Category: Strange World

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Wow. A study finds that only 54% of patients experiencing an anaphylactic episode requiring an ER visit or hospitalization get an epinephrine prescription within a year, and only 22% visit an allergist or immunologist in that time. (via this week’s FARE newsletter)

The article treats this as an education/compliance issue, but I have two big questions:

  1. How many of these patients discussed the incident with their regular doctor? It’s possible that more than 22% followed up with a doctor, just not with a specialist.
  2. How does insurance coverage correlate? If you don’t have insurance, it’s expensive to see a specialist, and expensive to get an Epi-pen (though there are generics now that are a bit cheaper)…especially after you’ve just received a bill for thousands of dollars for the emergency room.

Regarding #2, the study looked at “healthcare claims,” so if I’m reading that correctly, they may have only looked at people who do have insurance. If that’s the case, I wonder if it would be possible to break it down by type of insurance: HMO vs. PPO, do they charge a higher co-pay for specialists, etc. Our current system could do a lot more to encourage preventative care.

For the record: The first thing I did when I got home from that San Diego trip was to order a replacement Epi-Pen, and Monday morning, I called up my allergist to schedule an appointment. But then, I already had an allergist, a prescription, and insurance.

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Buildings reflecting the setting sun Reflected sunset in the lobby

Monday afternoon I noticed the sun was still shining into my office window. This was a bit odd since my window looks out at another building, and the sun had already sunk behind it.

I looked, and it was reflecting off the building I was in, then reflecting off the building across the way.

Later that evening, I stepped out of the elevator to the sight of sunlight streaming into the lobby from the east.

Wait, east? At sunset?

You guessed it. Once again, it was reflecting off another building.

This part of Los Angeles is built on a North/South and East/West grid, and with the autumnal equinox approaching, it’s lining up just about perfectly with the shiny reflective buildings.

It also aligns perfectly with the mirrors in my car when I’m driving east at sunset. The triple sun is almost worse than driving straight at it.

It’s no Manhattanhenge, but it’s still interesting. One of these days I’ll look up the grid alignment for downtown LA (it’s diagonal) and try to recapture a moment from a few years ago, when I was in exactly the right spot for the sunset to light up all the towers bright orange. That was awesome

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You’ve got to love this headline: Giant goat-cheese fire closes Norwegian roadway for six days. Apparently, brunost burns really well, and when a truck carrying it caught fire in a tunnel, responders were unable to get to it for days.

(Incidentally, the stuff is also really good. My family discovered it on a vacation to Disney World, of all places, where they served it in the smorgasbord at the Norwegian restaurant in Epcot.)

This is even weirder than the truck full of meat that caught fire on the 5 near Camp Pendleton a few years back, blocking the entire freeway in an area with no alternate routes for most of the day and stranding all of the Orange County & Los Angeles people trying to get to the first day of Comic-Con.

I’m going to have to start using “flaming goat cheese on a truck!” as a pseudo-curse.

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When my son was younger, I longed for the day when he’d be able to talk, just so it wouldn’t be a guessing game every time he wanted something. Now that he can tell us whether he’s hungry, thirsty, wants to play ball or take a bath, wants something specific to eat, etc., it’s a lot easier to respond (even if it’s to tell him that no, he can’t have any pie because he refused to eat dinner).

Most of the time.

There are still a lot of things he understands but can’t say, so he tries to get the idea across some other way. Instead of 20 questions, it becomes a riddle game.

As an example: Last night he kept saying “pee.” This variously means “piece” (either as an observation or a request), “please” (though he usually signs that still), or, well, pee. After ruling out the obvious, we couldn’t figure out what he was trying to ask for or comment on until I realized he was always saying it while pointing at, looking at, or touching my desk, where I had set a roll of tape that I’d let him play with pieces of the other day…and made the connection with the other random comment he’d been pulling out every few minutes: pointing to a half-healed scrape on his foot from last week and saying “Ow.”

He wanted a new band-aid for the scrape: A piece of something like the tape on my desk for the owie on his foot.

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Allergies to nuts, grains, vegetables, seafood and milk are common. Allergies to meat? Much less so. But that’s starting to change.

A few months ago I read about adults (author John Grisham in particular) developing an allergy to red meat after being bitten by ticks.* And not just a low-level allergy like your face turning red — we’re talking full-on hives and anaphylactic** shock, the kind of thing that requires you to carry an Epi-Pen to make sure you keep breathing long enough to reach the emergency room.

Researchers have determined that the lone star tick’s bite can cause the body to produce an IgE antibody for a sugar called alpha-gal, which is found in mammal meat.

The result: from then on, you’re allergic to meat.

CNN calls it mysterious. Allergic Living calls it baffling. It’s certainly weird compared to “usual” allergies, and the fact that the reaction is usually delayed by a few hours makes it hard to diagnose, but we’re ahead of the game in understanding it: Unlike most allergies, we know what causes this one.

With most allergies, we know the process, but we don’t know what gets the ball rolling to begin with. We know that in people who are allergic to a food, exposure to it causes an IgE antibody reaction that triggers a massive release of histamines that sends the body into some level of shock, but we don’t know why some people have that reaction and others don’t.

There are a lot of ideas being investigated, with varying amounts of supporting evidence, but there’s still nothing we can point to and say: “This caused you to be allergic to nuts” or “That caused you to be allergic to milk.” Advice to parents concerned about keeping their child from developing allergies is all over the map.

2025 Update

When I posted this back in 2012, I segued into a call for fundraising for research. The particular fundraiser has since been discontinued, but research has dramatically improved both medical understanding and practical actions around allergies.

First: it’s been clearly demonstrated that early introduction of a food lowers the risk of a child developing an allergy to it. It’s not a guarantee, but at least there’s clear advice to parents now!

Plus, immunotherapy and IgE-targeting treatments can reduce sensitivity and severity (though they can’t always eliminate reactions entirely) for those of us who already have severe allergies, those who develop allergies as adults, and the (much smaller!) percentage of children who still develop food allergies even with early exposure.

Unfortunately there’s still no clear explanation for why that ~3% of children who do have early exposure still go on to develop allergies — or why some people bitten by the lone star tick develop what is now called alpha-gal syndrome and others don’t.

Advice these days is basically: Try not to get bitten by ticks, and if you do develop the allergy, stop eating red meat.

Notes

*Naturally, this was a few days after I hiked a severely overgrown trail without taking precautions against ticks, so I freaked out a bit, but I also hadn’t found any ticks when I got home from the hike.

**Fun fact: Chrome’s spell-checker doesn’t know “anaphylactic,” and suggested such helpful alternatives as “intergalactic” and “anticlimactic.” Not sure about the former, but I get the impression a lot of viewers suffered “anticlimactic shock” when watching the Lost finale.