GI reactions and those involving breathing more closely tied to fatal anaphylaxis

Welcome--it's good to see you over here. I'd love to read anything you have about this.

My reactions are GI. I have a GI reacton thread in the Adults forum, and there are several of us here who have them.

At what point in your son's reaction did you give the epi--and what were his symptoms (unless you mind sharing)? I still waited for the second symptom, but I do worry about a drop in blood pressure with GI.

You're right--I think people tend to take them less seriously. Adele had a post about GI reactions and loss of blood pressure that was quite good.

Thanks!

I think folks recognize that *fast* GI reactions are in the serious/anaphylactic class, as they are still IgE mediated. It's the delayed stuff caused by IgG . . . gas and IBS happening a few days later, for example . . . that isn't quite so serious.

ygg

Well, I was referring to the general public, not folks on this board.

I will go through my spiel at a restaurant and then have a manager check up on me throughout the meal to make sure I'm okay. Well, there won't be a way to know if the meal was xcontaminated for a while. Things either hit me in 20 minutes or 2 hours. And my two worst shellfish reactins were 2 hours after ingestion.

I've repeatedly found that people don't take my allergy seriously because I don't swell up or develop hives instantly. Or get GI symptoms instantly, for that matter.

It's more of a hidden thing. I can look perfectly fine while having an ana reaction. Last reaction when I used the epi, I didn't use my epi until the second symptom (although then I wasn't counting spaciness as the first). I might have needed to use it sooner--like before driving an hour home. But I didn't want to call 911 and have an ambulance pick me up at work. All of my coworkers were completely surprised when I told htem I had had a serious reaction.

Even now when I've had a reaction I hesitate to tell someone because I don't think they'll believe me. I know I don't look like it.

So--I agree: the general public does not take GI reactions as seriously.

The 'Guidelines for Managing Life-Threatening Food Allergies in Connecticut Schools' that uses FAAN's medical advisory board as a source states, 'Anaphylaxis may occur in the absence of any skin symptoms such as itching and hives. Faltal anaphylaxis is more common in children who present with respiratory symptooms, or GI symptoms such as abdominal pain, nausea or vomiting. In many fatal reactions, the initial symptoms of anaphylaxis were mistaken for asthma or mild GI illness, which resulted in delayed treament with epinephrine auto-injector." (p. 5)

(Just so you know where I got this from.) I have also read that GI reactions are more closely tied to fatal ana because they are more closely associated with severe blood pressure drops and shock.

Going back to see the other questions you asked.

Quote:Originally posted by McCobbre:
[b]Welcome--it's good to see you over here. I'd love to read anything you have about this.

My reactions are GI. I have a GI reacton thread in the Adults forum, and there are several of us here who have them.

At what point in your son's reaction did you give the epi--and what were his symptoms (unless you mind sharing)? I still waited for the second symptom, but I do worry about a drop in blood pressure with GI.

You're right--I think people tend to take them less seriously. Adele had a post about GI reactions and loss of blood pressure that was quite good.

Thanks![/b]

Thanks for the welcome. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] I'll have to check out that other GI thread. Thanks.

Well, I should have given him the epi but I mistook the reaction for illness. I had given him Ian's kids meals before and one day I was rushing when I was shopping because my DH was ill and going to have a medical procedure the next day. I picked up another one of the Ians Allergy Free! kids meals and had it in my hand when DS said, "I don't want that one, Mommy. I want the one with the french fries (alphabetos)." I could have sworn the other boxes also said, "Allergy Free!" In the store where I normally shop the Ians Allergy Free stuff is in a totally different section than the regular Ians stuff but in this store they were intermixed it seems. I picked up another one that I think said, "allergy free!" and then for some reason put that back and picked up another. I quickly scanned the ingredients and must have missed a word at the very end because what I got wasn't allergy free.

That night I fed it to DS. He ate it happily and 45 min later he suddenly said he had to go throw up. I asked why and he said, "because my throat tells me so." (Should have been a clue there but I was so sure the food was allergy-free.) He had very severe stomach cramps, diarrhea, and then later vomitted very, very violently. Tons of stuff came out of him. the small trash can was about 1/5 at least filled with vomit. Not to be gross but it amazed me that that much came out of him. He is only 5 and small. I was thinking that whole time that if there had been any chance he had eaten an allergen I would be thinking this was anaphylaxis but I was sure he hadn't. I don't know why. He never had one tiny hive or any swelling at all. He did mention his throat feeling funny and I should have picked up on that as it was the 2nd mention about his throat after his initial, "I have to throw up because that is what my throat tells me." But even then I didn't pick up on it. He felt a bit better after that, took a bath, but the stomach cramps returned. I thought he was sick. He could barely stand after that. (I shudder thinking back at this.) I still thought it was sick. He was so tired. I got him to sleep with him moaning his stomach hurt. Then I *almost* went to sleep. I was exhausted, too, and we had to get up early for DH's medical procedure. I thought, "well, maybe they added sesame to the Ians meal. I'll go check." I got up, read the box and was like, "oh, this is so boring. I know it isn't going to say anything." I read through the long list of ingredients one by one. It looked just like the other Ians kid's meals we have used. Then I got to the very end and I think the 2nd to last ingredient or so said, "egg". My heart nearly stopped and my whole body started to shake. I called the allergist immediately and got a call back. I asked if I should give him the epi and call 911. the allergist said, 'no' becausee 'symptoms had stopped and he is sleeping peacefully.' I asked how long to watch him to be sure he doesn't have a biphasic reaction. The on-call allergist (not our regular) told me this was unnecessary and that he wouldn't have a biphasic reaction--that if he was going to have a biphasic reaction he would have had ongoing symptoms. This doesn't match with what I have read. I stayed up until 3 am watching my son breath with the phone and epi right next to me. Looking back I think at the least I should have called 911 and gone to the hospital and maybe I should have given the epi even. I don't know. His regular allergist did agree with the on-call doctor that there was no need to give the epi at that time but said I did the right thing to stay up watching him until 6 hours from the initial start of his reaction. I have to ask him more about why he didn't think calling 911 was necessary. We live 20-25 min from the hospital.

I know it might sound stupid that I didn't figure out that DS was having a reaction but I was just *so* very sure nothing I fed him could have his allergens in it.

We got lucky. If I could go back in time, when would I have given the epi? Say, he started saying he was going to throw up and I had instead grabbed that Ians box and seen the 'egg' listed? I would have given him the epi right then because he was obviously having very severe stomach cramps and diarrhea. I would not have waited. That would have been enough. Our emergency plan calls for giving th epi for anything systemic and these would count.

Quote:Originally posted by krasota:
[b]I think folks recognize that *fast* GI reactions are in the serious/anaphylactic class, as they are still IgE mediated. It's the delayed stuff caused by IgG . . . gas and IBS happening a few days later, for example . . . that isn't quite so serious.

ygg[/b]

Yes, the delayed GI reactions are something else in general. I was actually talking about those that occur within the normal 2 hour after ingestion window. I coulud have been reading people wrong but some posts I have seen here have talked about not giving the epi for "minor reactions" such as "just vomiting and diarrhea", etc. I have seen maybe 5 such posts and thought I would post here in case some people didn't realize that GI reactions are serious.

Quote:Originally posted by McCobbre:
[b]Well, I was referring to the general public, not folks on this board.

I will go through my spiel at a restaurant and then have a manager check up on me throughout the meal to make sure I'm okay. Well, there won't be a way to know if the meal was xcontaminated for a while. Things either hit me in 20 minutes or 2 hours. And my two worst shellfish reactins were 2 hours after ingestion.

I've repeatedly found that people don't take my allergy seriously because I don't swell up or develop hives instantly. Or get GI symptoms instantly, for that matter.

It's more of a hidden thing. I can look perfectly fine while having an ana reaction. Last reaction when I used the epi, I didn't use my epi until the second symptom (although then I wasn't counting spaciness as the first). I might have needed to use it sooner--like before driving an hour home. But I didn't want to call 911 and have an ambulance pick me up at work. All of my coworkers were completely surprised when I told htem I had had a serious reaction.

Even now when I've had a reaction I hesitate to tell someone because I don't think they'll believe me. I know I don't look like it.

So--I agree: the general public does not take GI reactions as seriously.[/b]

I hope you will be able to not think of what others will think in the future. I KWYM, though. MY DH has serious GI reactions that are delayed. He ends up on the bathroom floor, unable to move or speak, feeling that he is nearly going to lose consciousness. He has had severe drops in blood pressure. So far we don't know what causes it but the allergist instructed me to give him the epi and call 911 if this happens. I have given him the epi twice and had to call 911 three times for this. The paramedics seem to think I'm crazy since he doesn't have a for sure diagnosis of food allergies and we are still figuring out the cause (esp since the reactions seem to be delayed.) But the allergist is very reputable, quoted in the peanut allergy answer book and insists I ignore them and give the epi and call 911 and if they give me a hard time to have them call him.

Hard to ignore having people think we are weird but it is important to take care of ourselves/loved ones having reactions.

Give yourself some absolution.

I will tell you it's incredibly hard to know even when it's happening to you. My son is PA, and I'm shellfish and sesame. It's hard to know for DS, but goodness--I second guess myself all the time.

Even here--after my ana reation where I used an epi, folks on the board asked if I was sure it wasn't a viral thing instead--even someone who is a physician. It's just hard to tell sometimes. My answer was just, "I knew." (I don't have "impending doom," but my version may be the "uh oh--it's a reaction.") Also, liquid benadryl relieved the symptoms for a bit. So that was a giveaway. But goodness, it is so hard to know sometimes a) if it's a reaction and b) if it's an epi moment.

And vomiting after eating something seems to me more of a giveaway. I sometimes wish I did that. Sometimes I worry that I'm reacting that I am having cramps, and it's really just gas (of course, sometimes gas is a symptom for me, too), but that's not what I'm talking about here. Vomiting just seems more telltale than cramps.

I just had my first round of Xolair, and I'm hoping that helps me. Still, this GI reaction is a real pain.

I'm actually OK now. I felt terribly guilty when it happened. It is a horrible feeling to feel even though I try my best all the time I majorly messed up. I was so shocked that I could mess up because I'm so very careful. DS was telling me that night, "I know what this is--you didn't read the label! You didn't read the label" and even then I knew I had read it (apparently my eyes somehow missed that one word in the very, very long list of ingredients--the meal had 4 items so there was 4Xs as many ingredients as on a normal lable). Even then I insisted I had read it and the food was allergy-free. I know that I did my best. I use it as a learning experience. It did help in that now DS really understands he has a food allergy. Before he would sometimes cry for food to which he is allergic but not now. He listens to what I say about food much more. So it will keep him much safer but I still wish it hadn't happened. Oh, and I check labels much, much more now--once in the store and I try to check again as I unpack groceries and again before I feed him the food the first time (when I open the package.)

I'm sorry, I can't remember what else you posted. I wish I could see your post and what I have written in reply at the same time.

Quote:Originally posted by McCobbre:
[b]Give yourself some absolution.

I will tell you it's incredibly hard to know even when it's happening to you. My son is PA, and I'm shellfish and sesame. It's hard to know for DS, but goodness--I second guess myself all the time.

Even here--after my ana reation where I used an epi, folks on the board asked if I was sure it wasn't a viral thing instead--even someone who is a physician. It's just hard to tell sometimes. My answer was just, "I knew." (I don't have "impending doom," but my version may be the "uh oh--it's a reaction.") Also, liquid benadryl relieved the symptoms for a bit. So that was a giveaway. But goodness, it is so hard to know sometimes a) if it's a reaction and b) if it's an epi moment.

And vomiting after eating something seems to me more of a giveaway. I sometimes wish I did that. Sometimes I worry that I'm reacting that I am having cramps, and it's really just gas (of course, sometimes gas is a symptom for me, too), but that's not what I'm talking about here. Vomiting just seems more telltale than cramps.

I just had my first round of Xolair, and I'm hoping that helps me. Still, this GI reaction is a real pain.[/b]

Oh, yes, I had people ask me, "isn't that just a virus?" One woman said it sounded just like what her cousin had had the week before and her cousin doesn't have FAs and it was a virus. It just isn't the same. It comes on fast and then it is gone afterward--the person doesn't turn out to have a virus, you know? DS's ped asked if he had any hives or breathing trouble and when I said, "no" it seemed he didn't take it that seriously.

My pa/tna daughter also has severe GI symptoms - projectile vomiting, diarrhea, the works. Our pediatrician said this is because her organs are swelling - she is having an internal reaction rather than external (hives). Very scary to hear that this closely associated with fatal anaphylaxis.

Quote:Originally posted by mfharris:
[b]My pa/tna daughter also has severe GI symptoms - projectile vomiting, diarrhea, the works. Our pediatrician said this is because her organs are swelling - she is having an internal reaction rather than external (hives). Very scary to hear that this closely associated with fatal anaphylaxis.[/b]

Oh great. And here I thought I was 'safer' because I don't have a respiratory reaction.

When I had an anaphylactic GI reaction - it was sudden and severe - with extreme vomiting that I've never experienced even with food poisoning or stomach flu. Ditto for the diarrhea. 'Intense' might be a good word.

I've had plenty of cases of stomach flu and have also had food poisoning a time or two. For me, the difference between an illness and a GI reaction is RAPID ONSET and intensity.

When you're coming down the the stomach flu, you feel a little unwell, then queasy and this might continue for a few hours until finally you start throwing up. Even with horrible food poisoning, you have a little time between the first 'feeling' and the dash to the bathroom.

With the anaphylactic GI reaction I had, I went from feeling just fine - to thinking I was going to die - in about 10 minutes.

I read in the Food Allergy Newsletter that epi works wonders with GI reactions as it reduces the swelling in the gut.

Quote:Originally posted by lakeswimr:
[b]I'm sorry, I can't remember what else you posted. I wish I could see your post and what I have written in reply at the same time. [/b]

When you click on *reply* a screen pops up where you put in username, password and message. On the right side of the screen is a scroll bar. Go down a bit, and there is a subscreen which shows the thread that you are responding to. It also has a scroll bar, so you can go through the whole thread. HTH

And, welcome to the board. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

I found this very interesting: [i]I have also read that GI reactions are more closely tied to fatal ana because they are more closely associated with severe blood pressure drops and shock.[/i] Describes my worst reaction quite accurately.

Quote:Originally posted by lakeswimr:
[b] I have also read that GI reactions are more closely tied to fatal ana because they are more closely associated with severe blood pressure drops and shock.
[/b]

I questioned why my allergist called the major GI reaction I had as anaphylactic when there was only one system involved. He said that the type of diarrhea I had was caused by plummeting blood pressure - the second system. (he had a term for it - but I can't remember....
it may be been 'dumping' .......?

Sorry Lakeswimr, I neglected to say 'welcome to the boards'!

cheers, Adele

[This message has been edited by Adele (edited April 03, 2007).]

I never learned how to link, but I have a thread entitle "PLEASE HELP MY DS!"

It documents an "episode" that our family went through last year.

Adele, have you ever used the epi during such a GI reaction and experienced whether it immediately stops those GI symptoms or not?

DD's reactions have all been GI only as far as I can tell. They have also all been before I knew it was an allergy or anything about it. I would call the ped who would tell me that it was not and could not be an allergic reaction and to feed the suspect to my child again in a week. I quickly learned not to listen to the ped on this issue! (Later our ped told me that he went to a conference and GI reactions were said to be some of the most serious.)

DD has severe and almost constant vomitting within 30 min after eating the allergen. When she was an infant it was squash we "learned" on. Vomitting every 1-2 minutes for an hour and then laying limply in my arms while I was too uneducated to know that she was nearly dying.

I guess what I'm wondering here (after a lot of rambling, I know) is if I were to have given her an epi just a few minutes after the vomitting started, would it have ceased as it was a reaction? It is just hard to comprehend the effect of the epi on the GI to me when it is generally associated with respiratory.

I'm glad we're talking about GI reactions....I'll go read the other thread, too.

Patty

I`m pretty sure that McCobbre has used epi for GI reactions. Her email address might be in her profile.

Hi Patty,
The only major (ana) GI reaction I had was the one that prompted me to go an allergist to find out if I was allergic to peanuts.

Prior to that I had various GI reactions, but not all together and not that intense. I didn't realize that these reactions were caused by a food allergy.

According to the Food Allergy newsletter of August/Sept. 2006, some of the most dramatic improvements after giving epi occur in people having severe GI reactions. Apparently most of the stomach pain experienced in a reation is caused by the swelling in the intestines. It goes on to say 'the benefit of epinephrine is, therefore, not a surprise'.

After reading this, I decided I would not hesitate to give epi for a GI reaction.

Quote:Originally posted by Carefulmom:
[b]I`m pretty sure that McCobbre has used epi for GI reactions. Her email address might be in her profile.[/b]

Thanks Carefulmom!

Yep--I did--once. I think I should have used it for my very first reaction, too, but I didn't.

I used it in January 2006. My diarrhea had already stopped, but I still had cramping, and my chest had started to hurt. It relieved the cramping and chest pains.

It wasn't until the next day--oh maybe 15-18 hours later than another symptom developed (uterine contractions) and the cramping returned. But the epi stopped things for a while. I don't know if it would have put an end to the diarrhea, but I assume so.

I've never thrown up, but I started to with that reaction (things came up and when down), so then I my esophagus felt awful.

I really should have used my epi much sooner.

Reraising. This is an important thread.

I found this very interesting. Thanks for re-raising it.

I can add that my daughter's most severe reaction, after accidental peanut ingestion, was classic with outwardly visible signs but also did include severe stomach cramping and vomiting. She had already been treated with the epi-pen and IV Benadryl. The GI symptoms occurred about two hours after the fact, while she was still in the ER. They then started IV steroids.

Now I'm wondering about my son. He tests PA on the very mild end with no known reactions. Last night my husband bought ice-cream without reading the label and gave it to him. When DS was mostly through his bowl my husband looked at the label, because my daughter who is severely PA wanted some and we always triple check everything for her, and he discovered peanut oil as an ingredient. OOPS! We didn't worry too much for my son because theoretically the oil is protein free and besides my son is so mild right? Well about an hour later he started coughing and complaining of a sore throat, then a stomach ache. I gave him Benadryl and the cough stopped. He still has a sore throat and stomach ache today.

So is he sick or did he react to the ice-cream?

What do you all think?

Last year my DS was in preschool and at the time I knew he was allergic to peanuts, but we'd never been to an allergist and I didn't know how serious it could be. I had told his preschool teacher that he was allergic to peanuts, but we didn't have an epipen. About a month into the school year I picked him up from school one day and he was moaning and crying and saying his tummy hurt really bad. We got home and he had the worst diarrhea and stomach cramps for hours. Afterwards he was absolutely exhausted and out of it. I thought he had come down with the flu so I kept him out of school the next day. Well, he was feeling better so the day after that, I sent him back to preschool. Upon picking him up, he was moaning and screaming in pain and again we had diarrhea and cramping all day. Finally the next week he goes to preschool again and when I pick him up he looks sick again and I look in his hand and see a REECE'S PIECES!!!! What in the world is a preschool teacher thinking giving all the children candy filled with peanut butter, especially one that was allergic. When I confronted her the next day, she was just like, "Oh yeah, I forgot! I will give him something else next time."
At the time I didn't know how allergic he was (he is 100 plus on the RAST test), but had I known then what I know now, I would've given him the epipen shot and never taken him back to that preschool again. And now when I read about how severe GI symptoms can be, I feel just awful that I had no idea. But when you don't know they're eating something with PB in it, you just think it's a stomach virus.

4mykids, I would think it was the ice cream. I believe Dreyers thinks the peanut oil in some of their ice cream is harmless because it is refined, but I do not trust it. I have heard of too many people who have reacted from refined peanut oil.