When Robert Norris was growing up in North Carolina, his father took him bass fishing at Lake Gaston on the Virginia border. At their remote fishing cabin that first night, one of his dad’s buddies was stung by a paper wasp. He collapsed within minutes. The victim was obese with a known allergy to bee stings, but he’d brought along no lifesaving medication. As his airway slowly constricted, the other men struggled for a long time to carry him to the car.
“Because of his weight,” recalls Norris, “they had to trundle this guy into the car and then drive him at breakneck speed to a distant hospital. They managed to get him there in time to receive the injections he needed to survive, but it was an extremely close call.”
The medical term for such a severe allergic reaction is anaphylactic shock. It’s more common with bee, wasp, and fire ant stings; medicinal drugs like penicillin; and foods ranging from peanuts to shellfish. But even common outdoor plant allergens like ragweed pollen can trigger a life-threatening condition, especially if the person is highly sensitive and there’s excessive pollen in the air.
“It’s been said that anaphylaxis is one of the few two-way roads to heaven,” says Norris, who was so inspired by the episode that he went on to become the head of the emergency medicine division at Stanford University and editor-in-chief of the medical journal Wilderness and Environmental Medicine. “If you get a victim epinephrine in time, you can really snatch him from the grave. There aren’t many medical emergencies that are this remarkable.”
Some 50 million Americans suffer from allergies. Though most never go on to develop anaphylaxis, the itchy eyes, runny nose, and sneezing that accompany even the mildest seasonal allergy can be maddening. More severe symptoms can include rhinitis, or painful inflammation of the nasal passages and sinuses, as well as asthma attacks in those prone to this disease.
Unfortunately for sportsmen, the wilderness is, almost by definition, Allergy Central. Consider the multiplicity of plant allergens alone. “The most prolific early pollenizers are trees,” says Dr. Timothy J. Craig, a professor of medicine at Penn State. “Throughout the spring months, elm, hickory, walnut, pecan, sycamore, box elder, and a host of other tree species shower the air with pollen.”
No sooner have the trees finished than grasses, from timothy hay to Kentucky bluegrass, begin a fresh round of pollen shedding. “There’s no place outside of the North and South Poles where you don’t find grass pollens,” says Craig. Adding to a vulnerable sportsman’s misery is the fact that different types of grass pollen tend to “cross-react”-meaning that most people with sensitivity to one type are likely to develop sensitivity to others, as well.
By early August, grasses have mercifully stopped releasing pollen-just in time for weeds to take up the relay baton. Weeds are exceptionally potent allergy inducers, triggering more misery in more people than most other plant species combined. Different weed species on both sides of the Rocky Mountains shed their pollen well into autumn. “Ragweed, for example, hangs on till at least mid-October,” says Craig. “If you’re an allergic type, you can easily have outdoor plant allergies 10 months of the year.”
Even if you’re lucky enough to escape all of these, you could still be vulnerable to various animal proteins. Hunters have even been known to develop allergies to deer. “I know one hunter who gets severe hives, red eyes, and a stuffy nose that last a few days every time he kills and butchers a deer,” recalls Craig. “He’s probably reacting to proteins in the deer’s skin cells, because once the meat is cooked, it’s fine for him to eat it.” The presence of hives indicates a systemic rather than merely a local reaction, so Craig has warned this patient of the risk of anapphylaxis. “We have him carry medicine on hunting trips,” he says. “That way, if he gets in trouble deep in the woods, he’ll have the tools to keep himself alive.”
If you suffer from allergies of any sort, they don’t need to ruin your outdoor experience. Try the following:
1. Avoidance. If you know you’re sensitized by a specific allergen-say, a certain kind of tree pollen-schedule your hunting or fishing trips before or after its shedding season.
2. Wear a mask. If there are specific areas of the forest, like underbrush, which are particularly troublesome for you, a well-fitting mask can filter out the airborne particles before they reach your respiratory system.
3. Try antihistamines. Older-generation oral products like Benadryl work well to keep histamine levels in check, but many people find they have trouble staying awake after taking them. Newer nonsedating products like Claritin and Allegra are effective for mild nose and eye symptoms without inducing drowsiness. If your main symptoms are red and itchy eyes, ask your doctor about prescription eyedrops containing antihistamine.
4. Nasal steroids. If you have a history of painful rhinitis, talk to your doctor about an inhalable nasal spray like Flonase. Though this works quite well for many people suffering seasonal allergies, it’s not without potential drawbacks that range from high cost to nosebleeds.
5. Keep asthma symptoms in check. If your allergies have triggered wheezing in the past, consider packing a short-acting bronchodilator like Albuterol (prescription only).
6. Beware of anaphylaxis. If you’ve suffered an extreme allergic reaction before, prepare for the worst in the future. Extreme doesn’t mean bad sneezing fits. It does mean systemic symptoms, i.e., hives, a swollen airway, difficulty swallowing, a sudden drop in blood pressure, or other indication that your whole body is being affected. “I always tell such patients that it’s better to be safe than sorry,” says Craig. Not only should potential victims carry antihistamines and oral steroids like prednisone with them into the woods, but Craig also prescribes two premeasured doses of epinephrine (see sidebar) via an EpiPen.
7. Allergy shots. Regular injections of tiny amounts of an allergen can help your body develop so-called blocking antibodies, effectively desensitizing you. It’s a long and laborious process, however, requiring one or two injections per week for up to six months, followed by monthly “maintenance” injections every month for the next three to five years. Even given all this, it’s not always foolproof. For example, a person who’s suffered anaphylactic shock after an initial bee sting has a 60 percent chance of its reoccurrence if stung again. In those desensitized by shots, the risk drops to less than 5 percent. Reassuring, yes. “But definitely keep carrying your EpiPen,” says Norris. If nothing else, this could save your buddies from having to carry you.