Question:
In the last year my child's throat has swollen up twice after swimming. The
first time (Jan., 1998) was after swimming in an indoor pool that had
bromine in it. The reaction occurred 6 1/2 hours later. The second time
(June, 1998) was after swimming for 3 hours in a pool with chlorine. This
time the reaction occurred 12 minutes after getting out of the pool. It was
very hot that day and I don't know if the combination of the chlorine and
heat together caused the reaction. My child had great difficulty in
breathing. After treatment at the ER that afternoon and his doctor's office
the next day he is doing better. All the doctors that treated him felt that
he shouldn't go back into a pool with chlorine or bromine. If you can give
me information on a similiar situation it would be greatly appreciated.
Also I would like to know if preventative measures can be taken so that my
son can still swim and not react to the chlorine. Thanks for taking time to
read and respond.
If you don't know directly, do you know of any resources I might check out?
Answer:
What was the doctor's diagnosis? what was the treatment in ER?
How old he? Has he been diagnosed with asthma? Was throat swelling
diagnosed by doctor? The throat swelling sounds like a symptom of anaphylaxis; but I'm
not aware that chlorine or bromine could cause this. And a 6 1/2
hour time delay seems like a long interval
Chlorine and bromine are potent lung irritants that can precipitate
asthma. And effects would be dose dependent. If levels were high
due to the pool being treated or he was in for a long time. These
chemicals can cause permanent lung damage at high levels.
Continued exposure at low levels might also cause lung damage
if he is hypersensitive.
A good source to check would be National Jewish Center in Denver,
considered the top lung medical center in the world. www.njc.com
1-800-222-LUNG.
Some links:
http://www.njc.org/MFHTML/ANA_MF.html Anaphylaxis
http://www.health-line.com/articles/ap940001.htm Anaphylaxis Syndrome
http://www.njc.org/MFhtml/TRI_MF.html Identifying Triggers of Asthma,
http://www.ama-assn.org/special/asthma/support/educate/triggers.htm
What Triggers Asthma? JAMA
http://www.aaaai.org/patpub/resource/publicat/tips/tip20.html CHILDHOOD ASTHMA
The consensous of the doctors has been that they have no experience with
this kind of a reaction, but that they mst assume that it is an allergic
reaction. They looked for bee stings, etc. Finding none, they decided that
it must be the halogens (chlorine, bromine) even though they had no
knowledge of why the two should produce similiar results.
what was the treatment in ER?
The first time (Bromine) the treatment was Intol via an inhalor. The
effects of the attack lingered for for or five days. The second time
(Chlorine) a different set of doctors at a different location used
ephineferen (sp?) and after a second dose, the symptoms faded in less than
24 hours. The incident 12 min. after leaving a chlorinated pool sounds like
anaphylaxis; angioedema (throat swelling) is often involved. Hives
(urticaria) may also be present. The correct treatment for anaphylaxis
is an epinephrine injection. (I had it once from an allergy shot,
had 2 shots of epi). Epinephrine is adrenaline, a powerful
bronchodilator and heart stimulant. It takes effect within a few
minutes. Prelone is a steroid which takes many hours to take effect.
The delayed reaction 6 1/2 hours after leaving a brominated pool is a
little more puzzling. Bromine is normally used in hot tubs and whirlpools,
I think because its more stable than chlorine when heated. I have read of
deaths due to brominated hot tubs.
I would hate to see him give up swimming. Swimming is a good exercise
for asthmatics. Perhaps if he was allowed short intervals in the pool,
say 15 min. at a time, it might be safe. Since this appears to be an
anaphylactic reaction, an emergency Epi kit should be available.
Of course this would have to be cleared with the doctor. I would keep
him away from brominated pools; and pools that are heavily chlorinated or
indoor pools with poor ventilation.
Chemicals like chlorine and bromine can't cause true IgE mediated
allergic reactions; but they can cause look alike conditions.
