Anaphylaxis or Panic Attack?

There has been very little medical research into just how many people have a panic attack following a wasp or bee sting, and then have it diagnosed as anaphylaxis or anaphylactic shock by themselves or nervous medical professionals.

It is interesting but superficially there is little difference for the victim between panic attach and anaphylactic shock - there is of course a major difference pharmacologically but this is difficult to tell for the patient.  However let us start with a panic attack.

A panic attack is normally triggered by an event of which the victim may be conscious or unaware and the immediate effect is the release of epinephrine (adrenaline)  into the bloodstream.  Epinephrine is the "fight and flight" chemical that spurs us into action when in  a stressful or threatening situation. 

The effects of epinephrine in a typical panic attack are as follows:

• Increase in heart rate and palpitations
• Shortness of breath
• Feeling of doom and intense panic
• Fast breathing leading to tingling extremities

Interestingly all of the above personal symptoms can be found in anaphylaxis but typically there will be more objective measures for the diagnosis of anaphylaxis such as:

• Skin rash or hives
• Measurable drop in blood pressure (and consequent increase in heart rate)
• Noticeable "swelling" in seperate areas of the body
• Measurement of tryptase levels in the blood

It is of course ironic that epinephrine is the cause of a panic attack and yet is the defence against anaphylaxis.

It is unfortunate that many people with panic attack get to the emergency room complaining of the first group of panic attack symptoms and are then diagnosed by cautious and defensive medical staff as suffering from anaphylaxis even though the second set of symptoms are not suffered.  In addition there have been recorded cases of individuals who did not have anaphylactic shock injecting themselves with even more adrenaline during a panic attack. (R Pomphrey  Clinical and Experimental Allergy Vol 30, pp 1144-1150)

It is of course right to be cautious but there are the less cautious too who, when meeting someone with a mild form of anaphylaxis (a Mueller Grade 1) then proceed to diagnose it as just a panic attack. This can lead to undiagnosed anaphylaxis and the possiblity that inidivuals will die from full blown shock as a result.  Once again there is definite evidence that this has happened and a number of medical professionals have raised concerns about misdiagnosis of both panic attack and anaphylactic shock,

So, if you are confused about whether your sting reaction was a panic attack then ask yourself:

1)  Were there any hives or spots anywhere?

2)  Did the blood pressure drop?

3)  Did anything swell beyond the sting site?

4) Was a tryptase blood test taken and was there a positive result?

 If the answer to any of the above four was yes then the great probability is that the reaction was anaphyactic in nature. 

If the answer to the four questions was no then ask your doctor why he has diagnosed anaphylaxis because it may well not be.