Wednesday 8 May 2013

Anaphylaxis, The Shock Of The Peanut

What do a Rock Star and a Government Minister for Equalities have in common, other than an interest in their particular public images etc.?  In the last couple of days it is anaphylactic shock, the potentially terminal allergic extreme reaction to something that has become a permanent threat to their immune system.

In both cases the apparent cause was peanuts, Liam Gallagher, the rocker, when hungry went for a package of M&M’s, a popular sweet that turned very sour.  Jo Winsor the Lib Dem Member of Parliament doing her constituency duty had a bite of lovely home cooked cake and then bit the dust, almost.

They were among the lucky ones who had treatment in time.  With this problem it is possible that among the many sudden deaths are some that are anaphylaxis never either identified or suspected.  Also, there are many potential causes and a big one can come out of the blue.

One major problem is “words”.  Allergy might be a medical condition but the word is used colloquially in other ways.  Similarly, “reactions”, “attack”, etc. are also not precise.  What is missing is some sort of structure to define the levels as clearly as possible to allow better understanding and description.

Here is one below, based on a common framework a 1 to 5 Scale with the 1 being the least and the 5 being the most dangerous. 

In the case of the two cases that made the headlines they were both at Scale 5 and they were lucky to survive.



The Reaction to Allergy and Toxicity Scale (RATS) is a scale of one to five of the severity and impact of a physical and neural reaction to any substance or combination of substances.  The scale is a broad indicative measure of relative effect.  It is not diagnostic and at the margins of the central three parts of the scale the distinctions may be variable or not clear cut.

The intention of the scale is to enable both those affected and those involved in any treatment to have a common perception of the degree and extent of the problem.  Also where an individual has reactions to more than one substance either separately or concurrently it will help to estimate a simple differentiation of effect between one substance or another.

The RATS Scale is:

  1. Mild
  2. Moderate
  3. Serious
  4. Severe
  5. Extreme

Extreme (RATS 5)

This is a reaction that is potentially terminal within a short period of time or induces a collapse with loss of consciousness or brain or muscular control.  It includes anaphylactic shock or coma or toxic shock.  It will require immediate emergency treatment and probably hospital admission. 

A person vulnerable to this level of reaction will have restrictions, safeguards and monitoring at a constant and high level.

It will be critical to determine both the cause of shock and the extent of other issues and vulnerabilities.

Severe (RATS 4)

This may begin in many cases with a lesser form of shock but may arise from either persistent or cumulative reactions.  It is when the condition is debilitating with some loss of bodily or neurological function that may be recurrent or chronic. 

The impact on function and management of life will be extensive and will require continuing monitoring and safeguards to prevent the risk of a RATS 5 attack. 

It will require testing of a number of substances and possibilities to determine any immediate cause of shock and to ascertain whether more than one substance may be involved in the nature of the vulnerability.

Serious (RATS 3)

The impact and extent of the reactions will require continuing medical intervention, treatment and monitoring.  The nature of the reactions will have adverse effects on the individual’s ability to control their environment and in the making of life choices.  Commonly, at this level it will be necessary to impose restrictions, safegards and active avoidance procedures and measures.  Impairment of mental and physical functions will be evident and disruption of life management.

Moderate (RATS 2)

The reactions will cause marked effects and have more than nuisance value.  They will be more evident and medical advice should be sought on the actual and potential causes to try to avoid the risks of increasing severity of reaction.  They will require treatment and may be continuing in effect.

Mild (RATS 1)

The reactions will be noticeable and a source of either discomfort or minor medical issues.  They will not be such as to disrupt or to badly impact on life choices or activities but need an awareness of their risks.  In many cases minor medical treatments will be needed or helpful together with an awareness of possible causes.


There is a great deal of information about allergy and the many reactions that can occur.  This can be helpful and confusing at the same time.  An issue is that the word “allergy” is used extensively for many types and levels of reaction and as a colloquial descriptive word for any effect and sometimes opinion. 

Attempts are made to distinguish reactions by the use of words such as “intolerance” and “sensitivity”, which can be useful to assist recognition in terms of the Mild Level 1 RATS effect but are too broad in their meaning to deal with severity.

The issue of “toxic” effects is less recognised and may be difficult to define without immunological analysis but the word can be used in broad terms especially at RATS Levels 4 and 5, Severe and Extreme.  Possibly “toxic” is more applicable to effects that are immediate and powerful.

There are two matters that interconnect.  The first is that allergy, medically, is one set of reactions and toxicity is another.  However there may be areas of uncertainty and overlap.  The other is the difficulty of assessing cause and effect. 

One real and major problem is that most ordinary science is concerned only with a linear approach to research or investigation; that is the search for a single cause with an identifiable single effect. 

This dominates the handling of cases and treatment.  But allergy and toxicity issues are likely to be far more complicated.  Reactions may have complex causes and in turn particular causes might have complex effects.  Medical services at present cannot cope with complexity and are reluctant to admit them. 

Dealing with any complexity requires rigorous monitoring, assessment and analysis normally over a period of time.  What appears to be a cause may only be a means for another cause to take effect.


The picture above is of the safeguard that people at risk need to carry to buy time in the event of going into shock.  They are hypodermic auto-injectors of a set amount of the medication needed to try to control the reaction and buy time until treatment.

There is a delicate irony in a rock star being obliged to carry a couple of needles to keep him going when things go wrong, never mind a politician.

1 comment:

  1. "Medical services at present cannot cope with complexity and are reluctant to admit them."

    I suspect this is because each case could turn into a research project with little prospect of success.