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Another eating accident
Mar. 2nd, 2009 08:28 amFriday would have been a productive day, had I not spent most of the afternoon and evening dealing with another eating accident.
Being one of the 2% of the population that have severe allergic reactions to certain proteins makes for a complex life, eating-wise. Avoiding allergens is something of a hit-and-miss affair. I know specific restaurants (and specific menu items) that have been reliably reaction free; though even with these there have sometimes been mild reactions occasioned I suspect by accidental cross contamination in the kitchen; a knife not completely wiped after cutting cheese for example would provide sufficient contamination to set off a mild reaction in my case.
There are two brands of vegan cookies I've been eating for years. It's extremely difficult to find cookies without milk protein; those without the more obvious milk products often contain whey, which itself contains milk protein. The vegan cookies, by definition, do not contain any dairy. The No Cookie (an oddly unappetizing name) is one I've eaten since 95. Recently, a friend gave me a birthday present of 10 packs - a wonderful treat; they are difficult to find in Albuquerque.
So last Friday I ate a No Cookie cookie. Fifteen minutes later, my hands started to itch, and I started sneezing. I know these as early signs of a reaction. Checking the mirror, I was already blotchy from hives. I took 20ml of liquid Benadryl, and settled in to wait.
I know that there are two ways this is going to go at this point; the Benadryl will be ingested quickly enough and will be of sufficient quantity to block the cascade reaction of the mast cells that have started sending out instruction to flood my body with histamine; or, after 15 minutes or so, I'll be subject to an all out systemic anaphylactic reaction. This time the reaction didn't stop.
The next concern is my airway. One of the effects of histamine is generalized edema. This can involve swelling of the soft tissue in the throat, closing off the airway. I could feel that starting, but it didn't seem serious. I had an epipen on hand, so if that became a real threat, I'd take the epinephrine.
As it was very clear now that the Benadryl would not stop the cascade reaction, and as a compromised airway was a possibility, I decided it was time for the ER. I called Bill so he'd know what was going on, and drove myself to the hospital. There is some point at which I would have known that pressing the medical emergency button on the alarm system would have been appropriate; but without major airway constriction, I knew I could get to the hospital - just a few minutes drive - in time.
Once at the crowded ER, I went to the front of the line and told the receptionist I was having an anaphylactic reaction to food; within minutes I was in a gown and in a bed. They know not to mess with this reaction, which can go south very quickly.
The doctor concurred with my evaluation. About 3/4 of my body was now covered in hives; my hands and feet were swollen and burning; my airway was still good, though my voice was a little rasping. Given the elapsed time, it was unlikely that further swelling of the throat would occur before they reversed the reaction.
Edema is something of a problem for the nursing staff; it took three of them all trying multiple times to find a vein so that they could administer Pepcid intravenously. It may sound odd, but Pepcid is actually a very effective Histamine-2 receptor blocker. That coupled with Zyrtec (a Histamine-1 receptor blocker), and the Benadryl I'd already taken (Histamine 1 and 2 blocker), was sufficient to stop the production of histamine, and return me to normal.
One of the problems with this type of reaction, is that the drugs are blocking the cascade effect; but the original cause - the protein - is still in your body. As a result, you can experience a 'bounce' effect following the initial reversal, where the symptoms reappear. To avoid that, I continued over the weekend with large doses of oral Pepcid and Zyrtec; the net result was that I was OK but sluggish. Disaster avoided - again.
The worry remains; was the No Cookie contaminated, or have I now developed a new allergy? Only time will tell. It will be a while before I'll pluck up courage to eat another Vegan cookie!
Being one of the 2% of the population that have severe allergic reactions to certain proteins makes for a complex life, eating-wise. Avoiding allergens is something of a hit-and-miss affair. I know specific restaurants (and specific menu items) that have been reliably reaction free; though even with these there have sometimes been mild reactions occasioned I suspect by accidental cross contamination in the kitchen; a knife not completely wiped after cutting cheese for example would provide sufficient contamination to set off a mild reaction in my case.
There are two brands of vegan cookies I've been eating for years. It's extremely difficult to find cookies without milk protein; those without the more obvious milk products often contain whey, which itself contains milk protein. The vegan cookies, by definition, do not contain any dairy. The No Cookie (an oddly unappetizing name) is one I've eaten since 95. Recently, a friend gave me a birthday present of 10 packs - a wonderful treat; they are difficult to find in Albuquerque.
So last Friday I ate a No Cookie cookie. Fifteen minutes later, my hands started to itch, and I started sneezing. I know these as early signs of a reaction. Checking the mirror, I was already blotchy from hives. I took 20ml of liquid Benadryl, and settled in to wait.
I know that there are two ways this is going to go at this point; the Benadryl will be ingested quickly enough and will be of sufficient quantity to block the cascade reaction of the mast cells that have started sending out instruction to flood my body with histamine; or, after 15 minutes or so, I'll be subject to an all out systemic anaphylactic reaction. This time the reaction didn't stop.
The next concern is my airway. One of the effects of histamine is generalized edema. This can involve swelling of the soft tissue in the throat, closing off the airway. I could feel that starting, but it didn't seem serious. I had an epipen on hand, so if that became a real threat, I'd take the epinephrine.
As it was very clear now that the Benadryl would not stop the cascade reaction, and as a compromised airway was a possibility, I decided it was time for the ER. I called Bill so he'd know what was going on, and drove myself to the hospital. There is some point at which I would have known that pressing the medical emergency button on the alarm system would have been appropriate; but without major airway constriction, I knew I could get to the hospital - just a few minutes drive - in time.
Once at the crowded ER, I went to the front of the line and told the receptionist I was having an anaphylactic reaction to food; within minutes I was in a gown and in a bed. They know not to mess with this reaction, which can go south very quickly.
The doctor concurred with my evaluation. About 3/4 of my body was now covered in hives; my hands and feet were swollen and burning; my airway was still good, though my voice was a little rasping. Given the elapsed time, it was unlikely that further swelling of the throat would occur before they reversed the reaction.
Edema is something of a problem for the nursing staff; it took three of them all trying multiple times to find a vein so that they could administer Pepcid intravenously. It may sound odd, but Pepcid is actually a very effective Histamine-2 receptor blocker. That coupled with Zyrtec (a Histamine-1 receptor blocker), and the Benadryl I'd already taken (Histamine 1 and 2 blocker), was sufficient to stop the production of histamine, and return me to normal.
One of the problems with this type of reaction, is that the drugs are blocking the cascade effect; but the original cause - the protein - is still in your body. As a result, you can experience a 'bounce' effect following the initial reversal, where the symptoms reappear. To avoid that, I continued over the weekend with large doses of oral Pepcid and Zyrtec; the net result was that I was OK but sluggish. Disaster avoided - again.
The worry remains; was the No Cookie contaminated, or have I now developed a new allergy? Only time will tell. It will be a while before I'll pluck up courage to eat another Vegan cookie!
