Allernet > Newsletter > Real Stories

In this section of the AllerNet Newsletter real patients will have a chance to tell their sometimes exciting and very real allergy and asthma stories. All medical histories will be kept strictly confidential while at the same time allowing the AllerNet audience an opportunity to learn from the experiences of other allergy sufferers and their families.

Each educational cases presented here are selected from the Kagen Allergy Clinic as well as from the participating specialists in the National Pollen Network.

We sincerely hope that you will benefit from these patients' experiences.

AMY M.

Amy M. is a 22 year old who was experiencing symptoms of itchy eyes, itching in the throat, sinus headaches and skin rashes during the outdoor allergy seasons. Also, She said that she had a severe reaction to peanut butter with her throat swelling closed.

All of her symptoms were continuing in spite of using some very good allergy medications including decongestants, antihistamines (Claritin) and intranasal corticosteroids (Flonase).

Amy's allergy skin testing revealed remarkable reactions to airborne pollen allergens of ragweed, grass and trees, including birch. She was also found to be allergic to all of the animal danders, including dog, cat, guinea pig, hamster, horse and rabbit.

Importantly, she also related that she had experienced severe swelling of her lips when eating bananas and kiwi. Kiwi has within it allergy proteins similar to those found in latex products such as gloves and condoms, although from taking her history it did not initially appear that latex would be much of a problem for her.

Amy's diagnosis, then, was that of:

(1) Allergic rhinitis
(2) Food allergy
(3) Food-induced anaphylaxis

Amy's allergy management included instructions to avoid those foods such as kiwi, peanut butter and banana while also avoiding their "food relatives".

She was also given an adrenalin kit (Epi Pen) to be used if needed for severe reactions to foods and antihistamine therapy on a regular basis along with desensitization (allergy injections) using allergy extracts of those inhalant allergens which were responsible for causing her hay fever and sinus symptoms.

Amy was given a list of foods which might possibly aggravate her symptoms. Based upon her allergy education, she wrote down the following food diary:

• "Milk produces itching of the throat and severe itching in the ears." This is a symptom of a systemic allergic reaction and, therefore, all milk containing foods which includes all beef products should be avoided.
• The cousins of birch pollen allergens (apples, grapes, peaches, celery, apricots), produce severe itching in the throat and ears. This is a sign of a systemic and potentially life-threatening food allergy reaction. Cross-reactions occur in birch pollen allergic patients with foods that contain stony pits and as well as celery and carrots.
• Grass pollen cousins including tomato, onions, garlic, celery and white potato produce severe itching in her hands, abdominal discomfort (cramps and gas) as well as headaches. These symptoms again indicated a system wide allergic reaction involving the release of a great deal of histamine and other allergy chemicals which caused her symptoms.
• All nuts (which are not related to peanuts since peanut is a bean) produce a very itchy throat and ears. This is a sign, again, of a systemic reaction which may require the use of an Epi Pen adrenalin injection if breathing difficulties occur.
• Cousins of ragweed, such as banana, produce severe shortness of breath, puffy lips, throat and ear itching. These symptoms are again a systemic reaction due to cross-reactive allergens present not only in ragweed pollen but also perhaps in latex containing products.

Amy's initial diagnosis was that of food allergy and pollen allergy. As is illustrated by her case, many patients who have allergy to inhalant allergens such as the pollens of birch, ragweed and grass, may also have clinically severe symptoms of food allergy when eating these same protein allergens within commonly ingested foods.

PETER V.

Peter V. is a 6 year old boy who first found out that he had allergy problems when he experienced nausea and vomiting after eating "salads". Peter later ate Walleye pike and had a severe reaction involving "closing up of my throat". Immediate treatment was needed at a local Emergency Room with injections of adrenaline and anti-histamines.

Still, no referral to an allergy specialist was suggested to the family, in spite of Peter's dramatic reactions.

Several months later, and while continuing to avoid "salads and fish", Peter ate some tomatoes and had immediate diarrhea and stomach cramps.

Still, no one suggested to the family that they visit with an allergy expert to identify the offending causes of his excessive reactivity.

That was before he spent a day in the hospital following a life-threatening reaction to a "bee sting". After being stung by an unknown bee or Yellow Jacket, Peter felt sick right away. His face swelled up so he was beyond recognition, and he was short of breath and wheezing like a freight train. An overnight stay in a hospital where he was given emergency medical treatments made him look like himself again. This time, the family figured it out. It was time to see a specialist in allergy.

Peter was found on skin testing to be allergic to grass pollen allergens. This helped to explain why he also reacted to lettuce and tomatoes since both of these foods contain grass allergy proteins. Grass pollen allergens cross-react with food allergy proteins in tomato, lettuce, onion, celery, corn and sometimes carrots.

Not surprisingly, Peter's skin tests to foods including wheat. oats, rice, corn, cow's milk, egg, chicken, beef, pork, peanut (really a bean), and soybean were Negative. It is a common clinical finding that children often have significant allergy reactions to foods, but may not show on allergy skin testing which food source is causing the problem.

Luckily in Peter's case, we found him to have grass sensitivity which meant that he should avoid "eating grass", like the grass 'cousins' listed above.

His evaluation for bee sting anaphylaxis, or bee sting shock, will be completed next week by doing some venom allergy skin and blood testing to determine if he is in need of venom desensitization injection therapy.

In the meantime, Peter will be managed with (1) Avoidance of offending foods and hopefully insect stings; (2) Epi-Pen Jr adrenaline injections using an automatic injection device if needed for severe allergic reactions to either grass foods or insect stings; and (3) antihistamines when needed for nasal allergy symptoms in the grass allergy season.

Peter V. was found to be allergic to stinging insect venoms and food allergens within perch.

Since complete avoidance of these allergens was not possible, his treatment has included the use of an Epi-Pen (Junior) only as needed for systemic reactions to insect stings or food induced anaphylaxis (a severe allergic reaction including lowering of the blood pressure and/or wheezing). The Epi-Pen device is a self injecting vehicle for delivering adrenaline.

Adrenaline raises blood pressure and can reverse the severe spasm of the airways that occurs during either an asthma attack or anaphylaxis.

Peter is now taking allergy injections, otherwise known as allergen immunotherapy, for his bee sting allergy. His venom immunotherapy consists of his receiving injections of gradually increasing doses of the venom to which he has reacted. He is tolerating his therapy well, and he is now be able to be stung without having any systemic allergic reactions to bee venom in the future.

Venom immunotherapy is the only area in allergy where we can use the word "cure".

Allergen immunotherapy with pollen and mold allergens does not produce a cure. It produces a state of tolerance, wherein a patient may after receiving allergy injections now tolerate much more exposure to the offending allergens for which he/she has been treated.

In this regard, inhalant allergen immunotherapy using pollen, mite and mold allergens is a form of preventive health care. Peter V. is now prevented from dying with his next sting.

Unfortunately, there is no effective preventive treatment for fish allergy other than patient education and complete avoidance.