Tag: health

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I’ve been thinking a lot about Robert J. Sawyer’s Quantum Night the last few months. It links human cruelty, psychopathy, and mob behavior to the nature of consciousness, mostly focusing on the main characters but playing out against a global crisis brought on by a rising tide of xenophobia.

More recently, I’ve been thinking about Frameshift. His 1997 novel deals with (among other things) eugenics, Neanderthals, Nazis, and health insurance companies doing everything they can to avoid covering people with pre-existing conditions.

I can’t imagine why that keeps coming to mind….

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On every news story about someone who experienced a severe allergic reaction outside the home, there will be someone who says, “If it’s that dangerous, why would you even risk it? Keep your kid at home and make all their food yourself from scratch all the time!”*

Let’s think about this.

A car could kill your child. Today, tomorrow, years down the line. This is not a hypothetical. This is a fact, and it’s a risk that you live with.

Why on earth would you risk letting your child cross the street? Keep them at home! Don’t let them out of the house in case someone jumps the curb!

That’s…not exactly practical, is it?

You don’t keep your child inside 24/7 to avoid cars. You take them outside, with precautions. You teach them to stay on the sidewalk, cross at corners and crosswalks, and look for cars before crossing. You walk with them until they’re old enough to walk safely on their own.

You rely on drivers to follow the rules of the road…but you still look both ways in case someone’s distracted or feels entitled and plows through a red light anyway.

And then your children can live their lives out in the world instead of being frightened recluses who hide in the basement whenever a car goes by.

You can’t eliminate risk 100%, but you can manage it.

The exact balance is going to be different for each person with an allergy.** But it’s not unreasonable to expect the food industry to follow basic safety procedures to avoid cross-contact — and to not introduce a danger that wasn’t there to begin with.

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*Even if you have the time to prepare every meal at home, there’s still the risk of mislabeling or cross-contamination in the supply chain. Right now, there’s an ongoing recall of baked goods produced with peanut-contaminated flour. A year ago, supplies of cumin were tainted with peanuts. That impacted everything from prepared foods down to bulk-bin spices. Everyone’s at risk with the massive listeria recall of vegetables, allergies or no.

**Heck, it’s different for each of my allergies, and I’m one person. I’ll cheerfully walk into a coffee shop that serves almond milk and soy milk, but won’t set foot in one of those burger places that plops a bin of peanuts on the table. Even with my Epi-Pen. That’s just playing live-action Frogger.

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It’s clear that many people online don’t understand the concept of dosage or concentration when it comes to substances of any sort (food, drugs, additives, environmental factors, chemicals*, radioactive isotopes): Something can be harmless or even beneficial in small amounts, but dangerous in large amounts.

Trivial examples:

  • You need salt for neural function, but if you drink sea water you’ll get sick.
  • Vinegar is dilute acetic acid. It’s useful for cooking and great on salads. Highly-concentrated acetic acid is corrosive.

Think of it like turning the steering wheel on your car (or the handlebars on your bike, if you prefer):

  • Turn it too far, and you go off the road, lose control, spin out, or otherwise crash.
  • Turn it just right, and you change lanes, avoid an obstacle, or go down a different road.

Also, most things will have multiple effects, some positive and some negative. (Consider aspirin: pain relief, fever reducer, blood thinner, but high doses can cause ulcers.) The balance of how strong each effect is will change with dosage, so you might have a strong positive and mild negative at one dosage, and a mild positive and strong negative effect at a higher one, and at an even higher dose even the positive effects would become negative as described above.

So the next time you see a warning about how hazardous something is in high concentrations…think about whether that has anything to do with the level at which people are actually exposed to it in the typical case.

*Remember: Everything is made of chemicals, including raw organically grown food.

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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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Allergic Living has advice on how to respond to a severe allergic reaction, particularly when to administer epinephrine and seek emergency medical treatment.

At first she didn’t show any symptoms and her mother gave her a dose of antihistamine; but in 20 minutes the systemic reaction began. Her father, a physician, gave her three doses of epinephrine, but it wasn’t enough to stop the rapid-fire chain of events. She began vomiting, her throat swelled to the point where she could no longer breathe and she went into cardiac arrest. She died in his arms.

Natalie’s story has spiked fears among Allergic Living’s readers, in particular parents of children and teens with food allergies. It has also raised questions about just what to do in case of an accidental allergen ingestion, so we turned to two experts for answers.

The key takeaway: you can’t always be sure a mild reaction will stay mild, because it takes time for the body to absorb the food. I was fortunate enough to survive learning that lesson, exactly one week before Natalie Giorgi’s death. All I lost was an afternoon and the $200 co-pay for the emergency room. It could have been so much worse.

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Allergic Living reports on a peanut allergy treatment study that shows a great deal of promise. Called sublingual immunotherapy, or SLIT, it’s surprisingly simple: Introduce a small amount of peanut protein in drops beneath the tongue each day, slowly ramping it up over time.

After 44 weeks of the daily doses, 70 percent of those getting the peanut powder could tolerate at least 10 times more peanut in an oral food challenge before showing symptoms than they could have at the outset of the study. In a follow-up challenge at 68 weeks, they could tolerate about twice as much again.

It’s a similar premise to allergy shots, which work well for airborne allergens but not for food. And while I’m creeped out by the idea of deliberately ingesting something that I’m used to avoiding because it could kill me (this has to be done under medical supervision!), like so many other things it’s all about dosage. It makes sense that it could work.

The main drawback is that 30% of the participants didn’t show improvement, though the people running the study suspect that it’s a matter of finding the right dosage for each patient.

The article mentions another problem being that the amount tolerated is relatively small: they could eat the equivalent of two peanuts before experiencing allergy symptoms.

I say: Two peanuts? Are you kidding me? I would LOVE to be able to safely eat that much!

So it’s not enough to eat Thai food or PBJ. It would mean I can stop worrying so much about cross-contamination! I’d still carry my epi-pen around, but I’d feel a lot safer about, say, drinking a milkshake at a restaurant that also serves peanut butter shakes, or eating an eggroll at a place that also has kung pao, or eating a chocolate chip cookie that’s been stored on the same shelf as the peanut butter cookies.

One question I do have is how effective it is at reducing sensitivity to similar allergens. Would taking the peanut treatment help someone tolerate legumes better, or are they different enough to require a separate course of treatment?