A youth collapses while enjoying a crab meal on the beach in Digha. He complains of dizziness and shortness of breath before passing out. His friends assume it’s a heart attack and rush him to a doctor, but he dies before any medical help can be administered.

Such incidents are not uncommon. In 2021, two similar deaths occurred in Digha within a month. But what was initially believed to be a heart attack turned out to be a severe allergic reaction — anaphylaxis.

Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur within minutes of exposure to a trigger. “Common culprits include nuts, shellfish (like prawns and crabs), eggs, wheat, certain fruits and vegetables,” said Dr Anindya Kundu, a BJ Block-based paediatrician and paediatric allergist.

Kundu is also an executive body member of the West Bengal chapter of the Indian Academy of Paediatrics, Allergy and Immunology Chapter. “It can also be caused by certain medications, and insect stings such as from bees and wasps.”

Incidentally, it is believed that when Sunjay Kapur, industrialist and former husband of actress Karisma Kapoor, died last month after swallowing a bee, it was due to an anaphylactic shock from the bee stinging his mouth.

“Sadly, awareness of this condition is very low, whereas a simple emergency medication can save lives,” said Kundu, who sits at his BJ Block chamber and HP Ghosh Hospital. “The World Allergy Organization observes World Anaphylaxis Week between June and July to spread awareness.”

Common allergies

In Western countries, peanut allergy is very common. Though less prevalent in India, such allergies still exist and often go undiagnosed.

“A mistake parents make is delaying the introduction of certain foods, whereas by the age of one, a child should be eating everything,” Kundu explained. “Problems arise when children encounter allergenic foods like prawns for the first time through skin contact, which can trigger an immune response. The first exposure should be through ingestion, not by touch.”

Sunjay Kapur, industrialist and former husband of Karisma Kapoor, is suspected to have died of anaphylaxis

Some allergies—such as those to cow’s milk and eggs—can be outgrown, but others, like peanut or shellfish allergies, last a lifetime and must be taken seriously.

Half-hour window

Anaphylaxis can occur within minutes of exposure and includes symptoms such as intense itching or rash, swelling of the lips, tongue, throat, or eyelids, wheezing, difficulty in breathing or speaking, sudden drop in blood pressure, fainting, abdominal cramps etc. “And if not treated in 30 minutes, the patient could die,” Kundu warned.

In the West, those diagnosed with severe allergies carry a ready-to-use syringe preloaded with adrenaline to counter the reactions. Adrenaline is a hormone naturally produced in the body during stress, danger, and is central to one’s ‘fight or flight’ response.

“In India, this syringe must be imported and costs about Rs 10,000. It’s not affordable for everyone and comes with an expiry date,” Kundu said. If you do carry one, you must learn how to use it and also teach your family, teachers (for children), or colleagues to administer during emergencies.

Those without access to this pre-filled syringe must be rushed to a hospital for an adrenaline (1:1000) injection. “Adrenaline vials cost no more than Rs 20. The doctor needs to inject 0.5ml intramuscular on the thigh for adults and even less for children,” said Kundu.

“It can be injected even over clothing, since every second counts. Adrenaline has no side effects, so even if a doctor suspects anaphylaxis without being sure of it, injecting adrenaline could save a life.

Even after the initial jab, the allergy may relapse, so the patient must stay under observation for 24 hours in hospital.

Test for allergies

If you suspect you have an allergy but are unsure of the trigger, take a skin prick test. “Here, we prick the skin with extracts of common allergens like dust mites, walnuts, milk, chocolate, wheat, coconut, pollen, etc, after detailed discussion with patients. It’s almost painless, and results are ready in 15 minutes. There are more advanced tests too, but they are expensive and not recommended unless absolutely necessary,” Kundu said.

Macaulay Culkin’s character in the 1991 hit film My Girl dies of severe allergic reaction after being stung by bees

In some cases, allergies can be managed over time by administering low doses of the allergen, daily, for the body to gradually tolerate it over a span of around three years or longer.

Prevention before cure

If you know you are allergic to something, avoid it like your life depends on it. “Some allergies can be so severe that even if the plate you eat from previously held nuts and wasn’t washed properly, it can cause a reaction,” said Kundu.

So be vigilant when eating out and always check food labels before tearing open a packet and munching. “Sometimes the nutritional facts will vaguely say: ‘may contain nuts’. Assume this to mean it does indeed contain nuts and stay away,” he warned.

It is vital to keep a written note of your allergy and past episodes on your person. “Paste a note under your watch, inside your wallet, or behind your phone with details of what you are allergic to and that you’ve been revived with adrenaline before. Doctors will immediately know what to do,” Kundu said.

He especially called for awareness in the primary health centres of coastal towns like Digha, Mandarmani and Shankarpur, where many tourists try seafood for the first time.