Sudden unexpected food allergy - best to try to throw up or not? (do not need answers fast)

[DSeid]

@Beckdawrek

Her doctor didn’t see a need to prescribe her an Epi-pen.

Yup. And in general I don’t second guess a doctor who has actually spoken with the patient in person. So I’m dealing with a hypothetical.

As a hypothetical: there are no pills that will help in an actual emergency, even if having some gives you a feeling of being prepared.

The hypothetical IOW as described second hand by the OP, including general allergy symptoms, eye swelling, and asthma symptoms/“light respiratory distress” beginning within a few hours of exposure, would leave me, as someone with some medical knowledge and not easily scared, scared for my wife until it was proven that there was no IgE mediated cause to an ingredient in that dish that she might be exposed to again.

If a doctor told my wife there was no reason for me to be scared and some pills would be enough to be prepared for a future emergency I insist that my wife see someone else.

True, EpiPen use is not indicated for sneezing at a buffet; it is indicated if even past relatively mild IgE mediated reaction is proven and there are any of the symptoms I listed. The next episode may be a fatal one.

Epi is underused. That’s not my opinion. It’s well documented.

Underuse of epinephrine for the treatment of anaphylaxis: missed opportunities

… many patients may not use their EAI, even when it is available during an anaphylactic reaction. This can occur for a variety of reasons, including lack of the following: recognition of anaphylaxis, knowledge with regard to indications for use of epinephrine, or comfort using epinephrine. The training that each patient receives with regard to recognition of anaphylaxis will be variable and dependent upon the information provided by their personal clinician, their own online searches, or discussion with other patients and families. Hence, it is easy to recognize the variability in the amount and reliability of information received by each individual patient. In a national registry of patients with peanut and tree nut allergy, a consistent inability to recognize anaphylactic symptoms was found.19 Sheikh et al also demonstrated that even when patients with a reported episode of anaphylaxis carried an EAI, many did not use it at the time of their reaction.20Robinson et al reported more encouraging data and found that when available, 86% of children received epinephrine prior to arrival at the ED and those patients with multiple food allergies were more likely to use their epinephrine.5 Brooks et al, however, found that when epinephrine was available, only about two-thirds of patients used it to treat an anaphylactic reaction.6 Reasons for not using their epinephrine included as follows: not thinking it was necessary, fear of using it, or having an expired device. …

Too many incorrectly believe it is not necessarily to use it for the episode, and/or are needlessly scared to use it.

And too many doctors drop the ball:

As previously mentioned, delayed administration of epinephrine in the treatment of anaphylaxis is associated with increased mortality,9 and consensus guidelines recommend epinephrine as first-line therapy.1,23,24 Despite this, antihistamines and corticosteroids are often the first medications administered by physicians to patients presenting with anaphylaxis.25–27 Even more concerning is that several recent studies demonstrate that approximately half of patients presenting to the ED with anaphylaxis never receive epinephrine.26,28–31

Criteria BTW:

TABLE I. Clinical criteria for diagnosing anaphylaxis
Anaphylaxis is highly likely when any one of the following 3 criteria are fulfilled:
Sampson et al 393

1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (eg, generalized hives, pruritus or flushing, swollen lips-tongue-uvula)
   AND AT LEAST ONE OF THE FOLLOWING
   a. Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
   b. Reduced BP or associated symptoms of end-organ dysfunction (eg, hypotonia [collapse], syncope, incontinence)
2. Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours):
   a. Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula) b. Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
   c. Reduced BP or associated symptoms (eg, hypotonia [collapse], syncope, incontinence)
   d. Persistent gastrointestinal symptoms (eg, crampy abdominal pain, vomiting)
3. Reduced BP after exposure to known allergen for that patient (minutes to several hours):
   a. Infants and children: low systolic BP (age specific) or greater than 30% decrease in systolic BP*
   b. Adults: systolic BP of less than 90 mm Hg or greater than 30% decrease from that person’s baseline
   PEF, Peak expiratory flow; BP, blood pressure.
   *Low systolic blood pressure for children is defined as less than 70 mm Hg from 1 month to 1 year, less than (70 mm Hg 1 [2 3 age]) from 1 to 10 years, and less than 90 mm Hg from 11 to 17 years.

Please do not even remotely suggest to anyone that waiting until the need is obvious is appropriate.