This was anaphylaxis wasn’t it? Nuts.

[Mytortoiseisbetter]

Ds2 (16) has always had hay fever/throat-clearing type symptoms ans the odd rash after food but last night something more serious happened.

he ate 4 Brazil nuts and a few minutes later his throat felt weird and his breathing became noisy. His eyes were red.

We happen to have a neighbour who is a local GP and he kindly came over. He got ds2 to take antihistamine. Then he got an inhaler, then a steroid inhaler. The throat cleared a bit and he sent ds2 to bed saying he should go to hospital if it didn’t settle. He said “we’d know by now” if it was going to be severe (he stayed with us for an hour)

I slept in the same room as ds2. Shortly after going to bed he got very agitated saying his heart felt like it was on fire. I thought it was a panic attack but then he threw up and after that it all subsided. He says his throat still feels a bit “cottony”.

I had assumed the vomiting was a response to the inhaler but Google tells me that vomiting and heart issues are actually part of anaphylaxis especially if food-related.

this morning I obviously called our own GP who ordered a RAST(?) test but that’s not till next Friday. She said normally you call 999 with any breathing issues.

I realised I’d failed to tel, her about the heart and vomiting to called back and gave a message to the receptionist.

dh is in complete denial saying “it could be nothing”.

it’s not though is it?

my neighbour has shown us where their epipen is (it went out of date in 2020).

Not sure what I’m really asking here. I guess a handhold? My older son had a life threatening emergency just a month ago requiring neurosurgery and I’m only just recovering from that!

I had anaphylaxis to penicillin
I had to be treated for 72 hrs after the event
With anti histamines , 40mg of prednisone( steroid ) & double my asthma inhaler
As there's a high chance of a relapse within this time

Do not use someone else's out of date epipen, that could be very dangerous. Call a private hospital and arrange an ige food allergy blood test.

I'd say that that was an allergic reaction not an anaphylaxis, which involves a systemic shock response, and antihistamines are the right choice for an allergic reaction, so keep some piriton in the house.

On the subject of Brazil nuts, my brother has a similar reaction, it is not a nut allergy but an allergy to the mold on the outside of the nut. Interestingly my brother also reacts sometimes when peeling potatos due to fungus spores on the skin.

Yes it's anaphylaxis. The definition of anaphylaxis is allergy symptoms in more than 2 organ systems:

1. Throat & hoarsenes (airways)
2. Eyes
3. Vomiting (gastro-instestinal)
4. Heart rate (cardiovascular)

He needs to carry antihistamines with him at all times and 2 x Epi-pens
NHS GP needs to prescribe Epi-pens and refer him to Allergy/Immunology, not faff around with RAST tests. (Also the most appropriate test is IgE for nuts)

If no luck with GP, you can buy Eli-pens online or pay for private Allergy/Immunology consultant appointment at which point he/she will definitely give you a prescription for Epi-pens which you give to NHS GP to go on his records.

(I have anaphylaxis)

I'd say that that was an allergic reaction not an anaphylaxis, which involves a systemic shock response,

You cannot possibly know that it wasn't and until he's been properly tested etc it is better that OP takes this very seriously.

He sounds like he's sensitive to nuts as opposed to full on anaphylactic allergic to them

Thank god

I never know what full anaphylaxis is categorised as (always thought it was any swelling of the throat) but yes this was a severe reaction. I have 2 relatives with severe nut allergy who carry epipens and they vomit as part of the reaction, after breathing difficulties. The consultant we saw said sometimes people sort of ‘self medicate’ by releasing adrenaline which dampens the reaction. He surely needs a skin prick test and a prescription for epipens.

Obviously get it looked at further in case he's not so lucky next time and his throat closes up immediately and he can no longer breathe

even if you use an epipen, you should still go to ER - anaphylaxis can reoccur when epipen wears off.

My son is anaphylactic to numerous things including nuts but they're reasonably well labelled nowadays. Our biggest worry is egg, just being in the same room as a cake can set him off if it's been cut and there are a lot of crumbs around. Also did you know there's often egg white in wine? Neither did we!

Your gp friend made a good few serious mistakes there but luckily for your son he got away with it.

When my son goes, he goes very red, heart racing and the feeling of his mouth swelling and his throat closing up and not being able to breathe. Vomiting often happens which at least gets some of the allergen out of his system.

Anaphylaxis causes total organ failure so an inhaler isn't going to do anything for that - silly man!!!

Adrenaline (epipen) often two epipens are your first port of call while calling an ambulance at the same time. Don't dilly dally. Oral antihistamines too are good if they can be taken.
Often one epipen isn't sufficient so make sure you get two and he carries both at all times.
Carrying them as an early teen was a challenge in our house but we finally found hand made leather type carriers specially designed that went on his normal belt which suited my sons style!

It's a tough one, I'm always on edge travelling because you never know what's been on someone's hands when they've touched something or in our case, if someone has a muffin or nuts on a train or plane.

The bottom line is that you can't allow yourself to think about it too much. It has to be in the back of your mind but it could rule yours and his life if you allowed it to.

Be prepared, carry antihistamines that you know work for him (only benedryl works for my son) and his epipens (x2!!!) and be very careful. If anything happens err on the side of caution and don't waste any time.

Thinking of you both 💐

This might be helpful as a way to work out what action you/he needs to take if he starts showing symptoms again.

No, he doesn't.

Nothing from OP description and reaction to the situation (or the reaction of the costing GP) suggests a 'rapidly developing life threatening situation', which was then easily and successfully managed at home, with vomiting later likely caused by anxiety (OP is the mother so I'll take her word on that as she knows her child).

People are often to quick to shout anaphylaxis these days, google 'overdiagnosis of anaphylaxis' and you will get lots of recent studies and opinion articles, it's a hot topic.

Visiting not costing

Traditionally, Pesto should be made with pine nuts(which are not actually a nut). To keep costs down most brands now contain cashews which we found out through an allergic reaction 😱

I've been told by medical personnel that using an out-of-date epipen is better than not using anything. It will not be 'dangerous'. just potentially less effective.

My daughter has had anaphylaxis a couple of times now we she has a very severe milk allergy.

the most recent one was about a month ago. She first felt like her Brett was racing and she couldn’t breathe, but she thought she was panicking. Her tongue was spotty and then she projectile vomited. By this point she was grey. Stupidly, as we were out I walked her back into the main square (we were on holiday abroad), so I could get help. The consultant said that was bad as reactions are worse before, during or after exercise. She was grey, her voice was hoarse and suddenly she was begging for her epipen. She was also covered in hives. All happened very quickly.

If you have an epipen, you have to spend min 6 hours in hospital, as the reaction can reoccur. She was very unwell and ended up spending quite some time in hospital.

rast tests are blood tests, but she’s also had skin prick tests. I would try to get a referral to the allergy clinic we GPs aren’t generally good with allergies.

always have 2 epipens with you; I don’t know if there is still a shortage. We have 4 so she can have 2 at home and 2 in her school bag so she always have them.

Hope it was a one off

When I was young I used to say nuts made me mouth taste funny and gave me a headache (early 1980s so it wasn't a known thing). I had my first full blown anaphylactic at 15. My symptoms can vary and mine (unusually) are usually a few hours after contact. My reactions are worse during hayfever time.

It is definitely serious but can be managed. The anaphylaxis campaign have some great information

Hmm. To allay your fears I experienced something similar with cob nuts - oral allergy syndrome - and it was definitely associated with the mustiness you sometimes taste with 'raw' nuts. After this episode I did get a referral to an allergy clinic but due to covid this was over the phone. I found myself reacting to a whole bunch of things afterwards like honey and figs. I only eat nuts if they have been slathered in salt or sugar as part of the manufacturing process. Interestingly if you look up oral allergy syndrome it can be triggered by apples, carrots , cherries - all sorts. The consultant said this was not true anaphylaxis.

My exh developed a severe anaphylaxis to seafood (when I was 39 weeks pregnant in slow labour) after having eaten seafood all his life however with hindsight some of his asthma symptoms could have been a seafood allergy but obviously we didn’t record it at the time. The consultant said if he ever ate seafoods again he might die as some people have a limit and once you go over it that’s it.

i stuffed him in the car and drove to A&e because of where we were staying at the time I don’t think an ambulance would find us he went straight through to resus. With ambulance wait times these days I’d probably do the same again although I’d be unlucky as he’s my exh 🤣

I can agree there. Usually yes for breathing difficulties etc 999!

Adrenaline can still cause palpitations and anxiety etc.

This is what I was thinking has the GP neighbour though the OP's Ds was having an asthma attack or something 🤔

I have a peanut allergy and my reactions have worsened each time I’m exposed. I carry an epipen and make sure those close to me can use it. The only time you never have to wait at a and e is when you are anaphylactic in my experience.
My18 year old took a reaction to nuts recently despite having been fine with them before, he had a blood test which confirmed things and has an epipen now
hope you get tests done soon

You mentioned there is a history of hayfever so I thought I'd mention that about 10yrs ago I had what I thought was anaphylaxis after eating hazelnuts. It gave a weird feeling in the back of my throat, almost scratchy and an odd taste, it felt like my breathing was mildly affected and I also felt better after being sick. My GP ran tests and it turned out it was an extension of hayfever where I was having an allergic reaction to the tree pollen in certain fruit and nuts. Apparently it can come on years into hayfever (I was mid 20s at the time).