Tag: Allergies

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At first I thought this was a followup to another story about an anaphylactic reaction during an airplane flight last week. No, it’s a totally separate incident.

One patient had an expired epi-pen. The other had never had anaphylaxis before.

Both planes had bottles of epinephrine and a syringe, not an auto-injector. Fortunately there were doctors on both flights who knew how to figure out the dosage, properly fill and deliver a shot.

In the second incident, the patient who was experiencing anaphylaxis for the first time is a doctor, but…have you ever tried loading a syringe and injecting yourself while your throat’s rapidly closing up until you can’t breathe? There’s a reason they make auto-injectors!

It could be worse: the same site has an article about another in-flight reaction a month ago, where staff couldn’t get the emergency kit open for 10 minutes! This time it was a pair of nurses who measured and administered the shot.

This…seems to be more common than I thought it was.

And putting an emergency kit on the plane without training your flight crew how to use it is just ridiculous.

(Reminders to self: 1. Check epi-pen expiration date. 2. Make sure it’s easy to find in my carry-on next time I travel.)

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Food companies are adding sesame flour to foods that didn’t have sesame so they can “comply” with new labeling requirements by always labeling “contains sesame” instead of instead of adding it to their existing cross-contamination protocols.

Meaning people with sesame allergy are suddenly finding that foods they used to be able to eat are now hazardous.

This is like a skydiving outfit deciding to stop maintaining their parachutes and disavow responsibility in their waiver instead of complying with a requirement to maintain their parachutes a little better than they were doing before.

Actually it’s worse than that. It’s like actively damaging some of the parachutes, and adding fine print saying that people who want well-maintained parachutes shouldn’t fly with them. And not mentioning it to repeat customers outside of that fine print.

You wouldn’t add wheat to a dish just to avoid having to guarantee it was gluten-free. Or add lead to your water so you don’t have to worry about keeping environmental contamination out. Or…

Ugh, those sound way too probable. People can be awful sometimes, and business has a tendency to remove ethics from decision making.

Update: Malicious compliance is a good term for it.

Not the first time

And apparently this wasn’t the first time companies have done this crap, either. After the 2016 labeling law went into effect, some companies added peanut flour to foods that didn’t have it. Not enough to impact the baking or texture or flavor…but enough to trigger an allergic reaction.

Disturbingly, I missed that previous round. I say disturbingly because I actually am allergic to peanuts, so I’m lucky I didn’t end up in the ER from something that used to be safe. I can only think of two explanations for why I didn’t notice:

By 2016, I was doing most of my grocery shopping at some of the slightly crunchier stores, and buying snacks from smaller brands that were either less likely to take that shortcut, or already had foods I was allergic to by the time I took my first look at the ingredients panel.

2016 was also the year the Epi-Pen price-gouging scandal boiled over.

Corporations behaving badly

Pharma giant Mylan had already gained a virtual monopoly on epinephrine auto-injectors. After FARE spent years lobbying for states to require epinephrine to be stocked in schools for emergencies, Mylan raised the price of the auto-injector drastically (a factor of 5 or 6), to the point where many people who needed them couldn’t afford it anymore.

Whether FARE was used itself, or a co-conspirator who used its members, I lost a lot of trust in them and stopped following their newsletters as closely. That was also the last year I participated in FARE’s Walk for Food Allergy fundraiser, and I only did that after they stopped accepting money from Mylan.

(Interesting note: The Intercept article mentions that Mylan deliberately set out to stop selling single Epi-Pens in the early 2010s and only sell the two-packs in order to justify charging more. I was already carrying two-pack at my allergist’s recommendation, which turned out to be highly fortunate the time in 2006 or so when I was hit by anaphylaxis and messed up the first injection.)

Expanded from a thread on Wandering.shop

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There’s a peanut allergy alert for “Chocolate to Die For” ice cream.

I don’t think the name was intended to be taken literally 😬

It reminds me of the time I saw a recall of “Toxic Waste Nuclear Sludge” candy, which turned out to actually be toxic. I mean, with a name like that…? (In that case it was lead found in the candy bars).

Though now that I think about it, my first full-on anaphylactic reaction was to an ice cream cake that was allegedly “chocolate, chocolate, everything chocolate” (and turned out not to be).

That’s eerily familiar.

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Discussion of food allergies tends to focus on children (for a lot of reasons), but a recent study found a much higher rate of food allergies among adults than expected. They found that 10.8 percent of American adults – that extrapolates to 26 million people! — reported a convincing food allergy (based on actual symptoms reported – another 9% reported allergies, but their symptoms didn’t match the diagnosis – presumably at least some of the rest are genuine intolerances). That’s actually higher than the rate among children found by another recent study, which came up with 7.6%.

Now, my first thought on reading this was: Of course! Kids with food allergies who were counted 10, 20, 30 years ago have grown up, and we’re adults now! But it’s more than that: There’s a lot more adult-onset allergies than anyone expected to find.

The JAMA article goes into the numbers. Of those who had a convincing allergy:

  • 48% developed at least one allergy as an adult
  • 26.9% developed allergies only as an adult.
  • 53.8% developed allergies only before turning 18

More than a quarter of adults with food allergies didn’t have them as children. That’s a surprise! And it raises questions: Is there a different mechanism that triggers childhood-onset allergies vs. adult-onset? (Other than tick bites, of course.) What about those of us who had allergies already and added more? Is there some sort of saturation threshold?

There are still a lot of unknowns about food allergies. But we do know that they can be deadly serious, and they affect a lot of people.

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If you have environmental allergies to pollen, dust, animals, etc. you’ve long had the option of taking shots to desensitize yourself to the allergen. That hasn’t been the case for food allergies. But a pollen allergy is a lot less likely to kill you than a nut allergy. Some sort of treatment beyond “try not to eat it, and use epinephrine if you do” has been sought after for a long time.

Various forms of oral immunotherapy (OIT, SLIT) for desensitization have been under study for a few years…along with an injected medication that takes a different approach.

Around 10-15 years ago, my allergist at the time brought up the possibility of Xolair (omalizumab) for my asthma, suggesting it might also help with my food allergies. It’s an IgE inhibitor, which means it blocks the pathway through which food allergies operate. In theory, it would reduce my chances (or reduce the intensity) of a severe reaction to an accidental exposure.

It was an unproven, off-label use. Xolair had only been studied and approved for treating asthma, primarily asthma that other medication couldn’t control. And it would mean regular shots. And staying in the office after each one to make sure I didn’t have a reaction to the shot itself.

Ultimately I decided not to take her up on it. It seemed like more trouble than I wanted to go to for an uncertain gain. My experience wouldn’t have even helped clarify that gain. Any close calls I missed would have just been another anecdote, the medication’s impact unproven.

A decade and a bunch of clinical trials later (some alone, some in combination with OIT), the FDA has given Xolair a “breakthrough therapy designation” for treating food allergies. That means fast-tracking further reviews and development as a treatment. (more detailed article.)

There’s still risk/benefit analysis to do (in general and on a case by case basis), but things are starting to finally look up in terms of being able to treat the condition instead of trying to detour around it!

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OK, this is a bit morbid, but bear with me.

Most news stories about deaths from food allergies feature children or teenagers, maybe young adults in their twenties. You read about grieving parents. You rarely read about the 40-year-old who leaves behind a grieving spouse and kids.

Food allergies send a lot of people to the emergency room: 200,000 annually in the US alone according to FARE. Almost all are successfully treated. But people do die from anaphylaxis, roughly 63–99 each year in the US according to AAAAI.

So why are the fatalities we hear about so young?

Is it just demographics? Allergy prevalence has been increasing, after all, so kids are more likely to have food allergies than adults are.

Newsworthiness? A three-year-old dying at day care tugs at the heartstrings in a way that a 38-year-old dying from takeout doesn’t.

Is it onset age? A reaction is more likely to kill you if you don’t know about the allergy yet, don’t know you need to carry epinephrine, and don’t know that the warning signs mean “hospital now!” and not just “lie down and try to get through the asthma attack.” By the time you’re an adult, you’ve probably already encountered everything you might be allergic to, so you’re less likely to get that surprise first reaction. It happens – I’ve known people who developed shellfish allergies as adults, and I found my own nut and peanut allergies expanding their range in my early 20s – and there’s the Lone Star tick – but it’s less likely.

Are adults more careful? Teenagers take more risks. Children often have to rely on secondary caregivers who don’t always have the training or understanding that their parents do. And of course, the longer you deal with something, the more it becomes second nature. Is it that we’ve gotten better at avoiding triggers, keeping our medication on hand, and seeking treatment faster?

Are you more likely to have died of something else in the meantime? According to one NIH study, “Fatal food anaphylaxis for a food-allergic person is rarer than accidental death in the general population.” So the longer you live, as long as you’re taking precautions with the allergy, chances are that something else will kill you before the allergy can.

I suspect all of these are factors, but I do wonder how they balance.