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 potential terminal allergic
shock from something that has become a permanent threat.
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.
Quote:
THE RATS SCALE OF ALLERGY & TOXICITY
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:
Mild
Moderate
Serious
Severe
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.
Notes
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.
Unquote.
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.
We have a family member allergic to milk and foods containing milk at what is probably RATS 1 level.
ReplyDeleteThe concern is that it may get worse but our experience is that medical testing and advice is not readily available.
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