This weekend, we went camping in the Everglades. Florida in winter is the perfect time to go camping, as the weather isn’t too stifling and it may actually be cool enough to start a fire. When people think camping, they think campfire, marshmallows, and hiking. What they don’t think about are mosquitoes, smoke, and lack of privacy. When we arrived at the campsite, it was well past 7:00 PM, and the sun had set for the day. I started pitching the tents by moonlight and the headlights of the car. While I was doing that, I could hear the neighbor in the campsite next door complaining about the headlights, but I didn’t care. I was tired from the hour drive getting there and I just wanted to lie down. The mosquitoes were out in full force, nipping at my legs and arms. I put on the bug spray, but these weren’t your average mosquitoes. These here were your Everglades mosquitoes, the truly grotesque monster mosquitoes that can bite through alligator hide. A little bug spray wasn’t going to deter them. My wife was outside holding our dogs, Leah and Jimbo, to let them get some air. My son was waiting in the car with abuelita. After about fifteen minutes, we were able to get in the tent, tagged with bites all over. It was then that my wife noticed that Leah, our French bulldog, wasn’t looking right.
When I looked over at her face, she could barely open her eyes. Her face had swollen up, particularly around the eyes and face. At first, I was hoping it was only a couple of mosquito bites to the head, but within a few minutes, her face looked like a squished tomato. She was starting to become restless and uncomfortable, and sounded as if she was snoring more than usual. That’s when I started to worry. I could see the concern on my wife’s face. We were in the middle of nowhere, with no cellphone reception and no resources close by. It was at this point that I was volunteered to drive back home to get to the vet to get some help. The first thing that came to mind, “but I just got here?!”
Angioedema is the medical term for the swelling that happens around the eyes and mouth. It’s usually related to an allergic reaction, or a hypersensitivity response to an allergen. Angioedema and hives, or urticaria, typically go hand and hand. A way to understand the allergy cascade is to think of how a simple bomb works. With a bomb, there is a detonator and an explosive device. The way allergies start is that there is first an exposure to an allergen. Once initially exposed, the body will produce high levels of IgE antibody to the allergen, which would be the detonator in the case of this analogy. IgE will then attach itself to a mast cell, or the explosive device. Mast cells are present in all connective tissues and are apart of a normally functioning immune system. They contain inflammatory mediators, histamine being one of them. Once the IgE is fixed on the mast cell, the allergy is primed and ready to go.
Upon a second exposure, the bombs, which have now been activated, are set to explode, leading to a flood of histamine. Depending on the degree of priming, the response can be mild, where there is a mild skin reaction, to a full on anaphylactic response, where breathing can be compromised.
The treatment for these situations vary, but antihistamines are certainly a big part of it. When I have patients that come in complaining of allergies, the first question that is always asked is how they are treating them, since most, if not all, antihistamines are available over the counter. In addition, steroids can be also used to reduce inflammation even further.
When I got back home, the vet’s office was closed. I looked over at Leah, her eyes barely able to open and appearing listless. I felt a bigger wave of concern. It must have been the mosquito bites. I couldn’t think of anything else that could’ve caused such a bad reaction. After a quick internet search, it looked like all vet offices were closed and that the only thing available was a “pet ambulance.” Instead, I opted to just take her home, where I gave her some benadryl. Fortunately, after a few hours, her face started to improve. By daybreak, her face was almost back to normal. She was able to open her eyes again. After driving back to the campsite to pick up my family, I decided that this was the last time I’d be taking a hike out to the woods to go camping. The next time Dylan wants to go, the tent is going up in the backyard, in the convenience of our home, where I can plug in a bug zapper.