Is this anaphylaxis?
November 17, 2013 7:11 PM Subscribe
Several times in the past 2 years, my husband has had episodes of skin redness. He also seemed oddly drunk. He's already promised me he'll make an appointment with our doctor about it, but I'm curious what questions he should be asking and what precautions we should take.
We already know that my husband has a host of allergies and sensitivities. He likely has celiac (he'd already cut it out of his diet to positive effect when the doctor wanted to test him, and he didn't want to reintroduce it). And he's had a skin test for allergens in the past. He tested positive for an absurd number of food allergens (eggs, peanuts, coconuts, treenuts, corn, soy, milk, and a bunch that I'm forgetting) and wasn't given advice beyond avoiding them. Over time, trial and error have shown that he can eat some of these foods without effect but that he definitely needs to avoid nuts and eggs. In the past, symptoms were digestive. He also has asthma and several environmental allergies, which cause sneezing, watery eyes, and coughing.
In the past year, he's had several occurrences (4-5) of skin redness while eating out or in new environments (friends' houses, etc.). The skin redness--splotchiness over the face, neck, back, arms, and chest--didn't itch, so my husband has generally insisted this wasn't hives or an extreme allergic reaction. These experiences usually correlated with drinking, though I realize, in retrospect, that all of these occurrences also correlated with his seeming disproportionately drunk compared to the amount of alcohol consumed--slurred speech or apparent confusion. Once he had trouble breathing, which was alleviated by his asthma inhaler. In every case, I've been the one to notice the hives, at which point my husband takes a benadryl. Once, it took two doses of benadryl for the redness to go away.
My husband insists that these allergic reactions aren't serious, since they're alleviated by benadryl and don't involve swelling, itching, or shortness of breath save once. But they're getting really scary for me, particularly since we haven't been able to figure out definitively what's causing them. He's promised me he'll go to our GP this week about it to hopefully talk to them about epi-pens and perhaps get a referral to a better allergist. What questions should we be asking, and how serious should we be taking this? I'm very concerned, but my husband thinks I'm worrying needlessly.
We already know that my husband has a host of allergies and sensitivities. He likely has celiac (he'd already cut it out of his diet to positive effect when the doctor wanted to test him, and he didn't want to reintroduce it). And he's had a skin test for allergens in the past. He tested positive for an absurd number of food allergens (eggs, peanuts, coconuts, treenuts, corn, soy, milk, and a bunch that I'm forgetting) and wasn't given advice beyond avoiding them. Over time, trial and error have shown that he can eat some of these foods without effect but that he definitely needs to avoid nuts and eggs. In the past, symptoms were digestive. He also has asthma and several environmental allergies, which cause sneezing, watery eyes, and coughing.
In the past year, he's had several occurrences (4-5) of skin redness while eating out or in new environments (friends' houses, etc.). The skin redness--splotchiness over the face, neck, back, arms, and chest--didn't itch, so my husband has generally insisted this wasn't hives or an extreme allergic reaction. These experiences usually correlated with drinking, though I realize, in retrospect, that all of these occurrences also correlated with his seeming disproportionately drunk compared to the amount of alcohol consumed--slurred speech or apparent confusion. Once he had trouble breathing, which was alleviated by his asthma inhaler. In every case, I've been the one to notice the hives, at which point my husband takes a benadryl. Once, it took two doses of benadryl for the redness to go away.
My husband insists that these allergic reactions aren't serious, since they're alleviated by benadryl and don't involve swelling, itching, or shortness of breath save once. But they're getting really scary for me, particularly since we haven't been able to figure out definitively what's causing them. He's promised me he'll go to our GP this week about it to hopefully talk to them about epi-pens and perhaps get a referral to a better allergist. What questions should we be asking, and how serious should we be taking this? I'm very concerned, but my husband thinks I'm worrying needlessly.
My sister is allergic to alcohol, and this describes her reaction almost exactly, although she does tend to get itchy on her arms and throat.
ETA: You're not worrying needlessly. He should avoid alcohol. Breathing difficulty can get very serious very quickly.
posted by SamanthaK at 7:29 PM on November 17, 2013
ETA: You're not worrying needlessly. He should avoid alcohol. Breathing difficulty can get very serious very quickly.
posted by SamanthaK at 7:29 PM on November 17, 2013
This sounds a bit like histamine intolerance. There are many food culprits but alcoholic drinks are high on the list. He should definitely go to an allergist or something.
posted by Ouisch at 7:43 PM on November 17, 2013
posted by Ouisch at 7:43 PM on November 17, 2013
This may be a variant explanation of what Ouisch posted, which is what I've heard called alcohol intolerance. The idea there is that people with it don't have enough enzynes to metabolize alcohol as quickly, hence the flushing and the acting extra-drunk. It's more common among people of Asian descent, but certainly not exclusive to that group. That link says that anaphylactic reactions related to it are very rare, but given your husband's other allergies, it's probably good to get his GP's take on what he should do.
posted by Smells of Detroit at 8:22 PM on November 17, 2013
posted by Smells of Detroit at 8:22 PM on November 17, 2013
Red wine makes it hard for me to breathe. I've stopped drinking it, but every exposure gets worse -- about a year ago, I ran into an appetizer that didn't mention a red wine reduction. I now carry an epi-pen in my bag just in case. Definitely ask your (husband's) doctor.
posted by rdn at 8:25 PM on November 17, 2013
posted by rdn at 8:25 PM on November 17, 2013
re: slurred speech and disproportionate drunkenness -- alcohol + benedryl will definitely do that to you.
posted by i_am_a_fiesta at 8:37 PM on November 17, 2013 [2 favorites]
posted by i_am_a_fiesta at 8:37 PM on November 17, 2013 [2 favorites]
FYI - itching doesn't indicate seriousness. My sister esperienced a rare adverse (emergency room - potentially fatal) side effect to a new-to-her epilepsy medication, and the primary indication was a lacy red rash - that didn't itch. So doesn't itch doesn't necessarily mean much.
I'd definitely see a different allergist.
Have him ask his GP what happens if he uses an Epi-Pen when he doesn't really need one - I'm pretty sure it's nothing. Better safe than sorry!
posted by jrobin276 at 8:55 PM on November 17, 2013
I'd definitely see a different allergist.
Have him ask his GP what happens if he uses an Epi-Pen when he doesn't really need one - I'm pretty sure it's nothing. Better safe than sorry!
posted by jrobin276 at 8:55 PM on November 17, 2013
You are both right about different parts of this issue.
Your husband is right that this is not an anaphylactic reaction. Anaphylaxis is a severe multi-system allergic reaction that goes beyond developing hives.
You are right that your husband should have an epi-pen. He should have had an epi-pen long ago, since he knows that he has multiple food allergies already - but since he was only having digestive issues before, that's probably why he was never written for one. I'm with you that I'd be terrified every time he started developing hives if there was not an epi-pen at the ready in case things got worse - it's simply crazy not to have one.
Epi-pens are not intended to be used for allergic reactions that only involve hives (and it's unclear from your description that these reactions are in fact allergic reactions - but there's still no reason not to be prepared for a serious allergic reaction in a situation with known allergies). Epi-pens should only be used when the allergic reaction includes symptoms such as shortness of breath, lip or throat swelling, or passing out (to indicate low blood pressure), which are symptoms of anaphylaxis.
Since it's literally a matter of life and death that could be easily addressed by having a prescription filled, I'd just go in to one of those pharmacy urgent cares and get the Epi-Pen from them at your earliest convenience, and then you won't have to spend the time until your husband's GP appointment worrying that something might happen and you won't be prepared.
Also on preview, to respond to jrobin - using an Epi Pen when it's not needed is actually not a good idea at all - epinephrine is a serious medication that could be dangerous, particularly for people who may have other health conditions. That is why it is only meant to be used in life or death scenarios like anaphylaxis. (also, people have a bad habit of getting freaked out while using it and accidentally injecting it into their thumb because they're holding it backwards, which can also cause serious complications for the thumb in question).
posted by treehorn+bunny at 8:58 PM on November 17, 2013 [2 favorites]
Your husband is right that this is not an anaphylactic reaction. Anaphylaxis is a severe multi-system allergic reaction that goes beyond developing hives.
You are right that your husband should have an epi-pen. He should have had an epi-pen long ago, since he knows that he has multiple food allergies already - but since he was only having digestive issues before, that's probably why he was never written for one. I'm with you that I'd be terrified every time he started developing hives if there was not an epi-pen at the ready in case things got worse - it's simply crazy not to have one.
Epi-pens are not intended to be used for allergic reactions that only involve hives (and it's unclear from your description that these reactions are in fact allergic reactions - but there's still no reason not to be prepared for a serious allergic reaction in a situation with known allergies). Epi-pens should only be used when the allergic reaction includes symptoms such as shortness of breath, lip or throat swelling, or passing out (to indicate low blood pressure), which are symptoms of anaphylaxis.
Since it's literally a matter of life and death that could be easily addressed by having a prescription filled, I'd just go in to one of those pharmacy urgent cares and get the Epi-Pen from them at your earliest convenience, and then you won't have to spend the time until your husband's GP appointment worrying that something might happen and you won't be prepared.
Also on preview, to respond to jrobin - using an Epi Pen when it's not needed is actually not a good idea at all - epinephrine is a serious medication that could be dangerous, particularly for people who may have other health conditions. That is why it is only meant to be used in life or death scenarios like anaphylaxis. (also, people have a bad habit of getting freaked out while using it and accidentally injecting it into their thumb because they're holding it backwards, which can also cause serious complications for the thumb in question).
posted by treehorn+bunny at 8:58 PM on November 17, 2013 [2 favorites]
re: slurred speech and disproportionate drunkenness -- alcohol + benedryl will definitely do that to you.
OP here. The slurred speech and odd drunkenness happen before he takes the benedryl. After, he pretty much conks out promptly. I was curious as to whether this could be anaphylaxis because some online sources cite "confusion" and "slurred speech" as symptoms.
Interesting thoughts about the alcohol sensitivities. He drinks wine, whiskey, and occasionally hard cider or gluten free beer at home but in these cases when he's had reactions he seems unusually sloshed after very few drinks. This happened last night after a wedding where he ate nothing he's sensitive to that we could discern, but he did drink champagne and a few glasses of very cheap wine over the course of the night. He may have likewise had odd drinks in these other instances--at least once when this happened he drank a few woodchuck ciders, which make him generally feel "gross" and which he normally avoids. I wonder if it could, in fact, be a response to sulfides or histamines.
Please do keep any thoughts coming--your responses have already helped him feel better about going to the doctor and raised one more possibility to discuss with our practitioner.
posted by HivesMind at 9:15 PM on November 17, 2013
OP here. The slurred speech and odd drunkenness happen before he takes the benedryl. After, he pretty much conks out promptly. I was curious as to whether this could be anaphylaxis because some online sources cite "confusion" and "slurred speech" as symptoms.
Interesting thoughts about the alcohol sensitivities. He drinks wine, whiskey, and occasionally hard cider or gluten free beer at home but in these cases when he's had reactions he seems unusually sloshed after very few drinks. This happened last night after a wedding where he ate nothing he's sensitive to that we could discern, but he did drink champagne and a few glasses of very cheap wine over the course of the night. He may have likewise had odd drinks in these other instances--at least once when this happened he drank a few woodchuck ciders, which make him generally feel "gross" and which he normally avoids. I wonder if it could, in fact, be a response to sulfides or histamines.
Please do keep any thoughts coming--your responses have already helped him feel better about going to the doctor and raised one more possibility to discuss with our practitioner.
posted by HivesMind at 9:15 PM on November 17, 2013
My mother's shellfish allergy started as gastro and has progressed to scary major flushing. The first time it happened the ER doc told her that next time it might be flushing again, or it could go on to anaphylaxis. She's had an Epipen ever since. Each time she has a reaction it is somehow worse than the time before, but she's been lucky so far. She also always carries melt in mouth children's Benadryl, because it kicks in much faster than pills.
The problem with allergies is that they escalate so quickly and unpredictably. It can go from uncomfortable to deadly anytime. It isn't worth it to take the risk. And in many states, EMTs can't give epinephrine or can only administer if the patient's own epipen.
On preview: Even if he didn't eat the actual food, the reaction can happen just with pan and utensil contamination. My mother's last reaction happened when she forgot to tell the waiter that she's allergic, and neither of us had anything remotely shellfishy. And it was basically a burger place (Red Robin). I knew she was having a reaction before she did, because of the flushing. It doesn't itch and it looks scary and she feels like hell. It is worth being safe.
posted by monopas at 9:31 PM on November 17, 2013 [1 favorite]
The problem with allergies is that they escalate so quickly and unpredictably. It can go from uncomfortable to deadly anytime. It isn't worth it to take the risk. And in many states, EMTs can't give epinephrine or can only administer if the patient's own epipen.
On preview: Even if he didn't eat the actual food, the reaction can happen just with pan and utensil contamination. My mother's last reaction happened when she forgot to tell the waiter that she's allergic, and neither of us had anything remotely shellfishy. And it was basically a burger place (Red Robin). I knew she was having a reaction before she did, because of the flushing. It doesn't itch and it looks scary and she feels like hell. It is worth being safe.
posted by monopas at 9:31 PM on November 17, 2013 [1 favorite]
The other thing to consider with alcohol is that it is derived from plant sources, and sometimes not at all obvious or consistent. Different beers might be made from barley, rice, wheat or oats for instance.
posted by 445supermag at 9:34 PM on November 17, 2013
posted by 445supermag at 9:34 PM on November 17, 2013
Your husband's insistence that it is not serious yet is scary. Whatever it (multiple its) is, the symptoms are getting worse and likely to have greater adverse reactions with each exposure. Having had an anaphylactic reaction one time, I do not want him to experience that. I was in a hospital lobby and almost died before help.
Alcohol is a likely culprit but he should be keeping a food diary of every thing he puts into his system. It will cut down on the guess work. Then he needs to be at the doctor and you need to be there to help him describe his symptoms. Best of luck.
posted by OhSusannah at 9:59 PM on November 17, 2013
Alcohol is a likely culprit but he should be keeping a food diary of every thing he puts into his system. It will cut down on the guess work. Then he needs to be at the doctor and you need to be there to help him describe his symptoms. Best of luck.
posted by OhSusannah at 9:59 PM on November 17, 2013
I flush with certain alcohols. More often with wine but sometimes with other drinks. I love beer but some beers make me really stuffy. I have not been able to figure out a clear line between these things. I do not appear more drunk or confused or get rashes. His situation does seem a hair on the severe side. And these kinds of intolerances are common and can be quite dire.
Definitely worth talking to a doctor and probably getting an epi-pen and learning how to use it.
posted by amanda at 11:17 PM on November 17, 2013
Definitely worth talking to a doctor and probably getting an epi-pen and learning how to use it.
posted by amanda at 11:17 PM on November 17, 2013
Seconding pan and utensil contamination. Also, my allergist told me that alcohol exacerbates allergic reactions, sometimes tripling their effect. In my experience, back when I was discovering my food allergy, alcohol + allergy-tripping food = disproportionate drunkenness. By this I mean that I was wasted over less than half a beer.
I've never had an anaphylactic reaction but I carry my epi-pens everywhere. They are worth keeping on hand.
posted by 9000condiments at 11:44 PM on November 17, 2013
I've never had an anaphylactic reaction but I carry my epi-pens everywhere. They are worth keeping on hand.
posted by 9000condiments at 11:44 PM on November 17, 2013
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You might want to go to the GP with him, it seems like you might be able to explain the concerning symptoms more accurately, since he doesn't feel they were anything to be concerned about.
posted by yohko at 7:28 PM on November 17, 2013