2 nut? reactions in 18 months, after 36yrs of no reactions

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K308
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Joined: Sun May 20, 2012 10:58 pm
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by K308 on Sun May 20, 2012 11:27 pm

2 nut? reactions in 18 months, after 36yrs of no reactions

Hello

I was wondering if anyone can help/advise.

Ive eaten nuts all my life, Im fit, 36 in the army (hence career implications) and had 1st reaction 18 months ago. Tired and hungover, I ate 5 bags of m and m's and a bag of mixed nuts(containing walnut, almond, brazil, hazelnut).A piece of nut got lodged in throat. Symptoms developed - nettle type rash, very hot, elevated heart rate and went to A&E where I vomited. Saline, piriton and 3 hrs of observation resulted in release. No further information from GP (employed by Army) but issuance of EPIPEN and not any antihistamine or education on what I might have to do or how to avoid.

Ate peanut, pistachio(in large quantities), macadamia, walnut, pecan, hazelnut in various quantities thereafter without any reaction whatsoever SINCE first reaction.

2nd reaction 2 weeks ago - on empty stomach, large bag of mixed nuts containing walnut, almond, brazil, hazelnut and again small piece of nut lodged in throat. Went to A&E after symptoms developed 2 hours after nuts ingested, facial swelling, nettle rash on body and treated with saline, piriton and hydrocortisone. Neither time adrenaline administered. Both instances blood pressure normal, ECG normal. Reaction was subsiding before treatment on second time ( was not treated for at least 40 minutes after arrival).

Have been referred to allergy specialist for tests.If tests show severe allergy sensitivity to any foodstuff, this would potentially lead to a medical downgrade affecting ability to deploy operationally or abroad to any location without established medial facilities and thus has promotion and other career implications.

My questions are - can you be allergic to one particular type of nut and not others (I think possibly almond)?

or is it sheer quantity of nuts eaten (on empty stomach and nut being lodged in throat) that is presenting the reaction ?

If I am required to carry an epipen I face medical downgrade, potentially discharge, whereas both instances have been successfully treated with antihistamines and not adrenaline. Although with some education after the second incident I will be much more careful of what I do eat, I have eaten many foodstuffs with traces of nuts and zero reaction.

Will allergic reactions become more severe each time ?

Any ideas or advice would be useful in identifying the actual issue - bear in mind I have eaten many different types of nuts with zero reaction. It is slightly hard to understand at the moment ! Thanks.

williamsmummy
Posts: 31
Joined: Tue Jun 14, 2011 12:06 pm
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by williamsmummy on Mon May 21, 2012 11:10 am

Re: 2 nut? reactions in 18 months, after 36yrs of no reactio

its possible to develop a allergy at any age, as you have found out.

its possible that you are allergic to one or two nuts only. However, nuts are processed together and cross contaminate.
so its very important that you avoid nuts, all nuts, for the time being. I think it would be advisable to ask your GP for a referal to a immunologist and get a clearer picture of your allergies and allergy status.
If you are an asthmatic very important that you have this under very good control.

I dont think you got a nut stuck in your throat, its more likely that your throat was closing, as thats a common sign of anaphylaxis.(sorry to be bit blunt)

carry your epi pens everywhere, read food labels and ask questions about the food you eat that you havent cooked. May contain, does mean that nut pieces may be in the food, esp with relation to chocolate , biscuits and cakes.

during a reaction the protien causes large histamine rises in your body, this has two effects on your body. It can make small blood vessels leak blood, hence the lowering blood pressure, but also causes the smooth muscles in the throat and lungs to narrow and constrict.

Have a look at the anaphylaxis campaign web site for more information on symptoms , this will help you decided what medical treatment to take , but more importantly this is one huge area you can talk about with a immunologist.

Exposure or accidental ingestion of your food allergen doensnt mean that you will get anaphylaxis every time. the reaction can be mild and be resolved with antihistamine, but of course you need to have access to your medication in case you get anaphylaxis.

Factors that increase the chance of the reaction going from mild to severe are....

alcohol.
uncontrolled asthma.
illness such as recovering from a virus or infection.
amount ingested.
exercise ( dont walk or run while having a reaction)
no access to medication.
other allergies your body is coping with such as hay fever, etc ( sort of allergy overload really)


if you use your epi pen, you go to the hospital every time, call an ambulance so that your vital signs can be monitered. this is so that you can be given further medication in case reaction comes back (bi-phasic reaction) and that your lungs are clear and heart rate is normal. You should be sent home with a replacement epi pen, and given some steriods to take to ensure that your lungs remain clear .

I hope this is helpful, sorry this post is a bit long. please ask any other questions in case i have missed something!
Sarah Chapman
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K308
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Joined: Sun May 20, 2012 10:58 pm
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by K308 on Mon May 21, 2012 11:11 pm

Re: 2 nut? reactions in 18 months, after 36yrs of no reactio

Many thanks for reply.

I have eaten all nuts in small amounts directly without incident since first reaction - lets say I was poorly advised/educated by GP who issued epipen but not even antihistamine.

New GP at practice now. On both occasions debris lodged as it often does with me because of a dental problem I wont go into but I do not always chew my food thoroughly before swallowing. The throat was NOT closing over - this was checked at A and E. The same thing happens with other foodstuffs.
Im not asthmatic or have any other allergy Im aware of.

I did have a Hep B vaccination shortly before incident and also did heavy exercise a few hours before ingesting nuts.

Antihistamine has worked so far on the only two reactions and my fear is that a- reactions may get worse with time (1st was worse than 2nd tho) and that the allergy is severe enough to require me to carry an epi pen at all times. Although I have one, my blood pressure and ECG were normal and no sign of shallow breathing. The signs were abating before treatment started.

Allergy specialist appointment has been requested. could someone tell me more about the process of allergy testing and how it is identified to what level of sensitivity to allergens and thus need for an epipen might be concluded? I agree I have a sensitivity, but having been in A and E and the Dr saying it wasnt life threatening.

Also how proactive are the specialists in this field in trying to desensitise mild allergies?

williamsmummy
Posts: 31
Joined: Tue Jun 14, 2011 12:06 pm
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by williamsmummy on Tue May 22, 2012 8:39 pm

Re: 2 nut? reactions in 18 months, after 36yrs of no reactio

your first GP did the correct thing issuing you with a epi pen after your first reaction, which does sound quite substantial to me. what wasnt done was the refferal for testing and more info on antihistamine, however, that was more to to with the fact that antishistamines do not stop anaphylaxis. They help with mild reactions.

Reactions can vary each time, just because you had a milder reaction the second time it doesnt mean that you are more at risk of anaphylaxis, or that the allergy is reducing. Its a bit like being pregnant, you are either allergic or not. How each reaction after accidental exposure depends on the other factors i mentionedin earlier post.

Testing for IgE allergies is via blood test, called a RAST, or a skin prick test.
RAST can be done via GP, but how those results are understood by the doc depends on their allergy training and knowledge. (which might be a hazy ), most uk allergy clinics do a mix of both but rely on skin prick tests. RAST tests take weeks to get result, but skin prick tests are quicker, you get the result there and then. Again a immnuologist is required to look at these results and take in to account your reaction history, and personal history. They might investigate other allergies such as environmental ones for instance, as control of these does help when you have a accidental reaction to your food. It controlling that' allergy cup' in yr body.

As for desen , well thats only available for hay fever, and does not apply to food allergies. As yet there is not cure for IgE nut allergies only avoidance. The work done one TOLERANCE with peanut flour is still showing promise, but will take many years to considered a safe from of long term treatment for nut allergy.

although i have asked many immunologists if they have a magic wand, none so far have one. You have had two reactions that led to you seeking quick medical advice, so unless a immunologist says otherwise, you are at risk of anaphylaxis and epi pens are yr friends!

What the doctor in A and E said , again this depends on his allergy knowledge, and he might have just been refering to the reaction you presented in front of him at the time. If he saw you react again, with full blown anaphylaxis he might have said something different.

Please read the NICE guidelines on anaphylaxis so that if you go in to hosptial again you get the correct standard of help, re steriods , and replacement epi pens and are observed after reaction for some time (6hrs) for bi-phasic reaction.

let me know how you get on with seeing a immunologist, and i will try to help with any questions i can answer.

just so you know, my son is the one with the allergies and has used his epi pens 3 x. His current allergies are , peanut, beans , egg, yeast extract, kiwi fruit, dog, cat, dustmite, hay fever, tree pollon, and mold, and possibly seeds of some sort. I have a daughter with intol to milk and soya, (to be confirmed nxt month) and cat, hay fever, tree pollen and dustmite.

good luck. am keeping my fingers crossed that the immunologist will have good news for you!
Sarah Chapman
Alex Curtis Trust
Forum Moderator
talkhealth moderation team

K308
Posts: 3
Joined: Sun May 20, 2012 10:58 pm
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by K308 on Tue May 22, 2012 9:05 pm

Re: 2 nut? reactions in 18 months, after 36yrs of no reactio

thanks again for reply. Im waiting for appt with immunoligist/allergy specialist at addenbrookes.

Outcome Im hoping for is that I am not sensitive enough to small or trace amounts to trigger a reaction that I may keep my job... Im not too bothered by not being able to eat nearly 1kg of nuts in one sitting and over 500g in the second which is what I did eat for both reactions.

There is clearly zero logic or scientific approach in applying the 'allergic to any amount of nuts' rule if it is clearly the case no reaction is present having eaten nuts in substantial quantity with no effect. Since I have eaten more nuts without reaction, than I will again ingesting foodstuffs supplied with ' may contain traces of nuts' and will now actively avoid nuts themselves, I hope to have a logical conversation with the immunoligist.

williamsmummy
Posts: 31
Joined: Tue Jun 14, 2011 12:06 pm
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by williamsmummy on Wed May 23, 2012 1:05 pm

Re: 2 nut? reactions in 18 months, after 36yrs of no reactio

allergies are very complicated, you may have a high threshold to one nut you are allergic to, but really its more to do with the differing protein structures. and you may be allergic to more than one nut. threshold depends on the day you eat it, how well you are at the time, and of course the amount. So one day a huge amount of the nut your are allergic to will bring on anaphylaxis, and if you are /run down and eat a small amount you will still have anaphylaxis.
As for the protein, a test for the arah 2 protein in peanut is a pretty good test for those who have false neg or false posisitive to peanut, and you may not be as allergic to others nuts because of the protein difference. But later on once you have developed one nut allergy your immune system may suddenly find that it reacts to other protien nut structures.


a good book to read is The complete guide to food intolerance and allergy, by prof brostoff, published by Gamlin.

sounds like you have been reffered to a good place btw!
Sarah Chapman
Alex Curtis Trust
Forum Moderator
talkhealth moderation team

williamsmummy
Posts: 31
Joined: Tue Jun 14, 2011 12:06 pm
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by williamsmummy on Wed May 23, 2012 1:07 pm

Re: 2 nut? reactions in 18 months, after 36yrs of no reactio

Am sorry dont think i have explained myself too well, but good luck with allergy docs and dont eat nuts until then!
Sarah Chapman
Alex Curtis Trust
Forum Moderator
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