'Bubble girl' is allergic to life.
Story highlights
- Brynn Duncan has mast cell disease, which causes her to be allergic to almost everything
- Duncan has a feeding tube and is on constant doses of antihistamine
Easley, South Carolina (CNN)The
cracker or the bite of ice cream -- Brynn Duncan still isn't sure which
one sent her into anaphylactic shock that day. Her food allergies
change so frequently, keeping track is almost pointless.
It was just another day with another massive allergic reaction.
She
can always tell when one is coming on. "I just get this overwhelming
sense of -- they call it impending doom." Her labradoodle, Moose, starts
alerting, licking her hands frantically.
"I'll
feel like I'm being stabbed in the stomach, and then it gets hard to
breathe and my throat and tongue start swelling. And we have to treat it
really fast."
On that particular day
in March, multiple EpiPens didn't slow the reaction. The paramedics who
arrived to take Brynn to Greenville Memorial Hospital, or "Hotel
Greenville" as she likes to call it, knew her well. When she asked for
her security blanket, they knew to hand her her smartphone.
"New
day, new crisis," Brynn quips as she tells the story, as if it's about
her first day of college or a shopping trip gone wrong. It might as well
be. When you're allergic to life, a near-death experience is no big
deal.
Center of attention
Less
than a week after her trip to the hospital, Brynn, 21, is back at home
in Easley, South Carolina. She lies on her back, her head near the foot
of her bed, chattering away as her mom changes the access to her chest
port.
Melissa Duncan, a paralegal by
day, dons a mask and surgical gloves before disinfecting the area around
the tube that's connected to Brynn's jugular vein. The disinfectant
burns, and Brynn's blood pressure hits 150/102. Her heart rate rockets
to 128.
"The meds we have to give her
to keep her alive, she reacts to," Melissa says, shaking her head.
"Never in a million years did I think I would be doing this. "
Brynn was seemingly a normal
kid -- until she wasn't. Yes, she was a fussy baby. Yes, she got sick
often as a child, Melissa muses out loud -- but what kid doesn't? Brynn
was also incredibly energetic, always the center of attention. Her
father, Barry, jokingly rues the day she learned to talk. She started
taekwondo at the age of 9 and had her black belt by the time she was 11.
That was the same year doctors diagnosed Brynn with IBS, or irritable bowel syndrome.
"She's always been --" Melissa Duncan pauses.
"High maintenance!" Brynn fills in with a laugh.
It
wasn't until shortly before her 16th birthday in 2010 that Brynn had
her first serious allergic reaction. The next two years became a blur of
sick days and doctors' appointments.
Brynn
saw specialist after specialist. The gastrointestinologist diagnosed
her with gastroparesis, or partial paralysis of the stomach muscles. A
cardiologist said she had POTS, or Postural Orthostatic Tachycardia Syndrome
-- meaning that when she stood up for longer than a few minutes, her
blood pressure dropped, leaving her light-headed and nauseated. A Wake
Forest doctor diagnosed her with Ehlers-Danlos syndrome, a connective
tissue disorder that causes fragile skin and overly flexible joints.
After
doing hours of research, Melissa, Barry and Brynn came up with their
own diagnosis: mast cell disease. They found a specialist online, Dr.
Lawrence Afrin, who at the time was working in Charleston. They waited
nearly nine months to see him, but hearing him confirm their suspicions
was life-changing.
Causes of mast cell disease
Scientists
don't know yet what causes mast cell disease. Researchers have found
mutations in mast cells that may cause the abnormal behavior, but the
mutations vary from one patient to the next. Because of this, scientists
suspect the mutations are acquired early in life. But genetics may make
some children more susceptible to developing the mutations.
Mast
cells are the regulators of your immune system. They're the ones that
release histamine when a bug bites, or when you come into contact with
an allergen. They basically sound the alarm that lets the rest of your
immune system know something is wrong.
Until
recently, the only mast cell disease doctors had identified was
mastocytosis, which is characterized by "abnormal proliferation and
activation" of the body's mast cells -- meaning there are way too many
and they act in strange ways.
But in
the last few years doctors such as Afrin have started to recognize that
there are many different layers to mast cell disease. For instance,
Brynn has mast cell activation syndrome, meaning her mast cells act
strangely, but they're not growing in number.
"It's like I'm living in a 24/7 allergic reaction," Brynn explains simply.
Fruit,
vegetables, milk, soy, nuts, smoke, perfume, the sun -- you name it,
Brynn is allergic to it. But it's not really about the specifics; the
allergens change depending on how "angry" her mast cells are that day,
she says. On good days, she can eat small amounts of plain meat or
mashed potatoes. On bad days, even using her feeding tube causes her
extreme pain.
Not everyone with mast
cell activation syndrome has it as bad as Brynn does. "Oh God, no,"
Afrin says when asked. "No, no, no, no."
But
mast cells are located in your connective tissue, including your skin
and the lining of your stomach and intestine. They can affect every
system in the body, Afrin says, so the disease is capable of causing all
the symptoms Brynn experiences.
You
have to ask yourself, he says: "Is this poor patient so uniquely unlucky
to have acquired so many different, independent problems? Or is it more
likely that there is just one thing going on?"
Of course, having a diagnosis didn't make living with mast cell disease any easier.
In 2012, Brynn was admitted to the hospital 30 times. She started having seizures and episodes of dystonia
-- painful, violent muscle contractions that are "scary to see and
scary to experience." On multiple occasions, doctors have had to put
casts on her legs to prevent her joints from bending in the wrong
direction.
"I've seen doctors and nurses step back, kind of like 'What is this?'" Barry Duncan says.
Every
time she went to the ER, Brynn was given a large dose of steroids to
calm the inflammation. She's now steroid dependent -- and likely will be
for life.
"We could be here for
days, and you still would not understand all the inner workings of Brynn
and all of her medical issues," Melissa Duncan says. "But I think the
underlying one is the mast cell disease, which is a beast, and continues
to become a bigger beast, day by day."
Living in a bubble
Brynn
spent her 19th birthday in the hospital. An allergic reaction made her
miss a zip lining trip for her 20th. On December 31, her 21st birthday,
when many young adults would be out celebrating the legal drinking age
with friends, she was at home still recuperating from
Christmas. She had joined the holiday festivities by eating a special
pizza -- made with fake bread and fake cheese.
"It's
nasty," Barry Duncan says with a laugh. "It's the worst pizza you've
ever tasted." But "for her, the worst pizza you've ever had ... tastes
really good."
Brynn dreams about
real stuffed crust pizza sometimes. And mozzarella sticks. Occasionally
she lets her spunky attitude drop, and you see that she understands the
effect her illness has on those around her.
Her
parents have spent weeks sleeping in cramped hospital chairs. Her
younger siblings have missed vacations and school ceremonies; they've
learned how to inject Brynn with an EpiPen, and how to hold her limbs
still during a dystonia episode.
"There's
a lot of guilt that goes along with having a chronic illness," Brynn
says. "You feel like a burden. And people can tell you you're not, but
no matter what, in your head, you feel that you are."
She has moments when she gets
jealous of her high school friends who are doing all the things she
can't -- attending college, moving out, finding boyfriends. She and her
new friends, others with chronic illnesses she met online, have a
saying: "Single and ready to mingle -- as long as you have good health
insurance."
And with a giggle, the dark moment passes. Skyping with her friends keeps her spirits up. She's prolific on Instagram, with more than 5,300 followers, and writes regularly on her blog, which is called "Brynn's Bubble."
"A
lot of people with this disease ... do, in a sense, have to live in a
bubble, because it's really difficult to get the symptoms under
control," Brynn says. "You spend a lot of time alone. And it can be very
isolating. But thanks to social media, I haven't felt alone."
Over
the last two years, Brynn and her family have made progress in managing
her disease. She was one of the first patients in the nation to be put
on a continuous IV of antihistamine. Intravenous immune globulin, or IVIG, therapy, when a healthy donor's plasma is used to boost a patient's immune system, cut in half the number of drugs she needs.
Of
course, she still needs a lot -- a compounding pharmacy delivers a box
to her house once or twice a week. The meds make her brain foggy. She
punctuates conversations with "Where'd that thought go?" But that
doesn't stop her from talking. She plans to keep talking until mast cell
disease receives the attention she feels it deserves.
"'You
don't look sick' -- that's one of the comments that I get a lot. Or
they say, 'At least it's not cancer,' and that's another hard one,
because these illnesses can be just as devastating," Brynn says. "The
difference is they're not understood. And the only way to change that is
to somehow bring awareness to it."
Early
in her taekwondo career, Brynn's instructor told her that she could win
a match before it even began -- just by staring down the opponent. She
plans to fight mast cell disease the same way.
cnn.