Allergies can be more than just annoying. Some people have potentially deadly allergies to such things as insect stings, foods, medications, and latex. Being prepared with an EpiPen can mean the difference between life and death.

It was a vacation Ely Weitz will always remember. In August 2003, he, his wife, and their two daughters were guests at a lakeside cottage in Ottawa, Canada. The setting was postcard perfect and the family was having a wonderful time, until Mr. Weitz took out the garbage.

“There were potted plants and gorgeous flowers along the way—and there was also a wasp, which proceeded to sting the back of my right knee,” he says. “Within a half hour, I was red and swollen from the top of my scalp to the bottom of my legs.”

Alarmed and experiencing an excruciating blend of pain and itchiness, Mr. Weitz called a friend back in New Jersey: Dr. Leonard Bielory, who also is director of the Asthma and Allergy Research Center at New Jersey Medical School and an allergist at University Hospital. “First Dr. Bielory asked if I was having any trouble breathing, which I wasn’t,” says Mr. Weitz. “A search in the medicine cabinet for antihistamines turned up nothing, and he strongly recommended I go to an emergency room.”

Mr. Weitz and his family went to the hospital, filled out the required forms, and then, as a nurse was taking the Springfield man’s blood pressure and temperature, he collapsed. The next thing Mr. Weitz recalls, he was on a stretcher and being given steroids intravenously, surrounded by his family and an influx of doctors and nurses. “It was the end of wasp season, so they’d seen allergic reactions in the E.R., but apparently none as severe as mine,” says Mr. Weitz. Two hours later, he left the hospital with a prescription for antihistamines and an EpiPen®, injectable epinephrine used as rescue medicine during severe allergic reactions known as anaphylaxis. When he returned to New Jersey, skin tests showed he was allergic to wasps and hornets.

Today, Mr.Weitz , who had no known allergies, carries his EpiPen® wherever he goes and has once-weekly immunotherapy injections. Dr. Bielory is now not only a friend, but his allergist. “My experience wasn’t a fluke—a wasp’s or a hornet’s sting could be life threatening to me,” says Mr. Weitz, a professor at Baruch College’s Zicklin School of Business.

The Body’s Misguided Response

Dr. Leonard Bielory

Chances are that everyone knows an allergy sufferer. More than 50 million Americans have some type of allergy, according to the American Academy of Allergy, Asthma, and Immunology (AAAAI). Seasonal allergic rhinitis, or hay fever, affects about 20 percent of people in the United States. Although the sneezing, runny nose, itchy throat, and watery eyes brought on by pollen can cause misery, hay fever itself is very seldom life threatening. Rarer, but potentially more deadly, are allergies to such things as insect stings, foods, medications, and latex.

An allergic reaction is the immune system’s response to any substance it considers harmful. In some scenarios, such as when a virus invades the body, the defensive action of the immune system is welcome. But in the case of an allergic reaction, the immune system mistakenly targets an otherwise harmless substance, known as the allergen. Upon contact with the allergen, the immune system’s “attack” unfolds like this: The body produces an antibody, immunoglobulin gamma E (IgE), which signals mast cells to release certain chemicals, namely, histamine. Histamine produces the symptoms associated with allergies: swelling, itching, nausea, diarrhea, wheezing, and hives, for example. Usually, the symptoms are contained to the area of the body where the histamine is released.

However, severe allergic (anaphylactic) reactions are systemic, which means they affect the whole body. In addition to producing intense allergy symptoms, massive bursts of histamine can cause blood vessels to dilate and dramatically lower blood pressure. The throat can quickly swell and block the airway.

Without immediate medical action, someone experiencing an anaphylactic reaction could die within minutes. Most often, the initial action is an injection of epinephrine.

“Epinephrine is a hormone that counters some of the effects of anaphylaxis. It causes the heart to pump faster, relaxes the airways, and tightens blood vessels,” explains Dr. Bielory. Pre-measured doses of epinephrine are carried by allergy patients in injection form, known commonly as the EpiPen®. Even children can be taught when and how to use the drug, which is carried in a case and, when needed, injected into the thigh. However, says the doctor, patients who’ve had a severe allergic reaction need more than a dose of epinephrine. “Epinephrine wears off in about 15 minutes, but the effects of anaphylaxis could go on for much longer,” he says. “After using the EpiPen®, the patient should go immediately to an emergency room for evaluation and, if needed, follow-up care.”

EpiPenŽ and EpiPenŽ JR auto-injectors are the leading form of self-injectable epinephrine. Administering EpiPenŽ at the first sign of a severe allergic reaction can provide a person with the time needed to get to an Emergency Room.

A Danger for Some

Most people don’t think twice about a sprinkle of peanuts on an ice cream sundae or can take a dose of penicillin without worry. While everyone avoids stinging insects, most of the time removing the stinger and applying a baking soda paste can bring relief. And yet, for some people, what seems harmless (even helpful or pleasurable) can be hazardous.

Ask Loretta McConeghy, who is allergic to penicillin. “When I was a child, my mother noticed that my tongue and earlobes swelled after I was given a shot of penicillin,” says Ms. McConeghy, who has a complex medical history and is also allergic to other medicines and peanuts. “The doctor told her that I should not be given penicillin or any related drugs. However, once when I was in my 20s, a doctor mistakenly prescribed a drug for me in the penicillin family, and that sent me into anaphylaxis. Vancomycin, which is very strong and given to me intravenously, is about the only antibiotic I don’t react to.” So cautious is Ms. McConeghy, that anytime a physician prescribes medicine for her, she turns to Dr. Bielory. “I’m leery about any medicine given to me by another doctor, so I show it to Dr. Bielory before taking it,” says Ms. McConeghy, who also works for the allergist as an outreach coordinator at University Hospital. “He’s my guardian angel.”

“While many medications can produce unpleasant side effects, such as gastrointestinal upset or drowsiness, penicillin is the most common drug to which people are truly allergic,” says Dr. Bielory. About 400 people die from anaphylactic reactions to penicillin each year. Penicillin is one of the beta lactam antibiotics; others in this class include amoxicillin and ampicillin.

Once a doctor is aware that a patient has had an allergic reaction to a medicine, keeping a record of the allergy and finding a suitable alternative are two preventive steps. The patient also is counseled to wear an emergency bracelet or necklace stating the allergy. However, what about the herbal remedies that so many people take, often without their doctor’s knowledge? With at least one popular alternative therapy, echinacea, which is used to ward off colds or reduce cold symptoms, Dr. Bielory advises caution. He cites an Australian study that found more than 10 percent of 483 adverse drug reactions involved echinacea, with 26 of those reactions being true allergies.

Food allergies are often in the newspaper headlines, and apparently with good cause. According to a study released this year by the Food Allergy & Anaphylaxis Network, about 1 in 25 Americans are affected by one or more food allergies, and surprisingly, seafood allergies are about twice as common as nut allergies. It’s the proteins in nuts, shellfish, eggs, soy, and other foods that are the allergens.

Avoiding peanut butter or shrimp scampi might not be enough for people with those food allergies, especially when dining out. “At a restaurant, food might be cooked in peanut oil,” says Dr. Bielory. “Or, a pan used to cook a dish with shellfish might be used again to cook trout. The problem comes when shellfish proteins remain on the surface of the pan.” It’s wise for people with food allergies to ask how an item is prepared or, to be extremely cautious, not eat at seafood restaurants. Carefully reading food labels and educating allergic children about what they can’t eat are two other proactive measures that can be taken.

Foods can often be avoided, but stinging insects, especially in the summer and early fall, can live up to their reputation as pests. For a small but significant number of people, they can even be fatal. The venom of honeybees, wasps, yellow jackets, hornets, and fire ants proves deadly to about 200 Americans each year.

“Insect stings have been plaguing humans at least since the times of ancient Egypt, according to hieroglyphics,” says Dr. Bielory. “Common sense comes into play here—avoid wearing fragrances or brightly colored clothes, both which attracts stinging insects. Also, don’t go barefoot outdoors. Yellow jackets, for example, burrow underground.”

There’s another preventive measure people with insect sting allergies can take—immunotherapy, more commonly known as allergy shots. Over time, the weekly shots enable the patient’s immune system to develop a tolerance to the venom. While immunotherapy can be quite effective, Dr. Bielory says that the protective effect does not take hold for several months. “After the first shot, the patient is far from being protected. It takes between six months to one year to educate the immune system,” he notes. “Even then, immunotherapy is a year-round, lifetime commitment.”

If insect stings are one of the oldest allergies known to mankind, then latex allergies are among the newest. Latex has been manufactured from rubber plants and used without problems for many decades. However, the emergence of AIDS in the mid-1980s led to an overwhelming demand for protective latex gloves in the medical and dental fields. The manufacturing process changed, resulting in gloves that retained more of the latex protein. Healthcare professionals wore gloves more often, increasing their exposure to latex protein. It’s estimated today that 17 percent of healthcare workers have developed a systemic latex allergy, compared to 6 percent of the general population. As a response to this problem, many hospitals and medical and dental offices substitute vinyl protective gloves or do not purchase powdered latex gloves. In the latter case, the latex proteins bind with the powder, and when the gloves are taken off, the powder particles are dispersed in the air, creating another danger for people with latex allergy.

Testing for Allergies

A person’s symptoms can lead a physician to suspect an allergy, but only with testing can a diagnosis be made. The most common test used by allergists is the skin prick test. Tiny amounts of allergens are individually delivered in the skin on the patient’s inner forearm. After about 15-20 minutes, small, red, raised areas form where there’s been a positive reaction. The allergist can then formulate a treatment plan with the patient.

When an allergy is suspected, the skin test is a far better way to find out than by accident. But for every person who is tested, there are others, like Mr. Weitz, who have never shown signs of an allergy but may be susceptible. That’s why knowing the symptoms of an allergic reaction—mild and severe—could save a life.

To arrange for a consultation with Dr. Leonard Bielory, call (973) 972-2762.