A few weeks ago my wife ate a fish dish on a river cruise and unexpectedly got an attack of a food allergy that she never had had before.
She said she experienced the first symptoms seconds after swallowing. What followed was major allergy symptoms and symptoms of a mild asthma attack (feeling of light respiratory distress). She toughed it out because even if the ship stopped at the next city we’d be an hour or more away from medical help at this point. In the morning she was OK except from much swelling around the eyes.
My question in this regard: With symptoms of a food allergy experienced immediately after swallowing, is the standard medical advice
(1) to try and throw up ASAP then rinse the mouth
(2) not to throw up, because the offending food passes the mouth’s mucosal membranes once more on the way out?
Throw up, it might keep things from getting worse as you’ll get rid of undigested allergen. It will depend on how severe the reaction is/will be.
Don’t ever get on a ship/boat that doesn’t have basic first aid supplies.
You and your wife are damned lucky.
Now that you know, carry antihistamines, see if you can get an Epi-pen and stay away from seafood.
I’ve no FQ level answer to the question. My guess is to not induce vomiting. Any small chance of inhaling the allergen during the process would be a greater chance of fatal airway swelling. But that is balanced against decreasing a bigger systemic reaction with blood pressure collapse.
Back home get to her doctor ASAP. Identify exactly what the allergen was by testing; it might have been an ingredient other than the fish. The doc will prescribe the epipen and never be without it.
By all means, this. It would be a shame to have to avoid fish for the rest of her life if the actual allergen was, I don’t know, cilantro or something. Also she can find out if she has any other unknown food allergies that she hasn’t run across yet.
As for the emergency situation, I’m not a doctor, but I do have food allergies myself. Occasionally I have accidentally eaten something that I know I’m allergic to, and I usually know within a few seconds so that I can avoid eating more of it (my favorite example was some chef who used walnuts instead of pine nuts to make pesto, because they were cheaper). Because I know my own reactions, I am good with taking Benadryl and lying down for a while. I don’t want to give general advice, though. I’m glad she pulled through it okay, I know that kind of reaction can be scary.
The generic name of Benadryl is diphenhydramine. Drammamine is dimenhydrinate. So, no, not the same thing even if the spelling of one has some resemblance to the other.
I strongly recommend seeing an allergist to identify the specific culprit and equipping your wife with the proper knowledge and training for if it happens again. The next exposure might result in a much, much more severe reaction.
Also, the next time it happens on something like a river cruise TELL THE STAFF. They might have an emergency kit, or know how to contact authorities in case emergency medical care is needed.
Yes, Benadryl is diphenhydramine. Dramamine is the same thing with 8-chlorotheophylline (a stimulant) added. I was told by my doctor that Benadryl is just as effective as Dramamine for motion sickness, so I’d think Dramamine would be just as effective as Benadryl as an antihistamine.
In general, vomiting should always be a last resort. It can do real damage to the esophagus. I once had a partial tear of the esophagus (bit of Mallory-Weiss Syndrome) from making myself puke up something that I didn’t have to.
Just to make very clear: neither Benadryl or Dramamine would do anything to protect from airway closure in response to an immediate allergy reaction (anaphylaxis). And it can happen fast.
In anaphylaxis she wouldn’t be able to vomit. She was breathing, clearly. She kept eating.
I think it was probably a mild allergic reaction til it got swallowed resulting in swollen eyes and lips the next day.
Benadryl in my IANAD opinion could have helped her.
But, yes they need to look further into what ingredients caused her reaction and avoid it. Carry an epi-pen. Follow doctors instructions.
Personally I would’ve barfed as soon as I felt it was bad with the first bite.
It’s an interesting question, actually, and one I’m not qualified to answer: what would result in a greater exposure to the allergen? The many hours in the digestive tract or a second brief exposure of the esophagus and mouth? I guess, but am not sure.
If only it were that simple, though! Our experience in many years of giving ipecac eventually showed that what seemed like effective vomiting often left a substantial amount of the undesired substance in the stomach. (Reason 1)
Plus: many of the things people use to induce vomiting can be harmful in themselves. Ipecac, for instance, is somewhat cardiotoxic. (Reason 2)
But most of all, if there is ANY chance at all of someone losing consciousness or having airway problems in the near future, they really, absolutely do not need to be bringing up stomach contents. (Reason 3 with exclamation points.)
As others have said, she should be evaluated by a doctor, and get an epi autoinjector, then never be without it.
Also, without knowing more about the cruise and the particular vessel, it’s hard to guess whether they would have had the needed emergency supplies, but I sure would have asked.
Actually vomiting is a common part of an immediate type reaction. The immediate, within seconds, “asthma attack” symptoms scream IgE mediated immediate allergy reaction, and that is the sort that causes anaphylaxis.
Yes it was on the scale of an IgE mediated reaction mild. And for mild episodes an antihistamine may provide the relief desired.
But it does not lower the risk of progression to worse or treat the worse impacts.
Dermatology and allergy are very different specialities. And whichever they were they have the benefit of taking the history in person direct from the source. And an allergist knows allergy far better than I would ever even want to. (Derm likely not.)
That said if this was my spouse I would be assertive because I’d be scared. Very scared. I’d personally be begging her to not gingerly experiment with eating anything suspected to have been in that dish until testing proved it was not of significant risk.
Lots does not scare me. When our kids were small one of my wife’s standard lines was “a normal father would be worried now.” Risk of anaphylaxis without an Epipen available is on my short list though.
Epi-pen has side effects I wouldn’t want, if it was not necessary. Until there’s obvious breathing problems and tongue, throat swelling. I’d wait. But that’s just me. You do what your allergist says.
My allergist and dermatologist are in the same clinic. I tend toward skin allergies and I’ve seen both of them together, at one point.
Not having an EpiPen when needed has a common side effect that I would not want for my wife: death.
If you are at risk for anaphylaxis don’t wait for your airway to close and your blood pressure to plummet. Use the EpiPen, which buys you the time to get to an ED.
Anything of throat tightening sensation, asthma symptoms like wheezing or hard fast breathing or even cough, lightheadedness, fainting, belly pain, nausea, vomiting, diarrhea, or that infamous “sense of impending doom” are signs of anaphylaxis in progress which can advance quickly. Antihistamines do NOT treat or prevent anaphylaxis. They can help with mild allergy symptoms like itchiness but that is it. Use it if mild itchiness is all you are experiencing or as an adjunct after using the EpiPen.
If you are not sure? Use the damn EpiPen (or Auvi-Q or whatever brand you have). DO NOT WAIT UNTIL IT IS OBVIOUS THAT YOU NEED IT!!!
I assumed the OPs wife did not have previous problems with fish and didn’t carry an Epi-pen.
Now she’s seen a doctor and has pills, I’m going on the premise she feels prepared. I hope she’s much better.
I have to carry glucose rescue kit everywhere I go. I’m always watching my CGM because I know where my danger lies. I will not allow it to be given til that point. My aide knows this too. My family is informed.
You can’t walk around sticking yourself if you sneeze at a buffet. You need to know your own needs. Your family should know.
Of course if you have a history of extreme symptoms and subsequent breathing difficulties take the shot. Without fail.
This clearly was not the case here. The OPs wife finished eating. Did not pass out from lack of oxygen and had moderate symptoms. Her doctor didn’t see a need to prescribe her an Epi-pen.
In her case, if it were me as soon as I thought the fish was bad for me I would have barfed. Don’t think I could’ve help it. I certainly wouldn’t eat anymore.