Delayed Food Allergy Symptoms: Urgent Warning
Julie Ferrier Berghaus, a Texas mother, took her 3-year-old daughter to the hospital for allergy testing. She had no idea it would trigger a life-threatening response – but also provide important health information to protect her child in the future.
What nuts are there?
Julie brought Maren to the doctor for a tree nut-controlled challenge. The doctors gave her small doses and monitored her reaction.
Maren’s past tests for allergies to all nuts were positive. She had tried several different nuts and experienced no reaction.
The doctors wanted to confirm the allergy status of her patient a bit more accurately.
Julie wanted to share her experience with others so that they would take the first signs of an allergic reaction seriously. She hopes that it will help people understand the dangers of allergies.
One-tenth a cashew
The doctors gave Maren a tenth of a nut. Before this test, she had been able to eat nuts without incident. This is the outcome of her daughter’s controlled tree-nut challenge:
1. Itchy and with a tummy ache
Julie reports that “her first symptom was simple itchy ears in five minutes.” She was playing and happy. She then started complaining about a stomach ache. Then she started itching all over. “At this stage, there was no rash.”
Right now, we’re at the seven-minute mark.
2. EpiPen and Zyrtec calmed by EpiPen
Julie continues, “They decided to give her the first Epi shot because she had two symptoms at this time, belly pain and itchiness.” They also gave her Zyrtec orally. “The shot calmed down everything for around ten minutes.”
At this point, we’re somewhere around the 17-minute mark, plus or minus a few seconds.
3. Prednisolone and hives
After the ten-minute period was over, she started to itch a lot worse. On inspection, we saw her body breaking out into severe hives. She was soon covered with huge hives. At this point, they gave her prednisolone. She was still playing and showing no signs of distress.
According to Julie’s message, it has now been nearly half an hour.
4. High pulse rate and slow blood pressure
“About five minutes after that, she began coughing a bit. We could not hear her wheezing or breathing heavily. We asked the nurse to listen with her stethoscope just to be sure. She described her as wheezing, and that she felt tight. Her sats were in the 80’s and her pulse was high. She was playing and annoyed by the itchy hives.
We are almost 35 minutes into the game. It’s been 35 minutes since Maren first ate a tiny crumb of cashew nuts. It took this long for things to become dangerous. Life-threatening.
5. Blacking out
Julie, rattled by the experience, writes: “It changed in a matter of moments.” They laid her quickly and then she started to black out. She was given an albuterol injection and another Epi shot. Solu medrol was given to start an IV. She was lethargic for about ten minutes before she began to come around.
What a terrifying thought! Maren took over 30 minutes to react severely and fully. She almost lost consciousness.
It sneaked up on me
Julie said that her three-year-old had to be closely observed for several hours afterward “because anaphylaxis could return in a subsequent round, which can be just as severe as a first attack.” She also noted that it is important to call an ambulance in the event this occurs to anyone in your life.
Julie was surprised by the covertness of a series of allergy reactions.
“It wasn’t what we expected. It came on us unexpectedly and quietly. I was expecting to hear her wheezing and see her grab at her chest or neck. I thought the whole ordeal would be fast, obvious, and dramatic. It was very quiet, and she did not show any serious trouble until late in the game.”
If she had not been given medication before she went black, I can’t imagine how serious it could have been.
How to use the EpiPen
Julie encourages people to treat allergies seriously. Allergies are not a fad or a nervous condition. They can be life-threatening.
She urges everyone to never hesitate to use EpiPens, noting that her daughter did not experience any side effects from the dose given to her. Julie emphasizes that a combination of medications saved Maren’s life in cases like Maren’s. As soon as you suspect that there is an allergic reaction, call 000 to begin treatment.
Be aware of allergies and watch out for people who, like Maren, could have a severe reaction to even the smallest exposure.
Food Allergy
An allergy occurs when your body’s natural defenses overreact to exposure to a particular substance, treating it as an invader and sending out chemicals to defend against it.
Signs of Allergies
The body’s immune system keeps you healthy by fighting off infections and other dangers to good health. A food allergy reaction occurs when your immune system overreacts to a food or a substance in a food, identifying it as a danger and triggering a protective response.
While allergies tend to run in families, it is impossible to predict whether a child will inherit a parent’s food allergy or whether siblings will have a similar condition. Some research does suggest that the younger siblings of a child with a peanut allergy will also be allergic to peanuts.
Symptoms of a food allergy can range from mild to severe. Just because an initial reaction causes few problems doesn’t mean that all reactions will be similar; a food that triggers only mild symptoms on one occasion may cause more severe symptoms at another time.
The most severe allergic reaction is anaphylaxis — a life-threatening whole-body allergic reaction that can impair your breathing, cause a dramatic drop in your blood pressure, and affect your heart rate. Anaphylaxis can come on within minutes of exposure to the trigger food. It can be fatal and must be treated promptly with an injection of epinephrine (adrenaline).
While any food can cause an adverse reaction, eight types of food account for about 90 percent of all reactions:
- Eggs
- Milk and Dairy
- Peanuts
- Tree nuts
- Fish
- Shellfish
- Wheat
- Soy
- Sesame
Sesame is the 9th most common food allergen and is found in many popular dishes, including hummus, under the name “tahini.” According to the FDA, “Under the FASTER Act of 2021, sesame is being added as the 9th major food allergen effective January 1, 2023. Until that time, manufacturers do not have to list it as an allergen, although in most cases it must appear in the ingredient statement. An exception is when sesame is part of a natural flavoring or spice.”
Symptoms of an allergic reaction may involve the skin, the gastrointestinal tract, the cardiovascular system, and the respiratory tract. They can surface in one or more of the following ways:
- Vomiting and/or stomach cramps
- Hives
- Shortness of breath
- Wheezing
- Repetitive cough
- Shock or circulatory collapse
- Tight, hoarse throat; trouble swallowing
- Swelling of the tongue, affecting the ability to talk or breathe
- Weak pulse
- Pale or blue coloring of skin
- Dizziness or feeling faint
- Anaphylaxis is a potentially life-threatening reaction that can impair breathing and send the body into shock; reactions may simultaneously affect different parts of the body (for example, a stomachache accompanied by a rash)
Most food-related symptoms occur within two hours of ingestion; often they start within minutes. In some very rare cases, the reaction may be delayed by four to six hours or even longer. Delayed reactions are most typically seen in children who develop eczema as a symptom of food allergy and in people with a rare allergy to red meat caused by the bite of a lone star tick.
Another type of delayed food allergy reaction stems from food protein-induced enterocolitis syndrome (FPIES), a severe gastrointestinal reaction that generally occurs two to six hours after consuming milk, soy, certain grains, and some other solid foods. It mostly occurs in young infants who are being exposed to these foods for the first time or who are being weaned.
FPIES often involve repetitive vomiting and can lead to dehydration. In some instances, babies will develop bloody diarrhea. Because the symptoms resemble those of a viral illness or bacterial infection, diagnosis of FPIES may be delayed. FPIES is a medical emergency that should be treated with IV rehydration.
Not everyone who experiences symptoms after eating certain foods has a food allergy or needs to avoid that food entirely; for instance, some people experience an itchy mouth and throat after eating raw or uncooked fruit or vegetables. This may indicate oral allergy syndrome – a reaction to pollen, not to the food itself. The immune system recognizes the pollen and similar proteins in the food and directs an allergic response to it. The allergen is destroyed by heating the food, which can then be consumed with no problem.
Triggers
Once a food allergy is diagnosed, the most effective treatment is to avoid the food. The foods most associated with food allergy in children are:
- Milk
- Eggs
- Peanuts
Children may outgrow their allergic reactions to milk and eggs. Peanut and tree nut allergies are likely to persist.
The most common food allergens in adults are:
- Fruit and vegetable pollen (oral allergy syndrome)
- Peanuts and tree nuts
- Fish and shellfish
People allergic to a specific food may also potentially react to related foods. A person allergic to one tree nut may be cross-reactive to others. Those allergic to shrimp may react to crab and lobster. Someone allergic to peanuts – which are legumes (beans), not nuts – may have problems with tree nuts, such as pecans, walnuts, almonds, and cashews; in very rare circumstances they may have problems with other legumes (excluding soy).
Learning about patterns of cross-reactivity and what must be avoided is one of the reasons why people with food allergies should receive care from a board-certified allergist. Determining if you are cross-reactive is not straightforward.
Allergy testing to many items in the same “family” may not be specific enough – many times, these tests are positive, given how similar two food items in a “family” may look to the test. If you have tolerated it well in the past, a food that is theoretically cross-reactive may not have to be avoided at all.
Negative tests may be very useful in ruling out an allergy. In the case of positive tests for foods that you have never eaten but that are related to items to which you’ve had an allergic reaction, an oral food challenge is the best way to determine whether the food poses a danger.
How to Get Tested
A food allergy will usually cause some sort of reaction every time the trigger food is eaten. Symptoms can vary from person to person, and you may not always experience the same symptoms during every reaction. Allergic reactions to food can affect the skin, respiratory tract, gastrointestinal tract, t, and cardiovascular system.
It is impossible to predict how severe the next reaction might be, and all patients with food allergies should be carefully counseled about the risk of anaphylaxis, a potentially fatal reaction that is treated with epinephrine (adrenaline).
