As the days grow shorter, and in many areas of the country colder, the anticipation of the approaching holidays warms our hearts and boosts our spirits. For those who have food allergies holiday times may present a huge challenge to stay healthy and out of the emergency department.
Food and drug allergies account for the most common causes of severe allergic reactions. Anaphylactic reactions are the most severe forms of allergic reactions and often result in a trip to the hospital.
Signs and symptoms of Anaphylaxis
A main reason for life-threatening and fatal allergic reactions is a delay in getting a life-saving injection of epinephrine. Signs of anaphylaxis may go unrecognized or ignored for several minutes before action is taken to address them. These include generalized itching and swelling, sudden difficulty breathing, throat tightening, difficulty swallowing or choking sensation, lightheadedness or dizziness, stomach cramping or sudden diarrhea. The multisystem nature of the symptoms (throat, skin, stomach, and lungs) is what makes it an anaphylactic event.
The most important warning signs are those associated with throat closure, severe difficulty breathing and progressive lightheadedness. If any one of these symptoms suddenly occur while eating or within minutes to or an hour or two after eating, anaphylaxis should be considered. A combination of one of the above warning signs with itching, or swelling of the skin, or stomach pain or diarrhea, further signals the likelihood of an anaphylactic event.
First, identifying and confirming the trigger is essential. Your allergist can help you with this task by taking a thorough history, a brief physical exam and ordering tests. Food allergies may be confirmed by skin test or blood test. Drug allergies are most often identified by history but some drugs such as penicillin and insulin have available protocols for skin testing.
Venom containing insects (bees, wasps, hornets, yellow jackets and fire ants) may cause fatal anaphylaxis. It is important to see an allergist for testing if anaphylactic symptoms have occurred after being stung by an insect. Currently there is no need to worry about venom related allergic reactions in the colder, northern regions of the U.S. because they are not around during the winter.
Once the trigger has been identified avoidance is the key to preventing further reactions. But when it comes to food allergies, you don’t always know whether the meal you intend to eat may have an allergen trigger hidden in it. Peanut, milk and egg allergy account for the majority of food allergies in children. Seafood and peanuts are the most common culprits for adults. It’s easier to avoid these food triggers when you prepare your own meal but what about when you go out to a restaurant or over a relative or friend’s home?
Seven Tips to Help You Prevent Severe Anaphylaxis
1) Start with a comprehensive evaluation with your doctor to confirm what your allergy triggers are and how to avoid them.
2) When going out to eat inform the waiter/waitress about your food allergy and ask them to prepare your food separately in order to avoid cross-contamination with cooking utensils, pots or grills. Sometimes it may be prudent to ask to speak to the chef if the person waiting on your table seems unclear about your request.
3) Plan ahead when eating at a relative or friend’s home. Let them know well ahead of time, about your food allergy. Remind them again, within a day or two before the event. It doesn’t hurt to ask if they remembered one more time just before eating.
4) Always carry your epinephrine with you when eating out. Check the expiration date periodically and avoid leaving them in cars or exposed to extreme weather temperatures.
5) At least once a year, review how to use your epinephrine and share the steps with friends or relatives that are most often around you.
6) Get an alert bracelet that has an inscription which tells the reader what you have and what to do in case of emergency.
7) Periodically review the warning signs and symptoms of anaphylaxis and the criteria for using your epinephrine device. Clarify any uncertainties about this with your doctor. Be very clear about the next step after injecting epinephrine which almost invariably is to call 911 (if not already done).
8) The two most common reasons people with established food allergy may not survive a severe reaction are failure to have epinephrine available, and delay in getting the injection of epinephrine. In other words, sometimes people wait too long to self-inject or give the injection to their child.
What steps have you taken to prevent severe allergic reactions to food?