anaphylaxis

Fragrance allergy

Public understanding of allergy pathology is often inaccurate and can create dangerous misunderstandings. The most common is that you must ingest a protein in order to have an anaphylactic reaction. Another is that inhalation or skin contact cannot cause severe reactions.

Both of these are inaccurate, especially, but not only, for people with mast cell disease. People without mast cell disease have severe reactions to IV contrast without having allergy antibodies to the protein (Singh, 2008). Inhalation can cause anaphylaxis. There are even cases of patients who can tolerate ingestion of a food but not inhalation, such as seen in Baker’s asthma, the second highest cause of occupational asthma in the UK (Ramirez, 2009). While ingestion of protein is the most common mechanism for severe allergic reactions, it is certainly not the only one.

Fragrance allergy is a growing problem worldwide. Fragrance is now one of the top five allergens in North American and European countries and can cause skin, eye and respiratory problems (Jansson, 2001). At least 100 chemicals commonly used in fragrances can cause contact allergies when applied to skin, even passively (Johansen, 2003). European Commission’s Scientific Committee on Cosmetic Products and Non-Food Products’ 1999 list of allergenic substances contained 24 chemicals and 2 botanical preparations, all used as scents (European Parliament and Council Directive 2003/15/EC, 2003).

Though the exact mechanism is not clear, perfume is known to cause asthma and other respiratory problems (Elberling J, 2009). A Dutch study found that isoeugenol, a common component of fragrances, can cause increased proliferation of cells in respiratory tract lymph nodes when inhaled (Ezendam J, 2007). However, more research is needed in this area.

A significant portion of the population also reports adverse reactions to scented products in general, even when worn by others. Products like scent lotions, perfumes, soaps and air fresheners are all cited as problematic. A 2009 paper reported on the results of two surveys of over 1000 people. 30.5% of the general population found scented products on other people to be irritating. 19% reported health effects from air fresheners, and 10.9% reported the venting of scented laundry products as causing symptoms. Percentages were higher among asthma patients and those with chemical sensitivity (Caress SM, 2009).

Symptoms reported from exposure to fragrances on others includes: headaches, chest tightness, wheezing, diarrhea, vomiting, mucosal irritation, reduced pulmonary function, asthma, asthmatic exacerbation, rhinitis, irritation of the airway, nose and mouth, and dermatitis (Caress SM, 2009).

Many of you are aware of the recent dispute over whether or not essential oils can be dangerous. They can. Even in the absence of known chemical triggers, the oils themselves can be triggering to many. As an example, clove oil, which has a large eugenol component, has been tied to severe allergic reactions (A.O. Nwaopara, 2008). Oils of citrus fruits are known to liberate histamine and make it more available to cause mast cell symptoms (Novak, 2007). Furthermore, while the reaction profile of each mast cell patient is unique, the hallmark of mast cell disease is anaphylactic reactions to seemingly harmless substances. Mast cell patients are increasingly being viewed as “canaries in the coal mine” for their ability to detect minute quantities of offensive components. While mastocytosis is rare, affecting about 0.3-13/100000 patients, some level of mast cell activation syndrome (MCAS) is thought to affect a much larger percentage of the population, in the neighborhood of 5% (Molderings, 2014).

Fragrances, from essential oil or otherwise, can cause contact allergies, headaches and respiratory symptoms. In mast cell patients, scents can cause severe full body reactions that are potentially life threatening or fatal.

MCAD: General information for public

Mast Cell Activation Disorders (MCAD): Frequently Asked Questions

What are mast cell activation disorders?

They are a group of conditions  in which the mast cells in the body do not function correctly.  MCAD includes systemic mastocytosis, urticaria pigmentosa and mast cell activation syndrome, among other conditions. Mast cells are responsible for allergic responses. In MCAD, patients can have allergic type reactions to things they are not allergic to. These reactions can be very severe and even life threatening.

What are mast cell reactions?

These are reactions caused by mast cells being improperly activated. These reactions vary from person to person. Symptoms can include, but are not limited to, nausea, vomiting, hives, rashes, itching, flushing (turning red), dizziness, confusion and irritability. Symptoms are caused by the chemicals released by the mast cells.

What causes mast cell reactions?

Triggers vary from person to person. More common triggers include heat, cold, friction (especially on the skin), sunlight, foodstuffs, physical exertion, stress, dyes and fragrances. Triggers can also change over time, with new triggers presenting.

Are mast cell reactions dangerous?

YES. Many MCAD patients will experience uncomfortable reactions throughout their lives. However, every reaction carries the risk of anaphylaxis, a life threatening, severe allergic reaction. Therefore, avoiding reactions as much as possible is very important for mast cell patients. Each patient has an individualized response plan. For many, it involves removal of trigger and administration of medication, such as antihistamines or inhalers.

What is anaphylaxis?

Anaphylaxis is a severe allergic reaction affecting multiple organ systems in the body. These are the kinds of reactions observed in patients with bee sting allergies. Anaphylaxis can be fatal. It is a medical emergency requiring immediate treatment, usually epinephrine (Epipen.) Please receive guidance from treating physician on when to use an Epipen.

How are mast cell anaphylaxis and mast cell reactions different from normal allergies (like food allergies?)

With allergies, your body reacts by a specific method that involves ingesting and recognizing the allergen. In MCAD patients, the mast cells incorrectly think many things are allergens. Since mast cells are so sensitive in these people, ingestion of an allergen is NOT necessary to cause mast cell reactions or anaphylaxis. Smelling a perfume or breathing in very hot, humid air is enough to cause a reaction in many MCAD patients.

What causes MCAD?

Genetic mutations cause different kinds of MCAD. Recent studies have shown that mast cell disease can affect multiple members of the same family.

Why do some MCAD patients have spots?

These spots occur in locations where there are more mast cells than usual in the skin. These are NOT contagious rashes. In addition, MCAD patients who do not have permanent spots often have very sensitive skin, which may cause temporary marks or rashes.

How can I help an MCAD patient be safe?

By not being afraid of their disease. Respect their triggers and help them work around these limitations. Reactions can be painful and very scary, especially for kids. Learn the symptoms associated with reactions and be ready to help with a response plan.

 

Is there more information you feel should be included here?  Let me know in the comments and I can add it in.

Sorry not sorry – Why I’m calling out singer Natalie Grant

Saturday afternoon, a masto friend reached out to me.  She was upset about a Facebook post by a prominent Christian singer, Natalie Grant.  Ms. Grant posted the following to her Facebook wall on Saturday:
“Such a sweet time in Minneapolis at Women of Faith.  But now it’s on to LAX to continue filming the next episode of It Takes a Church.  And why yes, that is a battery operated essential oil diffuser that I’m using in my airplane seat.  Rocking the thieves oil and keeping the germs away.  And it’s helping the plane to smell much better #sorrynotsorry”
I groaned when I read it.  I actually groaned out loud.  I opened the thread to find mast cell patients commenting that oil diffusers can be dangerous for people like us, that they could trigger anaphylaxis. Grant’s fans argued that these people were just looking for something to complain about, that oils could never harm anyone, that you have to ingest a protein to have anaphylaxis.  The general spirit of their responses was that mast cell patients were just being oversensitive. 
That’s exactly right – but not the way that they mean.  Our bodies experience severe reactions to pretty much anything – and those reactions aren’t in our heads.  The fact that so many people commented that it was impossible for an oil diffuser to present a real health risk to others represents a serious danger to people like myself.  That is why the mast cell community found this so upsetting.
So let’s discuss why this is dangerous for people with mast cell disease.
Mast cell diseases are a group of disorders in which your body either makes too many mast cells, mast cells do not function correctly, or both.  Mast cells are the cells that are responsible for allergic reactions.  For normal people to have an allergic reaction, their body has to make a molecule called IgE that remembers it is allergic to something.  So people with peanut allergies have peanut IgE, and when they eat peanuts, the peanut IgE tells the mast cells to have an allergic reaction. 
People with mast cell disease pretty much skip this step entirely.  We have severe allergic reactions to things we are not actually allergic to.  This includes lots of foods, materials, environmental factors and others.  For some people with mast cell disease, these reactions include unpleasant symptoms that can be managed at home, like nausea/vomiting, skin reactions, headaches.  But some of us have severe, life threatening anaphylactic reactions based upon even very casual exposure to these substances.  These reactions require use of epinephrine (Epipens), IV antihistamines and steroids, and monitoring at the hospital to ensure that we survive.  People with severe mast cell disease can have several of these episodes in a year.  (I had three in 48 hours in May.)
To be clear: anaphylaxis can be fatal.  Mast cell patients are more likely to experience anaphylaxis and more likely to have severe reactions.  Our best protection is to avoid triggers and medicate appropriately, but this isn’t always possible.  Due to the rare and unusual nature of our diseases, there are few specialists worldwide so the vast majority of patients must fly to see them.  Hiding at home all the time with a mask on is both not practical and not an acceptable way to live. 
Every day, people with mast cell disease seek to minimize the damage to their bodies by avoiding triggers as much as possible.  In enclosed indoor spaces, this can be particularly difficult.  Once triggered, the only option is to medicate and end exposure to the trigger.  When flying, this is obviously impossible. 
While mast cell diseases are rare, fragrance sensitivities and asthma are not.  The CDC has stated that some risks of exposure to scents include asthma attacks, allergic reactions, headaches, migraines, sore throats, coughing, eye irritation, and other medical symptoms.  Asthma attacks can be triggered by fragrances in 72% of asthma patients.  Patients with multiple chemical sensitivity often have severe symptoms similar to those mast cell patients experience.  The fact that workplaces are gradually transitioning to be fragrance free environments is indicative of scent exposures negatively impacting the quality of life for many people. 
In an age of increasing allergies and allergic-type reactions, I find that people like me are often at odds with people who feel their personal liberties should not be curtailed.  Many people see this stand against the use of a personal diffuser as an attempt to impose the will of a suffering minority onto the population at large.  They are entitled to feel however they feel.  But as a mast cell patient, this is about allowing us to move as safely through the world as possible.  Is it worth feeling “infringed upon” to not use an oil diffuser in an airplane when it could kill someone?  Literally kill them?
Natalie Grant put up a follow up to the original post the next day.  While it initially looked promising, I was very disappointed.  It includes such gems as, “I am not here to argue about whether pure Young Living essential oils specifically, can harm those with this disease.” And, “I have a niece that is so allergic to peanuts, she can be in the front row of a plane and the person in the back row can open a bag of peanuts and she can go in to anaphylaxis.  However, EVERY TIME she flies, she has to inform the airline and flight attendents of her life-threatening condition.  May I make a suggestion to those who are suffering: be vigilant with airline employees.  DO not allow the plan to take off until the passengers have been informed there is someone on board who has a specific life threatening disease, so please do not use perfumes, lotions, oils, etc while on board the plane today.  No one will be a better advocate than YOU.”
This statement sums up exactly how much Natalie Grant is missing the point.  If I stood up in front of a plane and told people not to use anything scented, they would snicker and still use them because nobody believes we can actually die from a reaction to a scent.  When mast cell patients spoke up to point out that her use of an oil diffuser could be dangerous to us, we were mocked and shouted down.  We are advocating for ourselves.  The problem is that Natalie Grant, and her fans, just aren’t listening. 
And mast cell disease being dismissed publicly by someone with her sphere of influence?  Well, I’d venture my world is even a little bit more dangerous now than it was before Saturday.  So I’m calling her out.  #sorrynotsorry
A succinct presentation that sums up scent related health issues for the general public (along with list of references for above statistics) can be found here: http://www.slideshare.net/J_A_Miller/fragrance-sensitivity-awareness

Hope

Yesterday I got myself really stressed out and had full blown anaphylaxis.  I used my epipen and pushed meds and sulked on my couch.  It was a sulking kind of day. 
Today I woke up with sore, weak muscles.  My hands shook as I made coffee in the dark, my eyes too sensitive for light.  My skin burned.  I burnt my tongue on my coffee, swallowing a handful of pills.  I rolled my eyes when I confirmed that I still have a lower GI bleed.  I hooked up another bag of IV fluids and went back to bed.  I thought about some recent events and how low they had me feeling.  I thought about the danger to a community that doesn’t get all the information they need.
But tonight I got hundreds of messages from people supporting me and thanking me for all I do.  It was really, really humbling and amazing. 
There needs to be a safe place to vent about your experiences and receive support from people who understand you.
There need to be multiple reliable sources of information, with cited sources, readily accessible by people who need it to make decisions.
There needs to be security in the community that you are among honest people who do not seek to manipulate others. 
There needs to be certainty that when you entrust someone with your personal health information that they will not betray that confidence.
There needs to be an understanding that people who do what I do exist to serve our community, not the other way around. 
There needs to be democracy.  There needs to be a way for people to disagree without retribution.
There needs to be hope.  People deserve to know that it’s not hopeless. 
I have mentioned before that a lot of people tell me their secrets.  They’re not always health related; I seem to be the recipient of quite a bit of gossip these days as well.  I told a mast cell friend of mine recently that I didn’t know why people told me these things. 
She responded, “It’s because you’re our leader,” and I shivered.
I don’t think of myself as being a leader.  I think of myself as being a sick woman who is trying to help other people be less sick and more heard.  I am just another mast cell patient.  I am just like all of you. 
But if you think of me that way, then I want you to know this: 
It bothers me to see so many scared people when we live in an age of so much hope for these diseases. 
This is not rhetoric.  We are seeing real results with new medications and are diagnosing people earlier.  Just twenty years ago, mastocytosis was usually found on autopsy.  How amazing that now we can be treated and live with this, even when it doesn’t feel like a blessing.
I believe we won’t always be sick.  I believe that if just twenty years ago, very few could live with mastocytosis, that in another twenty, we’ll all take a pill every day and be free.  I really, really believe this. 
None of the nonsense that happened this week matters.  If I can give people hope, it is worth it. 
Hope is what’s important.  I have it.  So should you.

Beautiful things I can’t have

I’m a Buffy fan girl.  I’m sure this surprises no one.  Strong characters, the supernatural and witty banter is basically a recipe to get me as a loyal fan.  I know all the words to the sing along episode and have been compared to Willow more times than I can count. 

There’s an episode in the fifth season where Xander and Anya go to look at an apartment.  She is upset because she doesn’t think they’ll get it.  Xander asks her what’s wrong and she says this:
“What’s going on with me is that my arm hurts… and I’m tired… and I don’t really feel like taking a tour of beautiful things I can’t have.” 
That’s how I feel right now.  I don’t really feel like looking at beautiful things I can’t have.
I have always identified as a traveler.  As a kid, I would take out language books from the library with the clear intention of learning the language for when I went there.  When I was 19, it occurred to me that if I saved up my money, I could go wherever I wanted.  I got some books and planned a trip and went to Europe. 
In 2007, when I was starting to get sick, I went backpacking in Scandinavia.  I went hiking and got really lost in this beautiful national park in Norway.  I got drunk on a ferry sailing between Estonia and Finland.  I felt tired and at the end, I felt sick, but I was mostly able to do everything I wanted to do.
In 2009, I bought tickets to Ireland and went for a quick four day trip with my boyfriend at the time.  I was exhausted and sick, but I was still able to go.  I needed a lot of sleep but otherwise it was fine.
I took a bunch of other trips.  In 2012, I went to Seattle and we all know how that went.  I came home to lots of serious news and slowly I stopped thinking of myself as a traveler because it hurt a lot.  I stopped reading my dozens of travel books and drawing maps and studying languages.  Doing those things felt like sticking my hand into an open wound.  It felt like trying to push through the looking glass only to find I was still in this strange facsimile of my life where I was sick and couldn’t do this thing that defined me.
In the last couple of weeks, I started feeling like maybe this was going to be possible again.  Maybe I could travel, if I had someone with me to help me.  Maybe I could plan trips again and look forward to them.  Maybe I could go to all these faraway places and feel this stillness in my soul that I only find when I’m away from home. 
I was supposed to go to Asia in the fall.  I was originally supposed to go in the spring but I was too sick.  So we decided to go in the fall.  We were going to fly through Dubai to Bangkok, spend a few days in Bangkok, take a private tour to Angkor Wat in Cambodia, go to an elephant preserve, spend a few days in Dubai on the way back.  I have been planning this for months, both the fun part and the not insignificant logistical shuffle of travelling out of the country with a ton of medication, medical supplies and large bags of IV solutions.  I was planning to book our airfare tomorrow.
But a few days ago I found that one of my best friends was stealing from me, and she was supposed to go to Asia with me.  She was supposed to help me to live this dream that has buried for years under the rubble of mast cell disease. 
I’m more upset about Asia than I am about the money.  Because I found out a couple of weeks ago that I could still travel, but only if I’m with someone who loves me and understands my disease and what to do in an emergency.  I cannot travel alone.  I wish I could, but I can’t deny that it’s too dangerous for me. 
The fallout of this woman stealing from me has been significant.  I have needed epinephrine and lots of IV meds and steroids, and even now as I type this, my skin is burning and my heart is racing and my insides are doing that cringe and shudder that means that with just a little push, I can be in trouble again.
When you have mast cell disease and people mistreat you, your choices are to move on quickly so as not to anaphylax or to get mad and risk ending up in the hospital.
It’s not as much of a choice as you might think.
If I fall down and scrape my leg, it is an emergency.
If I forget to take a single dose of any of my many medications, it is an emergency.
If I forget to put on the AC and fall asleep, it is an emergency.
If I get too mad, it is an emergency.
Around 4 this afternoon, I locked a syringe of 50 mg IV Benadryl into my PICC line and angrily uncapped my Epipen.  “I really hate that I’m so sick that I have to use epinephrine at home on a regular basis.  That makes me really mad,” I told my mother as I brought the tip down against the outside of my thigh.
There seems to be some confusion over whether or not what my “friend” did was wrong because she “tried to pay it.”  (I know, don’t get me started.)  So let me make it really clear.
I don’t care about the money.  If she had asked, I would have given it to her.  This is not about the money.
This is about everything else she took from me.
She took my right to feel like I can trust people to take care of me.
She took my right to feel like I can accept help without getting screwed.
She took a lot of my energy over the course of our friendship.  A lot. 
She took my safety because this was such a violation that I can’t help but feel angry and it is making living in this body even more dangerous than usual.
She took my ability to go on this trip.  She took my ability to feel like I can get this part of myself back. 
So disappointing.  I have never been more disappointed in a person in my entire life. 
And for the sake of being thorough, I want to deal with this: at least one person thinks that it’s okay that they knew about it and didn’t tell me because she wasn’t “being malicious.” (I don’t even know what that means.)
What she did is criminal.  Stealing is a crime.  Stealing from a very sick person is a more serious crime.  This is not the personal opinion of Lisa Klimas.  This is the opinion of the criminal code of the State of Massachusetts.  If you know someone is preying upon an ill person, and you do nothing, you are just as guilty.  You are not a “good person” who is getting “blamed by association.”  You are a loser.    
My friends are closing ranks around me.  I have received over a dozen offers to do my food shopping, all with the added promise that they will not steal from me.  They are making me laugh.  (Quote of the day:  “’How does one pay a credit card without the bill?’ ‘Oh, I just write credit card on cash and throw it out the window, does that not work?’”) They are reassuring me that they will not betray me.  They are reassuring me that they will take care of me and that they love me.   They are letting me know that they will support me however this plays out.
They are really angry that this happened to me.  Honestly, I am a little surprised at how angry they are.  But I get it.
I’m tired of looking at beautiful things that I can’t have. 
And they’re tired of watching me. 
So disappointing.

On emergencies and making a scene

I am a pretty brassy person.  (I’m sure this surprises people who don’t know me in real life, as I am so shy on the internet.)  I am not easily embarrassed and never have been.  I have always been klutzy and loud, and I figured out early on that it was easier to just not be embarrassed by that.  Self acceptance.  I has it.


However, there is one thing that I get very embarrassed about, and I’m sure I’m not alone.  That, my friends, is making a scene, particularly if that scene is health related. 
Let me give you an example.  A few weeks ago, I was sitting at my mother’s house after eating Eggs Benedict talking about an upcoming family event.  I wasn’t feeling great but I had received some bad news that morning so I figured it was from stress.  Suddenly my stomach started hurting badly.  It hurt as badly as a bowel obstruction, but I knew it came on too quickly to be one.  At that point, I realized I was starting to anaphylax.
But instead of giving myself epinephrine, I decided to see if it would just go away.  (I’m actually laughing out loud as I type this because of the sheer stupidity.)  Shockingly, it did not just go away.  After several minutes of wailing like a wounded animal from the abdominal pain, I got that killer “Irish girl spent all day on the beach with no sunblock” full body flush.  You know the one.  The one that says I’m anaphylaxing. 
At this point, I should have given myself epinephrine.  (Please note: I am not afraid of epinephrine.  It resolves my symptoms quickly and I know that nothing bad will come from using it.)  But I didn’t want to use my Epipen because I didn’t want to cause a scene.  This is so stupid.  I know this is stupid.  I know everyone reading this is shaking their head because it’s stupid.  But it’s true. 
So my mother and sister noticed me changing colors like a decoder ring and asked if they should call 911 and give me epi.  I said no.  Instead, I pounded liquid Benadryl.  I actually can’t drink things quickly in regular life (I was an embarrassment in college – there was no chugging of any type of alcoholic drink as I was just physically incapable), but when I’m taking Benadryl to try and avoid using epi, I am a champion. 
As I was open-throating Benadryl straight from the bottle, my blood pressure dropped precipitously and my field of vision got fuzzy like a dream sequence from 90’s television.  Then my heart did that really entertaining thing where it skips beats.  At that point, my sister called 911.
Now, let’s recap.  I understand my disease – check.  I know that I should use epi sooner rather than later when having anaphylaxis – check.  I am a medical scientist and understand on a molecular level that epi will not hurt me  – check.  I know that sometimes I have to go to the hospital because I have a life threatening disease – check.
So why didn’t I just epi and call 911?  Because I didn’t want to make a scene.
Literally, as soon as my sister called 911, I was embarrassed.  It’s stupid.  I know it’s stupid, but it’s true.  I know they didn’t care that I interrupted their day because I obviously needed medical attention, but it didn’t matter.  It’s not logical.  I don’t like needing emergency care, especially if I am with other people. 
The ambulance showed up and then like half the neighborhood suddenly needed to walk their dogs by my mother’s house at exactly the same time.  You know how sirens make dogs have to pee, right?  Right.  So now there are people outside with binoculars and I’m in (unattractive, ill fitting) pajamas at 11:30 while I explain my disease to the first responders who have never heard of it.  It shouldn’t be embarrassing, and I wouldn’t be embarrassed to be present if it happened to any of you, but it embarrasses me. 
Side note: I think I would actually be more likely to seek emergency care if I could be sure no one would find out.  This has nothing to do with the behaviors of the people in my life.  They are all wonderfully supportive.  I know.  I’m weird. 
I find needing emergency treatment of pretty much any kind embarrassing.  Emergency room, epipen, whatever.  Needing this type of medical attention inherently puts me out of control.   There’s always the chance that I’m going to end up admitted to the hospital and lose days of my life.  I know it’s sometimes necessary, but that doesn’t change how I feel.  I’m usually not interacting with providers who know me, so I can’t predict what will happen.  I don’t like that.  And I don’t like it when people see that, either.
I don’t like making people worry about me.  Until fairly recently, I kind of coasted with regards to public perception of my illness.  By this I mean that people knew I was sick, but didn’t know the severity, and I knew they thought it was less serious and I let them.  It was easier for me, and I don’t regret making that choice.  But it did mean that when I told people, a lot of them were shocked.  Like, really shocked.
I knew that once I told people, they would be upset because they care about me and they worry about me and want me to be fine. Embarrassing!  I don’t want them to worry, and I feel like any time I have to make a scene and call a lot of attention to my failing health, it just sort of reinforces the gravity of the whole situation. 

And then there’s this other part, where I worry that I’m making a scene unnecessarily.  Like I worry that I’ll call the ambulance and they’ll arrive and be like, “Oh, you’re fine!  Why did you call us?” even though I AM ANAPHYLAXING AND THERE IS A CHANCE I COULD DIE FROM LOW BLOOD PRESSURE.  Like I said, it’s not logical.

If any of you mast cell people told me you waited forever to give yourself epi, I would be all over you.  I would send you pretty infographics about how you should use epi early and quote statistics about how often people accidentally stick themselves with epipens and live to tell about it.  Because you should use epi early.  It will help you.  I know the party line AND I AGREE WITH IT but this fear of embarrassment thing is really strong.  And I am sure I’m not the only one who feels like this.

This may surprise you, but I’m actually much less afraid of medical professionals telling me I wasted their time than I am of people in my life telling me that.  I can handle medical professionals.  This is not my first rodeo.  But feeling like I disappointed the people around me sort of mentally reinforces that my disease is “wrong” and therefore I am “wrong.”   (Again – this feeling was not provoked by the actions of the people around me.)
So I’m trying really hard to get over this because if I’m being honest, I can’t really afford to be cavalier with this anymore.  I am anaphylaxing a lot more than I used to and my body  is tolerating it a lot more poorly than it has in the past. 
So, there you go.  I wrote an essay and called a lot of attention to my fear of having a lot of attention called to me when I need attention.