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New here, New Anaphylaxis @ 56?


I had food allergies as a child but outgrew them.  I have asthma.  I've always had significant environmental and animal allergies.  I'm too allergic for allergy shots, I wheeze in response.  I'm allergic to 5 different classes of antibiotics (hives).  That was enough, or so I thought. 

1) In October, I ended up in the ER with an anaphylactic reaction to almonds.  Severe diarrhea, giant hives covering face, eyes, lips, inside mouth.  In the past, I recall feeling nauseated when eating cashews, but otherwise this reaction was out of the blue.

2) In November, I had a reaction to avocado (my favorite food).   In the past, I'd occasionally had a hive on my lips when eating avocado.

3) Today, it happened again after eating an orange.  Diarrhea, but less severe, giant hives, but not as many.  Regular hives covering neck and torso.  Some light-headedness, too.  In the past, I frequently had a hive on my lips when eating oranges (or grapefruit, strawberries, tomatoes, pineapple, and bananas)

I spoke with my physician after the first two reactions and he said I didn't need an allergist and he prescribed an epipen.

What the heck do I do?  Give up any food that has ever given me a hive on my lips?  Food allergies get worse with repeated exposure, right?

Thanks for the help!! 

Go see a board certified allergist!  A GP may know some info about allergies, but is certainly not an expert. 

Board certified allergist should conduct proper diagnosis via intake of patient history, SPT (skin prick tests), and blood tests.  Don't let your primary care doctor be a "gatekeeper" and not let you see an allergist, or talk you out of it.

My GP referred me to an in-network ENT whose secondary specialty is allergy.  I asked for an out-of-network referral to a board certified allergist whose first specialty is allergy and who's an expert in eosinophilic esophagitis (I developed severe esophagitis at the same time as my first reaction but so far no one's mentioned a possible connection to allergy).

I have an appointment on 4/15.  I have to bring my own avocado and orange, they'll supply the almonds.  Last time I was skin tested, around age 30, they could only do four at a time because the swelling was so bad.   

It will be good to have answers.  Thanks for your help.

You want the very best allergist who knows food allergies well you can find.  ENTs have not impressed me over the years based on stories I read regularly by people who see them.  It appears to me that most are not fully up to date on food allergies and allergies in general.  Yes, you should avoid any food that causes you haves.  That is a sign that future reactions to those foods could be anaphylactic, unfortunately.

Reactions are often dose dependent so if you eat more of the allergen the reaction is usually going to be worse.  But also, the longer you avoid a food, the stronger future reactions can be.  Past reactions can give you an idea of future reactions but reactions can vary a lot.  I'm glad you have epi pens and that you are asking these good questions.  I"m sorry you have food allergies, though. 

Skin and blood testing for food allergies is not all that accurate.  Testing has a very, very high false positive rate and a positive test by itself does not mean a person is allergic.  (Unfortunately many ENTs seem to diagnose based only on test results.)  Negative results are over 90% accurate, though, so can be helpful to rule things out.  The only way to know for sure if you are IgE allergic to a food is a food challenge.  It sounds pretty clear cut that you already did react to these foods, though.

What do you mean by 'developed severe esophagitis'?  What symptoms are you having?  If you think you have EoE, I'd check out the website for good info on it.  The big EoE symptoms in adults are having food get stuck.  Other symptoms can feel like reflux, chest pain, stomach pain, vomiting. 


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