Anaphylaxis on a plane – lessons I learned the hard way

Hi A&AA, I am allergic to nuts and recently went into anaphylactic shock on an airplane. My husband and I wrote this story soon after my reaction, partly to help us process what happened but also to help others learn from our experience. I have had severe allergies since my teen years, experienced several anaphylactic reactions yet had never experienced a second phase of anaphylaxis. I did experience a second phase on this flight. My girlfriend who has a daughter with food allergies told me about your group a few days ago. We just want to save people the trauma we have suffered and potentially save lives.

Two days ago, I went into anaphylactic shock on an airplane after having accidentally ingested cashew nut. If it weren’t for my medically trained husband, the flight attendants and pilots working together, I don’t think I would have made it.

Please share this warning. If you know anyone who is allergic to nuts or other foods, please share these lessons that I learnt today about anaphylaxis.

I have been there time and time again, but never like this. Sharing my story might just help save someone else’s life.

We had just taken off from Sydney, heading to Cairns. The flight attendant served me some lunch. I told her I was allergic to nuts, so together we checked the ingredients. They had every ingredient listed in a wonderfully detailed book.

We checked the chicken curry and it was clear, so she served it to me, with a small cheesecake on the plate. I didn’t check the ingredients of the cheesecake (my first mistake). I don’t know what I was thinking.

I have never come across nuts in a raspberry cheesecake. I think I just assumed it was fine. It was my all time favourite dessert and I was tempted.

The hostess was busy and she knew I was allergic to all nuts and still served it to me; but I didn’t ask. It was not her fault, it was mine. I didn’t check and I tried it, the tiniest bit, but that was all it took.

Within seconds my tongue started tingling. I told my husband and raced to the bathroom to wash the rest from my mouth. It wasn’t far, I was right next to it.

By the time I came back out (maybe 10-15 seconds) they had found out it was cashew. My throat had already started constricting and I knew I was going into anaphylaxis.

My husband got my EpiPen (adrenaline), ventolin and antihistamine and gave me all three and lay me down on the floor, he wouldn’t let me sit up. Being a former GP himself he knew to keep checking my blood pressure and heart and lung sounds every 5 minutes, and he kept doing so.

I did not have an ASCIA Action Plan. I did not know they existed. But I have had anaphylaxis numerous times before, and thought we knew what to expect. Within what seemed like minutes of having the adrenaline my throat was easing, though now I know in hindsight, not completely. It didn’t seem to go completely back to normal, though I would say I was 90% better.

After about half an hour my blood pressure stabilised to low normal and my husband felt my colour had also returned to normal. I was feeling ok, but still not great, so he kept me lying down. One of the pilots had come to check on me and a hostess stayed with us the entire time.

They asked us if we wanted to divert to the nearest capital city but we thought I was ok, so far, this was my typical response. We decided to continue to our destination which was 2 hours away from where we boarded. As far as we knew I was going to be ok. This was my usual reaction, from here on in, I should have been fine. I wasn’t.

After about 45 minutes, I was still lying down and being monitored diligently by my husband and watched by the air hostesses and my little girl.

Suddenly, I began to struggle to get a deep breath; I wasn’t wheezing, I just needed more space and I felt like someone had strapped a thick band around my chest.

I felt nauseous and had stomach cramps, but that normally happens at this stage for me.

I really wanted to sit up. I thought that would help me breathe better and help the nausea. I thought the space I was lying in was too cramped. I had never experienced that before, ever, and honestly thought I was just getting a little claustrophobic.

My blood pressure had returned to normal and had been stable for about 35-40 minutes, my colour was good but I did feel this strange tightness in my chest I actually thought was my bra. I thought it was too tight. My husband at this stage knew the adrenaline had worn off, but that the antihistamine had kicked in.

Seeing my blood pressure was stable and I kept telling him I was ok and needed to sit up, he slowly helped me sit upright (my second mistake).

Within minutes of sitting upright I felt dizzy, light headed and tingly all over. I began to sweat and apparently my colour drained. He very quickly lay me back down. I remember tingling all over.

My husband took my blood pressure and they put an oxygen mask on me. That was all they had, there was no adrenaline available in the medical kit.

I heard my husband tell the hostess she needs more adrenaline. She is having a second phase. I didn’t know people could have a second phase. I had never had one. We did not have a second EpiPen (our last mistake). I heard the hostess say we don’t carry them on the plane.

My husband restated, “We need adrenaline NOW”. He told the staff they needed to get the plane down NOW. I heard him run down the plane yelling, ‘Has anyone got adrenaline?’.

I was still conscious; I looked at my hand, it was ashen white/blue. Apparently, all of me was that colour.

All of a sudden a strange calmness came over me. I couldn’t talk. I felt absolutely nothing. They kept giving me oxygen. The hostess told me to hang on, it was 8 minutes until we landed and the paramedics were waiting.

I felt the plane descend. We were going down fast, diverting to Townsville. My husband came back quickly, but with nothing. No one had anything. He held my hand and I calmly held my daughters hand. I heard him telling me to hold on. I closed my eyes, but made myself open them again.

I knew I had to stay awake for Georgia, my 7 yr old. I had to smile at her. Keep her calm.

They landed the plane with me on the floor. The paramedics were there within seconds of landing. I heard them ask if I was conscious. My husband said, “ yes.” I still couldn’t move, but felt very calm. He told me I was going to be ok. They transferred me to the ambulance, gave me the drugs I needed and took me to the nearest emergency department and…..now I am sharing my story.

Editor’s note: This frightening story reminds us that:

• Most reactions occur when people with food allergy are away from home and eating unlabelled food.
• We must ALWAYS ask about food content (even if you think you are being a pain or someone is too busy to help!) otherwise DO NOT EAT.
• Like children, adults with food allergy need to be under the care of an allergist for ongoing education and management. Allergies change all the time.
• A&AA advice is to always take two adrenaline autoinjectors with you when travelling. If your doctor only prescribes one device, discuss the issue of how many devices you should carry with them prior to travel. Some people need a second dose after 5 minutes and 15% of people can have what is called a biphasic response as did the lady above. It is difficult to predict who will need a second dose of adrenaline and emergency help is not always as close by as we need it to be.
• Whilst most airplanes have adrenaline in their Medical Kit, some do not. Some have only adrenaline ampoules, some have adrenaline ampoules and autoinjectors and some have none. If adrenaline is available in the form an ampoule, a needle and syringe are required and flight crew rely on a doctor or nurse being on the flight (as passengers) to have it administered in an emergency.
• Every patient should have an ASCIA Action Plan for Anaphylaxis which specifically addresses posture of the person having the allergic reaction.
• To learn more about how to prepare for an emergency, and what to do if you or someone you are with has a severe allergic reaction, visit our Emergency Treatment – Being Prepared page.