anaphylaxis

Anaphylaxis detectives and the sneaky grass

30 April 2013 marked the one year anniversary of my toddler’s first anaphylactic reaction and our family’s baptism of fire into the world of peanut allergy. Just as we were celebrating having made it through a year reaction-free, anaphylaxis (or, at least, what appeared to be anaphylaxis) struck again in May. Thankfully, the second incident was nowhere near as horrendous as the first. The EpiPen stopped the symptoms in their tracks and, although my son was kept in hospital for 24 hours in case there was any second wave of reaction, it was a different league from the first time round.

The problem this time is that the cause of the allergic reaction is still a mystery. The potential culprits range from undeclared peanuts in the snacks he had eaten, to chemicals in the sun tan lotion, to grass in the garden where he was playing. Or an, as yet, unidentified allergen. This is maddening. In an attempt to find something (or things) to point the finger at, I have found myself (alongside our allergy doctors) assuming the role of anaphylaxis detective.

The reaction

Macclesfield actually had a couple of days of summer in early May. We went to a friend’s house for a playdate and, on arrival, my son and her little boy ran straight out into the garden and tore around for about ten minutes before being forced to take a time out. I applied some sun tan lotion to his face, ears, neck, throat, forearms and legs. Whilst it was still sinking in, he ate a chocolate digestive and a couple of baby crisps.

Immediately after eating, he stood up and started scratching his neck. His stock reply to anything at the moment is “no” and, true to form, when I asked to have a look at his neck, I was told “no” and he pelted off down the far end of the garden. Wrestling him into a swing to keep him still whilst I checked him over, I saw that he had a red rash on his face, throat, neck and arms (so places where I had applied cream) and two hives on right hand side of his throat. I brought him back to the house and gave him a spoonful of anti-histamine, which he swallowed hard.

At this point, he started getting extremely upset, clawing at his throat and neck, pulling his ears and shouting “I don’t like it”, over and over. Now, given he’s 2 1/2, tantrums aren’t exactly unheard of in our house. However, he seemed genuinely stressed, rather than having a run-of-the-mill toddler meltdown. I lifted his t-shirt and saw that the rash had now spread to his chest. I was looking at his face and his tongue and thinking “is it me, or do they look swollen?”, when he started coughing repeatedly.

We swung into action, giving the EpiPen and calling 999. The coughing stopped within a few minutes of giving the EpiPen and by the time the paramedics arrived, he was back to just the rash and the hives.

Once we were out of the danger zone, I started re-running what had happened in my head and attempting to pinpoint the cause of the reaction.

The investigation

The suncream?

At the time of this second reaction, my son’s only known allergy was to peanuts. The sun tan lotion was formulated for babies and the ingredients list did not refer to any peanut or tree nut oils. We had also used this particular sun tan lotion (from the same bottle) on him many times before, without any problem.

I remembered that, one time, he had developed hives on his hand after using an anti-bacterial handwash. I cross-checked the sun tan lotion ingredients against the handwash ingredients (a task which made my head hurt somewhat, being no scientist…) and found that they both contained “phenoxyethanol”. A quick google revealed that some people do have skin reactions to this chemical. However, is this the type of thing which could trigger a severe allergic reaction?

To find out whether the sun tan lotion may have contributed to the reaction, our allergists are going to put a blob of the lotion on my son’s arm, in clinic, to see if there is any reaction.

The snacks?

The packaging labels for the chocolate digestives and the crisps did not:

  • List peanut or any tree nut in the ingredients.
  • Carry a “may contain” warning for peanuts or nuts.

Following the reaction, I telephoned both the biscuit and crisp manufacturers. Both companies assured me that their respective products did not contain nuts as an ingredient and were made in a nut free environment.

Unfortunately, the leftover biscuits and crisps (and their packets) were accidentally disposed of at the hospital. However, luckily my friend still had a biscuit from the pack, and this is now with the manufacturer for testing. The hospital are also going to do food challenges with the biscuits and the crisps, to ascertain whether he is allergic to any of the other ingredients.

Could there be peanuts in the garden?

This line of enquiry drew a blank. There were no nut-containing bird feeders in the garden and, in fact, the family doesn’t eat peanuts as my friend’s husband is sensitive to them.

Some other trigger in the garden? Grass? Pollen?

After I ran through the timeline of the reaction with our allergy doctors, our toddler was skin prick tested for various environmental allergies. As well as peanut, we’ve now added allergies to grass, cat, dog and house dust mite to his allergy tally.

I have to confess that my mind boggled slightly at the discovery of his grass allergy. Was he allergic to grass in the same way as he was allergic to peanut? Wasn’t “grass allergy” “hayfever” by another name? Could grass trigger anaphylaxis? We had just about figured out how to adapt our lives to avoiding nuts … how did you go about avoiding grass, for goodness sake?

I found an article on the Allergic Living magazine website, which states that:

“Although symptoms are usually limited to the nose and eyes, some who are severely allergic to grass and will get hives upon contact with its pollen. In the most dangerous cases, they can experience a reaction that is close to anaphylaxis.”

Our allergy doctors have reassured me that a severe reaction is rare and my son now takes a daily dose of anti-histamines and montelukast to dampen down his allergic response.

Tips for anaphylaxis detectives

Get clear on the timeline and potential triggers

I personally found it helpful to type out a timeline of the reaction as soon as we got home from hospital. At the follow up appointment, I was then confident that I hadn’t forgotten to relay anything to our doctors. It was also easier to scrutinise lists of ingredients when they were pasted into a document on screen, rather than squinting at a packaging label.

Get advice

When your child has had a severe allergic reaction, it is a stressful experience. It helps to be guided through what needs to happen next. You can get advice (on how to go about making enquiries of manufacturers and getting food samples tested) from your allergy doctors and organisations such as The Anaphylaxis Campaign (helpline number 01252 542029).

Keep a sample of the food … and the original packaging

If you’ve had a reaction to food and you need to pinpoint the allergen, then (if possible):

  • Keep a sample of the food. You can put this in a plastic bag and freeze it, if need be.
  • Keep the original packaging, as food manufacturers will be able to tell (from the codes and best before date) in which factory the product was made and whether there was a run of, for example, nut containing biscuits, immediately before the plain biscuits you reacted to.

Contact the manufacturers

When you contact the food manufacturer, you can ask:

  • About their policy for “may contain” wording. Both of the companies I contacted told me that they don’t use advisory labels as they were confident that their products were nut free.
  • Whether they will test the product for you.

Get the foods tested

The manufacturer may be able to deal with this for you. Otherwise, the Food Standards Agency advised me to contact Environmental Health / Trading Standards.

Image courtesy of Flickr

2 comments

  1. I know this is way after your original post. However, I know that a lot of fertilizers and soils contain peanut shells. Reading over your post that is what would seem the most likely cause for the reaction.

    1. Thanks very much. I would like to be able to pinpoint a nut related cause of the reaction – it’s maddening not to know for sure what caused it (and that we might be now be seeing grass as more of an issue for D than it is). Thanks – will double check with my friend about this.

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