More Evidences Of An Anaphylactic Shock

[Tessa]

Hi

I am sure that you remember that I mentioned on a previous post that I am going to be tested for a wide range of allergies, among others to some drugs (anesthetics...)

The first reaction I had to Novocaine (a local anesthetic) was long ago and took place after having a local infiltration of the drug.

After passing out I ended at the ER.

They mentioned on my ER?s report that I had an allergy to local anesthetic inflitrated... But we thought it was not important, until further reactions to drugs happened...

I had an ap. with the alergologist and he is going to carry out some tests next month in order to determine if I am allergic to local anesthetics. He asked me about that first time that I had such a reaction but I had not much information, as on the report the treatment section does not specify if they had to give me a drug or if I gained consciousness by my own, which is what we thought and were told at the ER.

My husband was not allowed to enter with me into the Room at the ER and I passed out, so I did not know if they had done something to recover me...

Furthermore, we suspect that the ER?s report has been "modified". The bp is stated as 90/60, but the hr seems to have been written on a previous number written first...

According to my husband (because I passed out and did not see him), the specialist who carried the infiltration out scared to death when he got to his room to ask for help because I had fainted...

When I left the Hospital, the doctor said not to worry, as it was just a syncope, some sort of allergy he said- alhough he mentioned to return if I felt unwell...

Because the alergologist asked me to investigate the infiltration?s amount of Novocaine, I thought it could be of interest knowing what the doctors carried out at the ER.

I have not been able to get all the information (which is another story), but I managed to get a copy of some of the notes they wrote down at the ER (internal information). The Hospital has sent it to me by post, stamped by them (which is official).

To summarize:

I had an infiltration of Novocaine and had an allergic reaction to it.

At the ER I got intravenous TIMOLOL (to be honest, they spell it wrong on the form as TOMOLOL, but of course, TOMOLOL does not exist, but TIMOLOL does and is much more related to what we are looking for).

I have been surfing the net and found the following:

TIMOLOL (you can click on the link to read the full information. It is an official website).

Timolol maleate is a beta1 and beta2 (nonselective) adrenergic receptor blocking agent that does not have significant intrinsic sympathomimetic, direct myocardial depressant, or local anesthetic activity.

Isn?t that interesting?

Indications and Usage for Timolol

Hypertension

Timolol maleate tablets are indicated for the treatment of hypertension. They may be used alone or in combination with other antihypertensive agents, especially thiazide-type diuretics.

Myocardial Infarction

Timolol is indicated in patients who have survived the acute phase of myocardial infarction, and are clinically stable, to reduce cardiovascular mortality and the risk of reinfarction.

Migraine

Timolol is indicated for the prophylaxis of migraine headache.

Of course, 90/60 as bp is not hypertension and I had no headache nor migraine so...

It is hard to say, but I think that I had an anaphylactic shock and (thanks God) they usted the best drug they could to recover me.

Wouldn?t that be enough to determine my allergy?

I am a bit worried because they plan to provoke such a reaction next month to see if I am allergic. Do you think I should go again through all the process?

I know, it is done at the Hospital and under the specialist?s close eye... With all the drugs and fittings needed... But what do you think?

Thank you for your help

Love,

Tessa

I deeply appreciate all answers, please. Can you help me?

[pat57]

a doctor is the best one to answer those questions. I can't imagine they would put you at risk, and yet nobodies perfect so

I feel sure that what you need is a better understanding of the process.

[Jersey Girl]

Many local anaesthetics like novocaine may also contain epinephrine which I personally cannot tolerate. I also have chemical sensitivities to many medications as well-- more severely reactive than allergic-- reactions to Relafen and Alesse landed me in the hospital overnite twice without a good explanation. Martha

[Sunfish]

hi tessa -

while it's understandable that you're a bit anxious about the upcoming testing you have scheduled, having read all of your posts it seems that ultimately the thorough testing will bring you the best answers & - in the long run - give you a better understanding about what types of things you do or don't need to be concerned about. i think getting your records from the ER was a good idea & would definitely encourage you to show them to the doctor doing your testing but based on the bit you have shared it doesn't seem that they are thorough enough to really give you the answers you seek.

obviously the decision to go forward with the extensive testing is one that you have to make yourself & feel as comfortable with as possible, but it seems to me that the doctor you consulted with (& who it seems you liked?) thought the testing was a good idea & based on what you've shared on the forum i would probably agree, if only to help you understand your body better.

all the best,

melissa

[juliegee]

Hi Tessa-

Sounds like you've been doing some detective work... I'm a little confused by your experience. Were you at the ER because you had an allergic reaction to novocaine? What symptoms did you have with the novocaine that brought you to the ER? Then, (if I'm understanding things) as treatment for the allergic reaction, the ER administered Timolol. Strange choice of med. Did they think you'd had a heart attack? Then, did you have another reaction to the Timolol? Was one or both of your reactions anaphylaxsis? Is that what you are trying to figure out?

I'm sorry that I'm so little help, Tessa. Does this allergist, who is carrying out the tests, have a good reputation? If you have known drug sensitivities/allergies to certain meds, it seems pointless to re-expose you. Here in the United States, if a patient has a bad reaction to a certain medication, it is noted on our medical charts and we are not given that drug again. I can see why you are nervous. It'd be interesting to have Doctorguest comment on your experience.

Julie

[flop]

Hi Tessa,

well done on the detective work so far. However I don't think that the ER notes are sufficient to say that you had anaphylactic shock, or even a definite allergic reaction to Novocaine.

Anaphylactic shock is a life-threatening allergic reaction caused by massive histamine release in response to an allergen. The symptoms / signs of anaphylactic shock usually include: a rash (hives / urticaria); swelling (angioedema) which can include lips, tongue, throat; tight airways / wheezing (bronchospasm as in asthma); and the SHOCK part which is a very low blood pressure. The treatment for anaphylactic shock includes intramuscular Adrenaline injection, Oxygen, Salbutamol nebulisers, Steroids and Antihistamines.

People at risk of severe allergic reactions should always carry an Epi-pen to administer an adrenaline (epinepherine) injection as soon as symptoms start to develop.

I have quite a bit of experience of severe allergic reactions as one of my house-mates at university had severe allergies and I had to inject her with her Epi-pen on several occasions and call 999 for an ambulance.

The drug Timolol that you think you were given in the ER is a beta-blocker. It acts to slow down the heart and lower the blood pressure, one of it's side-effects can be to cause narrowing of the airways (mustn't be given to asthmatics). It is almost the exact opposite of the druge that would be given for anaphylaxis.

I wonder if the novocaine you were given contained Adrenaline? If it did then you may have been having an adverse reaction to the adrenaline (racing heart rate) and that may have caused you to faint? Lots of members on here report that they are intolerant of local anaesthetic containing adrenaline. (this reaction to the adrenaline is not a good one but it is not an allergy).

From your posts it sounds as though your allergist is very knowledgable and is planning on conducting tests to help find out whether you really are allergic or not. Although nothing in life is ever 100% guaranteed, they only do these tests in facilities that have all of the emergency treatments to hand and an allergy specialist would know exactly what to do if you were to have a bad reaction. As Melissa said it is your decision but knowing the answers would make future medical care easier for you as you would know more about what anaesthetic drugs are safe for you to have. It may be that you just have to avoid local with epi. An important thing to know if you ever get toothache!

Hope everything goes well for you and you get some answers,

Flop

[Maxine]

Tessa,

I've been doing a little research on novacaine/lidocaine ect. for a while because I seem to have a TOXIC reaction----not Anaphylactic. Are you sure your reaction isn't "TOXIC"?

While a toxic reaction can cause cardiac depression if it gets bad enough it usually cause central nervous system excitement, tremors, tachycardia ect. Since one administering the treatment for any toxic reaction, they must keep in mind that while your heart may be tachycardic at first, the later stages of the reaction can be cardio and pulminary depression.

The drug Timolol does not have significant intrinsic sympathomimetic, or direct myocardial depressant properties, as other beta/adrengic blockers will have---------------------so when the drug is used to calm the CNS excitement, it doesn't put the person under further risk for cardiac depression.OK-----------------now this is my guess based on what I read. TOXIC is different then anaphylactic. TOXIC can be just as dangerous at times depending on other underlying health conditions of the patient.

I have the number of an allergist given to me by the oral surgeon who is supposed to remove my back molar, but I doubt I'm truly allergic.

When I had my cardiac loop recorder put in a lot of lidocaine was used to numb the area---and the area is quite vascular. I had a terrible reaction, and I learned later from my EDS specialist that I could have had a TOXIC reaction, as the drug could be easily absorbed at a faster rate. I was first disoriented, felt numb all over, then dizzy and light headed. Tachycardia followed with bouts of tremors and nausea. This lasted over 8 hours---it was horrible. I stayed at the hospital, but not go to ER. I just sat somewhere off to the side for several hours until I felt safe to leave. The ER would just blow it off---I'm 99% sure of that.

When lidocaine is used without EPI, precautions are to be taken, as less lidocaine should be used. The vasoconstrictive effects of the EPI prevent rapid absorbtion of the lidocaine which can put you more at risk for toxic reaction if too much lidocaine is used.

But even if the correct amount is used, I think some can still be at risk for a toxic reaction. My EDS doctor thought I may be absorbing it too rapidly because my EDS also affects my vascular system. Sometimes the injections can be done improperly if the doctor or dentist is not experienced, and it can be absorbed too quickly if an artery is injected.

http://www.emedicine.com/med/topic1297.htm

http://www.theannals.com/cgi/content/abstract/18/7/554

Still afraid to get the molar removed.

I did consult with an anesthesiologist----he doesn't GET IT----------------we are a complicated bunch, and although he doesn't believe the doses commonly used could create a problem-----------problems do exist, even it people who don't have ANS dysfunction or EDS complication---

More studies need to be done on lidocaine toxic effects----AND WHAT TO DO ABOUT THEM ONCE THEY HAPPEN.

Maxine :0)

[Tessa]

First of all, thank you for all your answers, suggestions, comments and for sharing your own experiences.

Of course, Pat, I have never doubted to share the information I got with the alergologist. It was just that I wanted your comments before. The forum has always been most helpful and supportive.

I have not been able to know if Novocaine was given with another drug other than "Celestone", Martha. No idea if it was epinephrine as you have mentioned.

Thank you, Melissa. .

I see from all the answers that most (or all) agree that the testings would help us determine exactly the allergies and I agree with you and others, that I have to show the doctor (who is going to carry the test out) the information I got from the other Hospital. I am sure he will know what to do with the information. He was, indeed, nice, Melissa and I liked him.

He thought that the testing was a good idea. Furthermore, as I mentioned before he added that he was sure that I have an allergy to PPD which we will confirm with the TRUE patch testing.

BTW, as I mentioned before, Novocaine was not the only drug that I reacted to.

Flop, I had some of the reactions that you mention on another ocassion (but we could not find the trigger): swelling of lips, tongue & throat.

Furthermore, after the Nitroglicerine I had a syncope & very low blood pressure: 64-26

In relation with Novocaine (years ago), I do not know if the local anesthetic contained Adrenaline. I wish I knew. I imagine that the doctor will determine it with the tests. Thank you for mentioning it, Flop. I will tell the alergologist to rule it out too.

Thanks for the information, Maxine. Sorry for your reaction to Lidocaine. Toxic is another option... I will keep it in mind to ask it.

Julie, I will try to tell you how it happened, although this was years ago. After the inyection of Novocaine at the doctor?s room, we went to the information desk at the entrance of the Hospital in order to ask for another ap. It happened really quick.

I had flushing, lightheadness, brain fog, a rapid heart beat (I felt my heart beating hard and fast), chest pain that became accute and then syncope.

According to what my husband told me later, he had shouted for help and staff from the Hospital brought a disabled wheelchair. He runned to the doctor?s room (where I had the inyection) and asked for help to the doctor. I was taken straightaway to the ER by the doctor and my husband (though my husband was not allowed to enter). It seems they were all very scard and worried.

I was still withouth consciousness.

When I woke up, I was lying in a bed at the ER.

I really cannot assure that the ER?s internal report states the use of TIMOLOL, because as I mentioned before it is not very clear and it seems that they have written TOMOLOL IV but Tomolol does not exist, does it?

I am afraid that the report might not be of much help to the alergologist, because it does not include enough information and it is not clear...

On my copy of the ER?s report (given on the day of the emergency) is written that I had an allergic reaction to a local infiltration, and it mentions the use of Novocaine and Celestone Monodosis (as infiltration).

Regarding the reputation of the allergist who is carrying out the tests... I really do not know.

Our Health System does not give us the option to decide the doctor we want. When I told my GP that I needed an allergist to carry out some tests, he allowed an ap. with an allergist at the nearest hospital. The allergies department at the Hospital counts with a team of allergists who treat patients. There are plenty of rooms with allergists and on the day of my ap. it was him who was available for me... I even do not know his name as I do not know if he will be the one to carry out the tests on the day of my ap. in September or if another one will be available...

According to what he mentioned, he pretends to try the drugs that I am supposed to have an allergy to (at a lower dosis) and will increase the dosis step by step, to see the reaction.

Julie, you have expressed my real concern. I read it too, that you do not re-expose a person to a med that caused an allergy, because there are more possibilities of a bad reaction.

Here they use to test an allergy to gluten by re-introducing gluten to a diet in order to see the patient?s reaction... I think you know what I mean.

To what I know by now, I had reactions to Novocaine, Dolantine and Nitroglicerine.

I am also looking forward to Doctorguest?s comments on this experience.

Thank you all for your answers and support.

I deeply appreciate them,

Love,

Tessa

PS:

I forgot to mention what happened last night. Am I becoming more sensitive?

I woke up at about 5 am with an extremely itchy feeling on my left arm and hand. One of my fingers was red and I thought it was because having scratched myself sleeping...

At 9.30 am, we woke up and my finger was swollen. Part of it was red. I had an itchy feeling, pain and was unable to close it.

We ended going to our nearest Chemist.

It seems to have been a reaction to a normal mosquito bite.

I never had such a reaction to a mosquito.

They gave me hidrocortisone (Cream). It is better now, the redness has dissapeared, and it still a little swollen.

Have you had this reaction to a mosquito?

[flop]

Hi Tessa,

thanks for the further details - it is interesting trying to work out exactly what reactions you have had. Clearly you have had bad reactions to both Novocaine and Nitroglycerin spray. HOWEVER a bad reaction is not the same as an ALLERGIC reaction.

You can be allergic to some things (like mosquito bites) and have bad non-allergic reactions to other things.

Nitroglycerin spray is designed to widen (dilate) the blood vessels, it helps angina by widening the arteries arround the heart. My Grandad had severe angina and he was told to always sit down before using his spray as there was a high risk of fainting from low blood pressure after taking the spray. When given as part of a tilt table test it usually lowers the blood pressure and makes the heart work harder, it is often given to make fainting reactions show up faster.

The fact that your blood pressure went so low after the nitroglycerine spray suggests that your body is very sensitive to the spray. The low blood pressure and blackout were probably a bad reaction to the spray but not an allergic reaction. An allergic reaction would have the rash, swellings, breathing problems that I mentioned in my last post.

Mack'sMom - in the UK if someone clearly has a severe allergic reaction to a medication then they would not be given it again. e.g. if one had an anaphylactic reaction after an injection of penicillin they they would be labled as allergic to penicillin and not tested for it. However people often have allergic reactions but the doctor can't be sure which drug caused the reaction - in that case careful allergy testing would be considered. Often (like in Tessa's novocaine situation, the notes are not detailed enough to say what type of reaction the person had - so it could be allergic or it could be a bad side-effect.

Lots of people say that they are allergic to things like penicillin but in fact they have an unpleasent reaction (like vomiting or diarrhoea) but not an allergic reaction.

It is important to know what kind of reaction you have and allergy testing should give you the answers in a safe hospital environment.

Flop

[Tessa]

Thank you Flop

Your answer resolves many doubts and questions that I had and makes me feel more comfortable, even less worried.

You are right, the Nitroglicerine was given when tilted and was used to provoke the fainting.

Now I understand why the allergist wants to carry out the test, as if they were only bad reactions to the drugs, it would be "more or less" safe to use them if needed. Therefore, I assume that he wants to rule out and/or confirm. It is thus very important to see if it was a bad reaction or an allergic reaction...

All your help has been most helpful for both, feeling less scared and less worried, as well as to better understand the testing and the need of it.

I promise to keep you all updated on the testings and the results.

Love,

Tessa

[flop]

Tessa,

thank you for saying thank you - after writing my last post I was worried that you would think that I was being "nasty" saying that your reactions weren't definately allergies. Having had my university friend with severe allergies I know how important it is to know what you are allergic to (she got tested and was allergic to mushrooms and shellfish). Also if something (like the nitroglycerine spray) caused a bad side-effect it is important to know that it isn't a true allergy as one day you might need that medication (hopefully you won't get angina but we could all get any other illness) so it would be important for you to know that maybe you can only have half a dose and it might make you very dizzy but it could help your heart.

Good luck with all the testing, far better to get answers in the allergy clinic with the doctors and nurses there just in case of a reaction than to find out by accident in an emergency situation.

Flop

[Tessa]

Hi flop

Of course you are not "nasty". All your comments (and the suggestions of others) have been most helpful and not "nasty" at all. Please, do not apologyze for giving your opinion. It is what I asked for

Now I know how important it is to determine if it was a bad reaction or an allergic one and that the notes from the ER are not enough to confirm it.

If it was a bad side-effect, it was really scary and it it was an allergic reaction, well...It was scary no matter the reason. The most important is knowing for acting in the future.

Thank you and all for taking your time to answer my doubts.

As mentioned before, I promise to keep you all updated after my tests next month.

Take care,

Love,

Tessa