to me and would have been more alert (she has never been much of a "sleep through the night" kind of child and would love any excuse to get up).  She was a little wheezy and we were certainly nervous.  We were still learning about how to manage her asthma and I thought she was coming down with something, like a virus.  My husband and I were talking it over, like should we turn on the hot shower, should we do a breathing treatment, etc.  I decided to go get her puffer-spacer and do a breathing treatment and we did the warm shower thing, thinking it was an asthma flare.  That helped only marginally, but we thought it was all we could do.  She seemed stuffy, as well, so I decided to hold her upright in the glider, because there was no way I was going to put her back down in the crib.  

I took her to the changing table to see if she needed a fresh diaper and to let her cool off a little, because she seemed warm.  When I opened her pajamas, her chest was sucking slightly inward and I told my husband that didn't look right and it looked like she was working hard to breathe.  When we offered her the (non-dairy) milk bottle (her favorite thing in the world) she could barely hold it up to her mouth and we knew something was wrong.

I called the nurse line and this was her advice: "If the child is wheezing, flaring nostrils, labored breathing, rapid shallow breaths, but no blue lips, then go to the ER.  If their lips turn blue and/or there's wheezing that can be heard across the room - dial 911!"

We took her to the ER and as you might have read in the other post, she was diagnosed with an ear infection and bronchitis, but I now know it was an anaphylactic reaction to the flax seed.  The "dipping in" that her chest was doing was "retracting".  (For an excellent article, check out: How to Detect Breathing Problems in Children)  That can be very dangerous, especially for a child with asthma and one who is experiencing an allergic reaction.  Those are the images that stick in my mind.  I was just standing there, looking at her chest suck inward, perplexed, not knowing what to do.  The problem was, we were looking at this from purely a breathing/asthma perspective and forgetting that we are assessing an allergic child, here.  We were missing the bigger picture.  What about the fact that she had eaten muffins, then thrown up, and was now progressing to breathing issues?  Instead of missing the "forest for the trees", we couldn't see the "anaphylaxis for the asthma".  Luckily for us, we got her to the hospital, and it didn't escalate very rapidly, and she was OK.

In the article I mentioned at the beginning of this post, their advice is, "If patients with a food allergy and asthma have a sudden onset of severe asthma symptoms following food ingestion, they should presume that they had an accidental ingestion of their food allergen and immediately use their epinephrine."

Now, we didn't know she was allergic to flax at the time, but that really should not have mattered, because the signs of a reaction were there (vomiting, then breathing difficulties), and that is what would have happened with an accidental exposure, or in her case, exposure to an undiagnosed allergen.  I had no reason to expect a reaction from those muffins, yet there it was, happening in front of me.  We have to learn to react to what is happening in front of us, and not what we expect (or don't expect) to happen.  The problem is, we're not born knowing what to look for, so that's why I'm sharing this information, so hopefully we can all learn.  My daughter's experience was not as clear-cut as the examples in the AANMA article, but I still wanted to share the story and the information, because it's something of which we must be acutely aware, for those of us with children with food allergies AND asthma.

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On FAAN's Food Allergy Action Plan, it reads: 

"*Antihistamines & inhalers/bronchodilators are not to be depended upon to treat a severe reaction (anaphylaxis). USE EPINEPHRINE."  

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