Cat allergy anaphylaxis

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I got a call from the PE teacher this am just after the bell stating that a student look like she was having a reaction. I was set to go to her, but he said she was already on the way to me. Hives all around her mouth and chin and spreading to her cheeks as we were talking, also c/o throat "itchiness" and lips were looking a little full. I asked her what she thought she may have been exposed to, as this wasn't a child with an allergy plan and she said she was playing with a kitten and is allergic to cats. I'd say so.

So, stock epi administered, and s/s began to resolve. By the time EMS got there, hives were mostly faded and she said she was feeling a lot better. I can say that in my almost 2 decades of nursing, i've never before seen such a reaction to cats. I know it's always a possibility. I did discuss with the parent when she got there that a visit to an allergist is in order and to expect an allergy panel may be done to help rule out that it wasn't something else. Anyone ever see anaphylaxis from an animal?

Specializes in Peds Urology,primary care, hem/onc.
17 minutes ago, Flare said:

@rnsrgr8t if you presented like that in my office, you’d probably end up with a leg full of epi.

I had no doubts that it could happen, with it being uncommon, I thought I’d get the thoughts of my virtual nursing unit. I’ll be interested to follow up with her tomorrow if she’s in.

Thanks for your thoughts and experiences everyone!! You guys are terrific.

That's what happens when you grow up in a medical family.....you get a children's benadryl and a few puffs from your dad's albuterol inhaler and a pat on the head :). Luckily symptoms got better with that. Obviously my parents would have done more if this did not work. Different when you are in a school enviroment!

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So DH says he hasn't seen "true" systemic anaphylaxis that requires epi (throat completely shut, etc.) but 100% yes to the wheezing, urticaria, etc. He has patients who need to take antihistamines, use an inhaler and sometimes even steroids for a bad exposure. It's crazy how allergic some people can be. DS had a friend come over (we have 2 cats) and I told him not to sit on anything and not to touch anything. He was hanging out for like 15 minutes waiting for one other friend to arrive and then they were leaving. Within 8 minutes of being in my house he started having red, itchy eyes and kept clearing his throat. We have hard wood floors, he was literally standing still in the middle of my kitchen. It really can be terrible for people.

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Specializes in school nursing, ortho, trauma.
15 hours ago, rnsrgr8t said:

That's what happens when you grow up in a medical family.....you get a children's benadryl and a few puffs from your dad's albuterol inhaler and a pat on the head :). Luckily symptoms got better with that. Obviously my parents would have done more if this did not work. Different when you are in a school enviroment!

To be honest - School nurse Flare would give you the epi.. Mom Flare would do the same as was done in your house growing up. ?

14 minutes ago, MHDNURSE said:

So DH says he hasn't seen "true" systemic anaphylaxis that requires epi (throat completely shut, etc.) but 100% yes to the wheezing, urticaria, etc. He has patients who need to take antihistamines, use an inhaler and sometimes even steroids for a bad exposure. It's crazy how allergic some people can be. DS had a friend come over (we have 2 cats) and I told him not to sit on anything and not to touch anything. He was hanging out for like 15 minutes waiting for one other friend to arrive and then they were leaving. Within 8 minutes of being in my house he started having red, itchy eyes and kept clearing his throat. We have hard wood floors, he was literally standing still in the middle of my kitchen. It really can be terrible for people.

I do think that at the end of the day, a dose of benadryl would have probably done just fine. But i stand behind my decision to give the epi. As we've discussed on here before, it's better to do it and have it be a bit of overkill than be timid and later on full of regrets. It does make me wonder how my epipen trained staff would have reacted in the same scanario. They are not allowed to give the stock benadryl by law in this state

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7 minutes ago, MHDNURSE said:

So DH says he hasn't seen "true" systemic anaphylaxis that requires epi (throat completely shut, etc.) but 100% yes to the wheezing, urticaria, etc.

Wheezing, hypotension and swelling of lips, tongue or throat are hallmarks of systemic anaphylaxis. One does not need to have their throat completely "shut" to be suffering from "true" anaphylaxis. I have required IM epinephrine twice with cat exposures due to severe wheezing along with racemic epi nebs. To be fair I have had many more reactions along the line of urticaria and allergic conjunctivitis (which is something you never forget).

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Specializes in medsurg/school nurse.

on the topic of cat allergies my son was having reactive airway and I didn't even realize it. thought he had a mild cold with slight runny nose and occasional cough. we happened to be at the allergy office for routine testing due to his food allergies and the doc discovered it during her assessment. I know I know, I should have cancelled the apt but glad I didn't! she did a pulmonary function test which he did poorly on of course, did an svn in office, flu swab, sent us for chest xray, prescribed steriods. we had at least one visit in the ER with retractions before we had been prescribed the full blown inhaler and svn's for home. ER sent us home with an inhaler and I think prescribed us svn's or maybe I called the office and say hey we need this stuff please so we don't have to go back to the ER. Once we were able to do official allergy testing for environmentals we were able to narrow down the trigger to our cat which we had for 2 years before he developed this new allergy.

my son is a trifecta for immune stuff. type 1 diabetic (dx at age 5), food allergies (dx 11 months) , and environmental allergies (dx age 4 maybe, I can't remember when the cat stuff went down now).

we re-homed the cat because even with inhalers daily, singulair, claritin, and svn's prn he was still sick a lot and probably had steriods 3 times within a relatively short time frame. thankfully now we are down to singulair daily and rarely need his inhaler. I can't remember the last time we needed an svn. he seems to be able to be around cats and in peoples homes without a big issue. I usually have to add claritin back in if I know we will be around cats and still keep inhaler on us. we always have his epi due to his peanut, treenut, unbaked egg allergies.

allergies are so crazy. one reaction to the next can be so different. I get asked often "how allergic" is he. there isn't a straight answer for that.

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5 minutes ago, ARN said:

allergies are so crazy. one reaction to the next can be so different. I get asked often "how allergic" is he. there isn't a straight answer for that.

Ain't that the truth. I never know how badly I will react so Epi-pen it is.

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Specializes in ICU/community health/school nursing.
32 minutes ago, ARN said:

my son is a trifecta for immune stuff. type 1 diabetic (dx at age 5), food allergies (dx 11 months) , and environmental allergies (dx age 4 maybe, I can't remember when the cat stuff went down now).

Sweet Baby Moses....and wow! Just wow. Hang in there. I bet he's good at telling people what he can and cannot do/have....

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Specializes in medsurg/school nurse.
41 minutes ago, ruby_jane said:

Sweet Baby Moses....and wow! Just wow. Hang in there. I bet he's good at telling people what he can and cannot do/have....

He is learning. In pre-k he ate someones chocolate cheerios not knowing they were chocolate peanut butter cheerios. at the time of that reaction we did not know he had actually ingested his allergen or he probably would have gotten epi then. he was hyperventilating, complaining of back pain and had some small hives. thankfully it resolved fairly quickly without intervention. I think the hyperventilating was because it was causing him some intense GI pain. He didn't divulge that he had eaten something until later in the day. in kindergarten he high fived a kid who had been eating peanut butter, got some on his hand, thought it was his sunbutter he was eating and realized it pretty quick when he licked it off that it wasn't. thankfully that reaction was just some hives around his mouth and he told an adult right away what happened. he ate someone elses cheese (not his allergen, but the point is DON'T EAT OTHER PEOPLES FOOD!) in kindergarten and that earned him a seat at the end of the lunch table so the TA's can keep a closer eye on him. I was trying to avoid making him feel singled out but he needs to mature and be more responsible. now in first grade he has been asking me why he has to sit at the end of the table and he can't choose where he sits. so we go over again all the past experiences and why its important he sits a little further away from anyone eating his allergens. I told him maybe next year we can trial him sitting where he wants but this year he isn't ready.

we will get there! he is generally good if someone offers him something to eat he will ask them if it has nuts in it and if there is a label. I know he is listening to me and he does frequently advocate for himself. 7 year old temporary lapses in judgement happen though.

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Specializes in School nursing.
4 hours ago, ARN said:

7 year old temporary lapses in judgement happen though.

Heck, I've had plenty of 15 year old lapse in judgement happen, including a kid severely allergic to tree nuts and peanuts eat a peanut butter almond cookie.

This thread is fascinating. As a cat and dog owner, I try my best to wipe off any hair from my clothing prior to work, but I know I'm not perfect. Haven't had a kid with severe of an allergy but as I've learned in school nursing, only a matter of time...

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On 11/13/2019 at 9:11 AM, MHDNURSE said:

Wow! I have seen severe SOB, wheezing and only hives if the cat licked the person. I am going to ask my husband who is an allergist if he has every heard of such a strong reaction. Pretty scary if that is the case.

That’s a pretty severe reaction.

On 11/13/2019 at 9:11 AM, MHDNURSE said:

Wow! I have seen severe SOB, wheezing and only hives if the cat licked the person. I am going to ask my husband who is an allergist if he has every heard of such a strong reaction. Pretty scary if that is the case.

That’s a pretty severe reaction.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Cat was #1 on last years allergy retesting + part of my desentization allergy shots. Can't tolerate rabbits either learned from feeding my next door neighbors pet during his vacation. Dogs 50/50 -dachshunds ok. ?

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Specializes in Med/Surg, Emergency Room, School Nurse.

Glad to hear that the little one bounced back quickly. I understand her reaction.

When it comes to cats its "no Buenos" I'm allergic to both dander and saliva. I get the swelling eyes, stuffy nose to the point I can't breath, hives head to toe. I can't go to anyone's house that owns a cat d/t my allergy. If my kids go somewhere with a cat they have to leave their clothing at door and run to the shower before they can come within 5 feet of me. I pretty much avoid cats like the plague.

The last time I had a severe reaction is the last time I was in Kohl's my husband had to wisk me out and ran to the Target across the parking lot to get me some b-dryl. Lets just say it was borderline Will Smith in the movie Hitch. "Juice Box"

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