Avoiding Anaphylaxis this Advent

Christmas parties, meals out with friends and family, stockings full of candy, chestnuts roasting on the open fire…

While all this sounds like great fun, there’s a risk that more people than usual will be accidentally exposed to foods they are allergic too. Food allergies are common. An estimated 9 million, or 4%, of adults and nearly 6 million or 8% of children have food allergies with young children being those most affected.

Although childhood allergies to milk, egg, wheat and soy generally resolve in childhood, they appear to be resolving more slowly than in previous decades, with many children still allergic beyond age 5 years. And allergies to peanuts, tree nuts, fish, or shellfish are generally lifelong.

If you’re one of those affected by food allergy, what can you do to avoid accidental exposure this holiday season?

Remind people! Sure you might once have told your hosts that you have an allergy, but a gentle reminder is always helpful, especially at Christmas when things get busy and the alcohol starts flowing!

Just say ‘no’ – if you don’t know what’s in it, don’t eat it. And even if you do, can you really be sure there was no cross-contamination in the kitchen.

Bring snacks, rather than rely on your hosts to have food you can eat…or

Stay home. Host the party yourself – then you know it’s safe.

Bring your epinephrine auto-injector with you –and keep it close to hand! Make sure somebody else at the party knows you have food allergies, where your auto-injector is and how to use it.

Know the Symptoms – within minutes, an allergic reaction may turn into a life-threatening severe allergic reaction. Sometimes the reaction can occur in two phases, with another reaction occurring up to 48 hours after the initial reaction.

Use epinephrine immediately after you have been exposed to your allergy trigger – it may prove to be life-saving.  If you are even thinking should I give myself epinephrine, the answer is almost certainly yes!

After giving epinephrine, seek emergency medical attention – call or have someone else call 9-1-1 or your local emergency medical services.  In most individuals, epinephrine is effective after one injection. However, symptoms may recur and further injections may be required to control the reaction. Epinephrine can be re-injected every 5 to 15 minutes until the severe allergic reaction stops completely.

Do you have your anaphylaxis Action Plan ready?  If not, make it part of your holiday preparations. It could be the best Christmas present you give yourself this year.

Some VERY strange allergies

According to the Centers for Disease Control and Prevention (CDC), 90% of all food related allergies are caused by milk, eggs, peanuts, tree nuts, shellfish, fish, soy and wheat.

While these are the most common, there are other allergy triggers you may not be so familiar with.

How about water?  Yes, it is possible to be allergic to one of the most abundant substances in the world, including the water in our own bodies. People with this condition, properly known as aquagenic urticaria, can experience severe itching and hives within five minutes of coming into contact with water, regardless of its source or temperature.

This condition is rare – only around 30 cases have been reported in the literature and the reason for it isn’t known. Worse still for those affected, histamine levels — the usual allergy culprit — don’t actually increase in these patients, meaning that traditional antihistamines don’t work.

While it might be hard to envision a life without water, spare a thought for women who are allergic to their own female hormones.  Although it’s not uncommon for women to suffer from acne, water retention and premenstrual syndrome (PMS) at certain times their cycle, a small number of women suffer from a condition called autoimmune progesterone dermatitis (APD). This skin disorder is triggered by progesterone hypersensitivity after ovulation.

And speaking of women’s problems – just imagine if you were allergic to semen.  While it’s more common in women, we need to point out that it’s also possible for men to be allergic to their own sperm.

Dutch researchers recently reported 45 cases of post-orgasmic illness syndrome. In both cases, the men experienced allergic symptoms around their eyes and nose, and transient flu-like symptoms within seconds, minutes or hours after sex, masturbation or spontaneous ejaculation. Yikes!

As if life without water or sex is difficult to contemplate, imagine if you were allergic to the weather.  In some people, a drop in the temperature can set off an inflammatory disorder known as cold urticaria.  Patients with the condition can experience redness, itching, swelling, hives and, in rare cases, death when they come in contact with cold air, cold water or even cold drinks. For others it’s the sun that’s the problem. Solar urticaria, can cause similar symptoms within minutes of exposure, in affected individuals.

And if all of this has left you feeling a little faint, be careful where you lie down! Although as we told you earlier soybeans are a common food allergen, and sufferers need to omit soy products from their diet, soybean allergies can be triggered by beanbags. According to a case study reported in the Annals of Allergy, Asthma & Immunology, a 6-year-old boy experienced respiratory distress while playing at school. His reaction was apparently triggered by dust from the dry soybeans in the beanbag.

Are you allergic to anything strange?  Share your stories and suffering with us!

Peanuts and Pregnancy

As we’ve discussed before, peanut allergies are on the rise. One study showed that the incidence of peanut allergy in children doubled between 1997 and 2002. Now, it seems researchers have discovered one of the reasons why.

A study of almost 62,000 mothers showed that the children of those who ate peanuts and tree nuts while pregnant were less likely to develop asthma or allergies than the kids whose mothers shunned nuts.

The results support the recent withdrawal of recommendations in both the US and the UK that pregnant women should avoid nuts because they might raise a child’s risk for allergies to the nuts.

There is little research on peanut eating during pregnancy and the subsequent risk for peanut allergy in her children yet the fear continues to lead many expectant mothers to steer clear of nuts.

So, researchers at the Centre for Fetal Programming at Statens Serum Institut in Copenhagen, wanted to take a more extensive look at nut exposure and the possible health outcomes in kids.

The mothers provided information about how often they ate peanuts and tree nuts, such as almonds and walnuts, during pregnancy.

At age 18 months, the researchers found, the kids whose mothers ate peanuts were less likely to have asthma.

Fifteen percent of kids whose moms ate peanuts more than once a week, had asthma compared to more than 17 percent of kids whose moms never ate peanuts.

When other asthma risk factors were taken into account, the researchers concluded that kids whose mothers ate peanuts regularly were 21% less likely to develop asthma.

At seven years old, this same group of kids was 34% less likely to have a diagnosis of asthma than kids whose moms had abstained from peanuts.

Similarly, mothers who ate tree nuts more than once a week had 18-month-olds who were 25% less likely to have asthma than the moms who avoided the nuts, although this difference appeared to fade as the kids reached seven years old.

Peanuts appeared to have no effect on whether kids developed nasal allergies, and the children of moms who frequently ate tree nuts were 20% less likely to have allergies.

Lead author, Ekaterina Maslova said the findings are further reassurance that moms-to-be don’t need to avoid peanuts and tree nuts, although the study doesn’t prove that nuts are actually protective against asthma and allergies.

Mahr, who is also chair of the section on allergy and immunology at the American Academy of Pediatrics, noted that interviewing people about what they eat can introduce some accuracy issues, but the findings are still interesting.

SRxA Advisor Todd Mahr, a pediatric allergist at Gundersen Lutheran Medical Center in La Crosse, Wisconsin, who was not involved in the study said “A take home from this would be if there’s no food allergy in your family, but there’s an asthma history in your family, maybe you might not want to avoid peanuts specifically.”

All of which is good news for moms with peanut butter cravings.

Watching What You Eat

In case you hadn’t noticed, the world did not come to an end on May 21^st.  Most of us, so we’re told, were not eaten by zombies. However, we did learn of one 6-year-old boy who nearly lost his life because of something someone else ate.

No, we’re not making this up.  In fact, this story comes from the highly respected New England Journal of Medicine, no less. The article reveals that the boy suffered a severe allergic reaction following a blood transfusion from people that had consumed peanuts in the hours before donating their blood.

Dr. Johannes Jacobs, one of the study coauthors, described how three of the five blood donors in this case reported eating peanuts on the evening before they gave blood. It had been a Sunday evening, the night of a big soccer game, and the three donors had been snacking on peanuts as they watched TV.

The boy who received the nut-tainted blood was being treated for acute lymphoblastic leukemia.  During a platelet transfusion he experienced an anaphylactic reaction in which he developed a rash, angioedema, hypotension, and difficult breathing.  Fortunately doctors recognized his symptoms and treated him with epinephrine (adrenaline) and he recovered within 30 minutes.

The patient’s mother stated that her son had had a similar reaction after eating peanuts at the age of 1 year. Since that time, peanuts had been excluded from his diet.

The authors of the report say the boy experienced an allergic reaction because peanuts contain a protein known as Ara h2, which is extremely resistant to digestion and can stay in the blood for up to 24 hours. While such a scenario had been presented as a theoretical possibility in the past, this is the first clinical report of this phenomenon.

Speaking exclusively to Word on Health, Dan A. Waxman MD, President of America’s Blood Centers said “Donor screening measures are quite effective in terms of detecting infectious agents and donor questionnaires tell us if donors need to be excluded because of medicines they are taking such as aspirin or antibiotics.  But, when it comes to what they’ve eaten, we really don’t ask”.

According to the latest Food Allergy Guidelines,  peanut allergies are known to affect about somewhere between 0.6 and 6% of the population.

While the researchers involved with this study are not recommending that blood donors avoid all foods known to be associated with systemic allergic reactions, they caution that more research must be done to determine the level of risk.

In the meantime, SRxA’s Word on Health suggests it may be time to adapt the phrase “Think before you drink, before you drive” to “Think what you ate before you donate.”

Pass the Nuts!

Although living with an acute peanut allergy can be scary and potentially life-threatening, according to the latest research from the American College of Allergy, Asthma and Immunology (ACAAI) it doesn’t mean that schools and airlines should totally eliminate peanuts from their surroundings.

“People with severe peanut allergies can work with their allergist to develop an action plan to prevent or manage attacks,” said ACAAI President, Dr. Sami Bahna.

Highly allergic people may react after ingesting minute hidden quantities of peanuts or even after touching or smelling peanuts. These patients often live in fear they will come in contact with peanuts but however much they try to avoid them, there is no guarantee that specific allergens can be removed entirely from an environment.

“Unfortunately, life is not risk-free,” said Dr. Bahna. “A minority of people are severely allergic to peanuts, but it is not reasonable or possible to expect schools or airlines to be peanut-free. Consideration should be also given to the freedom of the vast majority of non-allergic persons. Also, peanut is not the only food that can cause severe allergy.”

Dr. Bahna suggests that people and parents of children with severe peanut allergies check to be sure the school and airline carry emergency treatment and educate their personnel about food allergies, rather than call for an out and out ban.