Latex & Latex fruit allergy (& almonds...)

[jennifer1]

Hi everyone
I recently went through allergy testing (skin test) because I've have a history of pretty obvious reaction to certain foods.  I've known for some time that I can't wear latex gloves at work (I'm a lab tech), but I didn't realize that banana, avocado, & kiwi are related to latex.  I tested fairly strongly positive for latex and banana and almonds.  They didn't have a test for avocado or kiwi, but my doctor said they are all related.
I also have celiac disease, so while not a true allergy, I can't eat gluten. 
For about the last 10 yrs if I eat banana, avocado, kiwi or almonds within 1/2 hr I'm doubled over with horrible stomach cramps and have diarrhea and sometimes break out into a cold sweat.  I used to react this way to eggs also, but since going gluten free I can eat eggs with no problems, so I assume it had something to do with the damage to my GI tract from celiac disease (also I tested negative to eggs).  About every 6 months or so I would try a banana again (my favorite fruit back when I could eat them), but I'd always get the same reaction.  Same with avocado if I had some guac or something.  Doubled over with stomach cramps in about 30min.  But, usually about 5-6 hours later I feel totally fine.

My doctor sent me home with a prescription for an epi-pen as well as instructions to get a medical alert bracelet.  My first thought was honestly that he was over-reacting, since I never have any symptoms of rash or trouble breathing.  I guess after reading more about allergies, I'm realizing that the GI symptoms are an allergic reaction?  Am I correct in thinking this?

I now have my bracelet and my epipen, but I guess I'm a little unclear as to when to use it.  My doctor did say to err on the side of using it, but that was when I was still thinking that an allergic reaction was tied to the airways.  So, would I use it if I get the abdominal symptoms or only if it I end up with airway involvement?  I guess I never really thought of the abdominal stuff as potentially serious?

Thanks
Jennifer

[CMdeux]

HI Jennifer!

I have a latex allergy as well. I do not tend to have problems with cross-reactivity (as you seem to) though I do have other life-threatening food allergies, so I carry epinephrine.  I'm so glad that you have a doc who is way on top of things and has prescribed you epinephrine!!

Have you taken a close look at the anaphylaxis grading chart?

This is derived from a journal publication from some years back (the original is also linked in our 'starter' page-- see sticky at the top of this particular board), but it is really useful as a tool for assessing when a reaction rises to the level of "emergent" and requires epinephrine.

As you've correctly surmised, GI symptoms are particularly problematic this way.  Obviously, mild diarrhea that self-resolves doesn't require a trip to the emergency room, and airway impairment of any level does... but that leaves a lot of grey area in there in between.  Unfortunately, I'm familiar with this particular problem myself.   

There's 'diarrhea' and then there's "DIARRHEA!  OMG!!"  I've found that the latter tends to be associated with my shellfish reactions. TMI, I know... 

Let me pull up that link to the anaphylaxis grading chart for you.  It's really useful.   

[jennifer1]

Thanks
I've looked at the chart but am still a little confused.....
I get diarrhea bad (as in need to be within about 1 minute of a bathroom or there is a BIG problem-I don't consider that loss of bowel control but maybe it is?).  I do get some warning, don't know that I'd call it nausea since I've never felt like I was going to vomit, but I guess my stomach feels off about 5-10 minutes before the bad cramping/diarrhea starts.  I often will get really hot feeling about this time.  When the cramping/diarrhea starts I will often get a cold clammy feeling.


So, with GI, that's a #4, but don't get any of the symptoms on the GI list before it, or after and it makes it sound like you need at least one other symptom the way it is phrased any of the above plus D.

With the cardiovascular list, I don't know if any of those apply.  I've never taken my pulse at the time, but seem to recall a time or 2 when it seemed like it was going fast.  I'd also be curious about my blood pressure during those episodes, since the clammy cold sweat I think can be a symptom of a dropping BP.  But, I just don't know for sure.

[CMdeux]

I rely on severity and duration, mostly--

if it's kind of over-and-done-with in ten or fifteen minutes, then that's one thing.  Unless I have diarrhea bad enough that I actually feel lightheaded.  That is a warning sign that blood pressure may be impacted, or that fluid balance has been due to rate of fluid loss.  KWIM?

My DH points out (he's got his own walnut and soy allergies, btw);

it's the difference between "Oh.  Sh**."

and something more like "OH!!!! SH**!!  SH**!! HELP!"     (Yes, we have an odd sense of humor about FA at our house-- might as well laugh about it, right?)

The latter is an epinephrine moment, and the former is probably a wait-and-see without anything else happening.

Any cramping like menstrual cramping?  THAT is a hallmark symptom of anaphylaxis for me personally.  I always know when I get that going on that I'm in trouble and in for a more severe reaction than if it were entirely GI.

Some of those other symptoms can be pretty subtle.  They are things that as reasonable adults, we'd be inclined to ignore or just tolerate as "Yeah, whatever," but in conjunction with a suspected systemic allergic reaction going on, they become a lot more ominous.  For example, a stuffy nose or itching-- anywhere-- along with diarrhea would be reason enough to use epinephrine.   The reason is that that adds up to two body systems. 

Some symptoms are serious enough that they warrant epinephrine even with nothing else going on, of course.  But some of them are merely annoying unless you view them in context.  The reason is that most laypersons don't have a pulse oximeter and BP cuff just laying around ready to use during a reaction, and without them, you're just guessing that airways and cardiovascular function are both unimpaired.  Those are the things that kill, and unfortunately, once a reaction becomes systemic... (that is, more than a local, contact response) it's a little unpredictable. 

GI symptoms are peculiar in that they may be systemic symptoms, but with a food ingestion, they can be merely "localized" ones, as well.  It sort of depends on severity and onset.   

[jennifer1]

Thanks
I think the 5-10 min warning that I get are sort of like mild menstrual cramps.
When I am having the cramping with D, it's more like someone has tied my intestines in a knot and it pulling on both ends   I really can't stand up straight for a few hours.  Often it's just best to stay curled up on the couch in the fetal position-it doesn't hurt as much in that position.
I think what I'll try next time is to just keep some benadryl around and take it during my "warning" period.  Hopefully that can ward off anything more severe.  Since I never tied it to an allergy, I never tried benadryl or anything.  I'd tried pepto and that sort of stuff, but it never did any good, guess now I know why.  Plus, now that I know it's an allergy, I won't be trying bananas or avocado again just to see if it's better this time!

Also, I've never had a problem with cooked bananas (banana nut bread for example).  Does cooking somehow denature the protein or something, or is it something that I might eventually react to?
Thanks
Jennifer

[CMdeux]

It can-- I don't know enough about the proteins which are latex analogs to say for sure, other than that some people with oral allergy sydrome (which is a pollen-food cross-reactivity) eventually do NOT tolerate allergens that they previously tolerated cooked, and others seem to do fine with them long term.  That's a different animal in some ways, though, because the latex proteins which are allergens seem to be anaphylaxis-producers, and pollens obviously aren't for the very vast majority of people.

I'm really lucky that I've only once had a problem with any of the latex cross-reactives.  I had a banana reaction just once, but it was on a day when the grass pollen levels here were topping out at close to 11,000 particles per meter, so my allergy cup was pretty darned full at the time.  I eat bananas and love avocado and kiwi, too.  So I'm really glad that it hasn't been a problem.  <sigh>  Though I'm well aware that it could become one at some point in my life.   

My allergy started as occupational exposure as well.  I worked as a vet tech and then wore latex gloves routinely for years doing lab work, during which time I got increasingly worse rashing up my arms (which I stupidly thought was 'irritation' from powder until I started also getting some asthma while at work).

[SilverLining]

My son's latex allergy started with his part time job, working in a deli.

He has had a few instances of what he thought was food poisoning after eating in restaurants.  But I have told him to check if the chef is wearing latex gloves while preparing food.  A few times others in his group ate the same meal he did, and he's always the only one sick.  Sounds more like an allergy to me.