Last month, there was a news report about an 11-year old boy who died after a severe allergic reaction to fumes from the fish his grandmother was cooking. His father tried to give him his asthma medication but the nebulizer wasn’t enough to help him as he was gasping for air.
That just underscored the importance of understanding the seriousness of food allergies. While they are not always fatal, they can be. Here’s more information about allergies and how to be safe if you or your child suffers from them.
We’ve heard of allergic reactions from eating something but you can actually die from breathing fumes?
Yes parvalbumins in fish and tropomyosins in shellfish are responsible for the majority of immunoglobulin e (ige)-mediated allergies.
Under what circumstances can an airborne reaction to a food occur?
Symptoms of asthma increase sinus allergic rhinitis symptoms, or dealing with an active infection.
What would be a reason for an Epipen or nebulizer not working to relieve symptoms?
If there is a high allergen load or if there is an underlying illness that the young man or that anyone was dealing with. Asthma is a very strong predisposing factor.
How can we prevent tragedies like this from happening?
An underlying illness such as asthma should be well controlled. Any signs of infection should be treated aggressively as well by seeking appropriate medical attention; strict avoidance of the offending food; preparing own food; take long-acting antihistamine before accidental exposure; carry self-injectable epinephrine (2 doses), fast-acting antihistamine, and albuterol inhaler; wear Medic-Alert® identification.
What are some common airborne food allergies?
Wheat, soy, peanut, tree nut, shellfish, fish, milk, egg
How are allergies diagnosed?
History & physical, skin testing, blood testing, oral challenge
Seasonal allergy symptoms are often very similar to a cold. How can you know the difference?
Typically allergy symptoms can get better with antihistamines. It is easier for people with allergies to get a cold.
If your mate eats something that you’re allergic to, how much time should you wait before a kiss?
Depends. The allergic patient has to verify that mouth is thoroughly clean and even then there are no guarantees(they can have reflux from stomach causing anaphylaxis in the spouse/significant other). The patient has to have epinephrine on hand, fast-acting antihistamines, i.e. Benadryl, inhalers for asthma, etc.
Can other problems develop if an allergy is undiagnosed?
Yes. Allergy can lead to hives, sinus problems, acne, eczema, reflux and GI problems, swelling of mouth and lips, and asthma.
Do people outgrow allergies?
Some people do. Most children outgrow food allergy to soy, egg, milk, and wheat. Not necessarily for fish and shellfish as well as peanut and tree nut. Some allergies to indoor and outdoor inhalants can become dormant but then return later in life.
How often should you visit an allergist?
Everyone should visit an allergist at least once in their lifetime. For active problems such as asthma, we see patients every 3 months. For food allergy, we can now treat with close follow-up.
What treatment options are available for allergies?
For asthma, allergic rhinitis, and allergic skin diseases, we can perform skin testing, figuring out what allergic responses you have, then using this test to prepare an allergy serum for desensitization. In addition, we can perform oral desensitization treatment for food allergies, consisting of giving you small doses of the food and increasing over 6-9 months and desensitizing you so you can eat that particular food.
For those with severe allergies, will insurance cover the cost of the medication?
Yes, depending on your insurance plan.
Dr. Vital answers your ‘Text Tom’ questions on the next page.
How can we find out what we’re allergic to without being exposed to it?
There are 2 ways you can find out what you are allergic to. You can have a blood test, called RAST testing (RadioAllergoSorbent Testing) which evaluates the specific IgE, or you can have Allergy Skin Testing to evaluate specific indoor and outdoor inhalant allergens as well as foods. I prefer to do allergy skin testing because results are immediate and I can start treating my patients immediately.
What are the options if you can’t afford the Epi-pen?
Brand name EpiPens have gotten very expensive. Other brand name epinephrine includes AuviQ as well. There are generic epinephrine injectors that are available for much cheaper prices. In addition, in certain cases, although doesn’t last as an Epi-pen, an allergist or specialized MD can prepare injectable epinephrine for you for usage in emergency the same day, but preservation and storage is an issue in these circumstances. So for longevity, best to get commercial branded or generic epinephrine.
Is avoidance the only solution for Oral Allergy Syndrome?
I love treating Oral Allergy Syndrome. Avoidance is not the only solution. At vitalallergy.com, we now treat Oral Allergy Syndrome with either allergen immunotherapy, in which desensitization to the pollens that cross react with those specific fruits and vegetables results in reduction of tolerance; or oral immunotherapy, in which we desensitize orally using small concentrations and increasing the foods over 6-9-12 months, thereby inducing tolerance orally.
I’m allergic to shellfish and when I smell it, my eyes start watering and then I start throwing up, what can I do to counter that? After hearing about people passing from allergies, I have gotten really scared. What are my options?
At our practice if vitalallergy.com, as well as some allergy practices across the country, we now can treat you with oral immunotherapy, in which we induce tolerance to the shellfish over 9-12 months. Before we treat the food allergy & anaphylaxis, we evaluate for concomitant indoor and outdoor allergic responses, treat that 1st with allergy shots, then treat with oral desensitization thereafter.
Dr. Carlos Vital is board-certified in adult & pediatric allergy, asthma, & immunology. Dr. Vital received his bachelor’s degree from Xavier University and his medical degree from Louisiana State University School of Medicine.
