The test that could save your life
Last week I wrote about how a patient said he was allergic to fruit and vegetables. Certainly, in my almost 30 years of clinical practice I have seen the rise of allergies, intolerances and avoidance. I have seen hundreds of people rushed to hospital after being unnecessarily jabbed by an epipen, a few nearly die from full blown anaphylaxis and thousands avoid things because of a suspected allergy. Seafood is a classic example. There is a condition called Scombroid, (go on, Google it) where a cluster of symptoms such as itching, rash, nausea and vomiting are caused by bacteria on fish which may not have been stored properly. A histamine ingestion can mimic allergy within minutes to hours of eating the fish, usually from the tuna family. So, the patient is not allergic to the fish, but poisoned by the bacteria on the fish. So, you don’t need to avoid seafood, just avoid the bacteria.
I saw a man who presented to the emergency department after one episode of vomiting after eating prawns. He has not touched prawns for 35 years after a vomiting episode age 10 after eating seafood so had avoided it for more than three decades. I suspect the vomiting was due to anxiety rather than the prawns. On the other hand, I have had anxiety myself after seeing patients with full-blown anaphylactic shock after receiving Penicillin. The allergen such as Penicillin or peanuts creates a massive histamine cascade in which blood vessels leak fluid into surrounding tissues, blood pressure drops and breathing becomes restricted by an engorged airway. It’s scary for patients, families and medical staff and can be fatal.
It’s not easy to differentiate between an allergy, a side effect and a potentially life-threatening reaction for patients and doctors based on old information. We often get ‘‘I’m not sure what happened but my Mum said I was allergic as a baby’’. If there was a rash then it may have been due the virus you had as a kid, not the antibiotics you were inadvertently given to try to kill the bacteria that weren’t the problem in the first place.
The point of this is to enable those who don’t need to avoid things to enjoy them and those who are truly allergic to be prepared with knowledge and the right treatment should they become exposed to a life-threatening or just painful allergen.
One of the ways to do this is to see an allergy specialist for a skin test. Find out what you are reactive to and what you aren’t. A few strategically placed skin pricks with an appropriate trigger/allergen sets off activity under the skin, appropriately named a hive.
When I was a boy I was stung by a bee on my little finger and my whole body swelled up. There was an internal hive of histamine like I had been stung by 20 bees.
Over the years I had a series of desensitisation injections of essentially small amounts of bee venom. I have been stung a number of times since but haven’t yet had to use the epi-pen on myself.
So, if you are fearful of what you maybe allergic to, have some tests where possible, find out if it’s true and, if serious, have a plan of attack. It may improve and also save your life.