Identifying what caused a reaction

[gufyduck]

Does anyone know if there is a way to determine which allergen caused an allergic reaction?  It was most likely trace amounts of something, I'd just like to know which something. 

[CMdeux]

If it is traces, the ONLY real way to know is creative sleuthing with whoever prepared or manufactured it (if they'll tell you or remember or even know), unless you have a sizeable sample left and want/can send it to FARRP.

(The U.Nebraska runs a testing program and will test suspected foods for allergens, though not all, and not necessarily at the LOD that some people react to.)

If you mention what it is and what you suspect COULD have caused it, folks here can probably help you come up with the most likely culprits or ideas for things to ask about.

[gufyduck]

I was eating frozen French Onion Soup by Plats du Chef.  They are individual sized, and there still is a few left in the freezer so testing may be an option.  I looked around the FARRP website and it was really jumbled and hard to read on my computer, so will need to call tomorrow for info on that. 

The ingredients are: Vegetable soup base [water, cooked vegetables (carrot, onion, celery), natural flavor (Hydrolyzed plant protein {corn, soy}, autolyzed yeast extract), salt, sugar, corn oil, potato flour, carrot powder], Onions, Swiss cheese (pasteurized milk, bacterial culture, salt, calcium chloride, microbial enzyme, cellulose), Croutons [enriched wheat flour (enriched with niacin, reduced iron, thiamine mononitrate, riboflavin, folic acid), organic sugar, salt, sunflower oil, yeast], Gelatin, Salt, Caramel color, Garlic, Spices.

Allergy Alert: This product contains soybean, wheat and milk product.  [Other products on their website had may contain warnings, this one did not]

Everything on this label is a pretty typical food for me, which is why I'm thinking cross contamination.  This reaction was anaphylactic, no questions.  Epi was used, more was given to me in the ER.  I am still quite shaken by this.  I'd really like to know the what behind this reaction with how little it took. 

Known anaphylactic allergens are shellfish, tree nuts, and peanuts.  I'm allergic to sesame but historically it has not been anaphylactic (I know, I know, past reactions don't predict future reactions).

[CMdeux]

Have you called the manufacturer?

I'd ask specifically about shared production lines for all of those allergens.  For frozen savory items, shellfish is the most probable culprit, IMO-- but you are right to think that it could well be peanut or sesame, too.  Unfortunately.

Call FAAN if you can't get anyone at FARRP to talk with you directly. 

I know that we used to have a thread in reactions that detailed how to go about getting a food reported/tested in the wake of a reaction.

[gufyduck]

I tried calling yesterday, but they were closed.  Darn time zones.  I did email them a few days ago and will have to try again.

An interesting thought I had.  The only other food I ate that night was an apple while waiting for the soup to cook.  I don't have a history of oral allergy syndrome, but apple is listed on a few sites I checked as cross reacting with the same pollens as some of the tree nuts I know I react to.  I do know my allergy cup was also very full at the time.  Just a thought.

[CMdeux]

It would be really odd for OAS to appear the first time as a systemic reaction, though.  Most people who eventually have systemic reactions via OAS have a considerable amount of warning with increasing local symptoms over time.

Besides, it's not really pollen season at the moment, no?

Was the apple extremely well-washed?

Because at this time of year, I often worry about nut cross-contamination in produce much more than I ordinarily do.  Pistachios, pecans, walnuts, and mixed nuts in the shell are commonly stocked in produce departments this time of year (around the holidays), even in places that don't ordinarily pose a risk. 

[gufyduck]

I had just rinsed it.  I hadn't even thought about the nut bins near the apples.     I will be avoiding THAT produce section until the loose nuts are gone. 

[CMdeux]

Well, then, if the answer from the manufacturer seems to check out, then I bet that is the explanation.

[lakeswimr]

I'm sorry that happened!  Glad you are OK!

I would guess the 'spices' may mean 'sesame'.  I know you know you can't know if a product has sesame in it unless you contact the manufacturer.  I would call and ask.  When DS has had mystery reactions I start with known allergens first then move to x-contam and then consider if there is a new FA in that order.  I'd suspect sesame or x-contam.  I'd want to ask about cleaning procedures between products containing all known allergens.

What have past reactions to sesame been?  If they have been IgE in nature then there is the risk of ana with any future exposure so personally I don't separate out allergens as more and less serious (even now when DS can eat some of his baked I consider other forms still equally serious to all other FAs he has.)

[catelyn]

Helga reacts to fruit all year long and the very first apple incident happened one february so OAS can and does happen outside of pollen season.

[gufyduck]

OAS from the apple was a random thought.  I've never had issues eating apples previously, and although it is not pollen season, we are having a very warm and dry winter with no snow, where usually there would be 4+ feet on the ground right now.  I don't have any issues with any other fruits.

Sesame reactions have not been anaphylactic but are IgE confirmed with a SPT .  I've had three known sesame reactions.  The first to sesame ginger salad dressing was an itchy mouth that was treated with benedryl.  The second was due to cross contamination (found a few seeds on my plate despite telling the restaurant about my allergy) and was mainly GI where I had a terrible stomach ache that responded to benedryl, and kept coming back for about 12 hours every time benedryl wore off.  The third (a day before this reaction) was from accidental ingestion, and again itchy mouth and some wheezing.   

This reaction isn't the first from trace amounts to need epi, although it is the first where 2 minutes after taking my inhaler I sounded worse.  I'm still shaken from this.  Especially after reading the stories of the 7 year old, and how she commented was her throat was tight.  That was me in this reaction.  Before the epi pen, and again in the ER.  I remember telling them how tight my throat was.  And tonight a few family members decided to call me a drama queen when I made the decision it was not safe to eat with them due to how some shrimp was being handled.  Sorry, I WILL keep myself safe! Tomorrow before work I will call the soup company.

[lakeswimr]

Dr. Wood had his worst peanut reaction from eating cookies that had been cross contaminated by a spatula that hadn't been cleaned well enough.  Prior to that his reaction had been from accidentally eating peanuts.  The reaction to the food that was contaminated by the spatula was far worse.  Reactions are usually dose dependent and the more allergen a person eats the worse it is but reactions can change.  Your sesame allergy could be much worse now.

The reaction where you had an itchy mouth and breathing trouble sounds serious to me.  My son's plan would call for giving the epi for that.

I dont think you were overreacting to people not handling shrimp properly while preparing food.  You recently had a reaction, too, so they are being insensitive and don't seem to understand food allergies.  I'm sorry! 

Allergens don't stay in neat little categories of some being ana and some not if you have IgE.  Or, they may but we don't have a test that can tell us which will always stay in the non-ana category.  Your sesame allergy sounds serious and I would not eat a single thing that had any ambiguous wording on the label (spice, natural flavor, flavoring, etc) without contacting the company first since in the USA sesame can be listed as these things.  There are other names for sesame that Ana Canada lists (till, gingilly and more.)  I'm not sure whether in the USA those other names can be used for sesame or not. 

'Other names for sesame seeds

Benne, benne seed and benniseed
Gingelly and gingelly oil
Seeds
Sesamol and sesamolina
Sesamum indicum
Sim sim
Til
Food and products that contain or often contain sesame seeds

Bread (for example, hamburger buns, multi-grains), bread crumbs and sticks, cereals, crackers, melba toast and muesli
Dips and spreads, for example, hummus, chutney
Ethnic foods, for example, flavoured rice, noodles, shish kebabs, stews and stir fries
Sesame oil, sesame salt (gomasio)
Tahina
Tahini (sesame paste)
Tempeh
Vegetarian burgers
Other possible sources of sesame

Some baked goods
Dressings, gravies, marinades, salads, sauces and soups
Herbs, seasonings, flavourings and spices
Vegetable Pâtés
Snack foods, for example, crackers, sesame snap bars
Vegetable oil (may contain sesame oil)
Non-food sources of sesame seeds

Adhesive bandages
Cosmetics, hair care products, perfumes, soaps and sunscreens
Drugs
Fungicides and insecticides
Lubricants, ointments and topical oils
Pet food
Sesame meal, for example, poultry and livestock feed'