Peanut allergic reaction

I’ve used this blog for my professional interests thinking that my personal life just isn’t all that interesting. I still don’t think my personal life is of broad interest, but I’m going to describe what happened to me after an accidental exposure to peanuts yesterday. I’m motivated for two reasons. One, I couldn’t find much personal discussion of these allergic responses and I think it would be helpful to have more (there was lots of discussion from moms, or potential causes, or badly written pseudo science but very few actual stories). Two, I was supposed to meet a friend last night and had to cancel because of this, and his reaction made me realize that these severe allergic reactions don’t seem to be well understood or accepted in general.

After the jump I’ll go into detail. If you are squeamish don’t read, and/or if you know me professionally you may not want to continue, in order to permit some dignity to persist in our future interactions. But I think the story is important for others who suffer from this. I remember lying there wondering if this or that that was happening was normal. Turns out, yes, but that’s not easy info to find.

I’m severely allergic to all nuts and peanuts. I’ve known this since I was two years old and my dad asked me if I’d like to try a walnut. He held out a walnut half in his palm. I was super excited since they look really cool, like brains, and I remember shouting “Yes!!” and popping it in my mouth. I immediately started throwing up and broke out in hives – like giant mosquito bites all over my body – and had asthma and difficulty breathing. I remember being very uncomfortable and upset. My mom put me in the bath with baking soda and I think we just waited until I recovered (I think she did take me to the doctor but that part of the memory is fuzzy). The treatment probably wouldn’t be much different today, except perhaps adding benadryl and an epinephrine injection, since there really isn’t much you can do for these reactions.

I had asthma as a kid growing up and I still have it. It’s pretty mild and doesn’t interfere much with my life, but it can flare up especially with pollen or dust or other forms of physical stress. I’ve had inhalers most of my life, but I’ve always somewhat ignored it and been athletic and active (as I said, it wasn’t that bad). I also had excema as a kid – patches on my arms etc which mostly went away until the stress of grad school, which brought on dyshidrosis, a somewhat severe form of localized excema that tends to pop up reasonably frequently on my hands ever since. I mention because asthma and excema are confounding risk factors for severe nut/peanut allergic reactions. I never thought anything of these things – several of my childhood friends had asthma/excema as well and it just didn’t feel particularly unusual and wasn’t especially bothersome to me.

Yesterday I was at a catered event and a friend was eating a wrap. She commented how delicious it was – like eating fried chicken. I hadn’t eaten that day so I investigated whether there were any left and I saw some that looked like hers – crumbled chicken fingers with some bits of the breading wrapped in. What I didn’t realize was that it was some other type of wrap with chicken and dark peanut pieces (not breading). Every reaction is different and I didn’t get much of a peanutty taste or feeling when I bit them, which was weird as I usually do. But I couldn’t identity them (thought maybe they were lentils?) so I stopped eating. Then I started to feel the usual tingliness in my mouth/throat associated with eating nuts. I immediately swallowed two benadryl and tossed the wrap. Usually when any form of nut allergen hits my mouth I know it right away, but in this case I think I swallowed some peanuts before I knew.

In the past I think I may have been able to avert some reactions by taking the max dose of benadryl right at the time of exposure. I don’t really know but in those cases I didn’t have a full anaphylactic response. So when I took two benadryl I thought I might be ok and hoped for the best. I continued to talk to my friend even though I wasn’t feeling well, and left for my (really short) hair appointment in midtown east. I took the subway over with another friend from the event and wasn’t feeling well, but I was trying to maintain conversation and normality and doing ok. I think I was more responsive rather than interactive though and having some trouble concentrating. I walked to the salon and it took some effort, and I remember putting my bag down and just crouching in the elevator since standing was getting hard. I got through the appt which was only about 15 minutes and left. I called the friend I was supposed to meet and it was hard to talk and walking was getting tougher. I knew I needed to lie down but I was still hoping the bendryl would avert a full reaction and I would be ok after a short rest. I remember really wishing there was a place to sit while talking to him. I got off the phone and just focused on walking to the train station. I felt really ill and it took quite a bit of effort. I had to stand on the train – only one stop, but about 8 minutes – and that was hard. I remember just folding over and hanging onto the pole. I didn’t think I was going to collapse at any moment, but walking from the train I did start to feel more that way. I concentrated to put one foot in front of the other and get there. I could feel hives developing on my sides and back, upper thighs and crotch, ears and neck.

I have had two allergic reactions in the past where I did collapse (ages 16 and 23). Both times that happened it was a trigger that caused me to end up in the hospital (people around me just made that decision). In this case I was conscious and when I got near the vicinity of my bed I just lay down.

I felt pretty dreadful while lying there. It was about 6:30pm. I noticed a lot of hives, especially around where fabric was cutting into me from clothing. My face was not moving correctly because of the swelling – eyes, especially the ears and around, back of my neck and scalp were really really itchy. I really tried not to scratch but it is so uncomfortably itchy. I managed to make myself get up to wash my hands, thinking that if I was scratching the last thing I needed was secondary infection from the subway. I noticed my neck, upper chest, ears, face were bright red, and the insides of my wrists had raised “plaques”. Clothes were really irritating and I got rid of as much as possible. Plaques on my inner thighs and around my armpits and down my sides. This is typical for my adult reactions – the individual giant hives I got as a kid are long gone. I put on a soft sweatshirt since the hives on my back were being irritated by my bedding and my hair. But everything was irritating and scratchy. I felt sick to my stomach and ill. I was rocked by really strong shivers – it is like a feeling of being grossed out. Hard to describe. Even now at one day later if I think about peanuts or that wrap I can induce one of those strong shivers. They feel gross and slightly vomitous. It also means that the last thing I want to do when having a reaction is talk about it – it really makes it physically worse.

The worst was the difficulty in breathing. I knew my lungs were swelling and filling with liquid since I couldn’t breathe without a lot of effort and I was wheezing. Wikipedia says I also had “stridor,” a new word for me, but yes lots of contraction in the upper airways and weird breathing noises. I had to force myself to keep breathing and concentrate on that, since not breathing was a welcome rest. My heart was noticeably hurting. It didn’t seem to be correlating with any activities such as breathing but it was painful, no matter which side I was on or my back. That was worrying. Turns out this can happen and is due to the lack of oxygen, dilated blood vessels, and histamines. I was trying to breathe deeply to get oxygen in. I didn’t know this at the time but the epinephrine can help with the impact on the heart. I had thought that the adrenaline was really a last stop to prevent the heart/brain from shutting down but I found out it can also help the heart cope before it gets to cardiac arrest. It felt sortof like I had swallowed something too large that was stuck painfully in my chest.

I am glad I was alone. I don’t want friends around when my face swells and I can’t breathe. It is not embarrassment, it is just breathing takes all my concentration and effort and I can’t take the energy needed to interact with friends away from that. And I can’t not prioritize my friends if they are around. So they need to stay away. The only thing that would be helpful is sneaking in with a warm blanket and putting it on me and leaving (the skin redness and blood vessel dilation makes you feel really cold) or a passive form of observation like a camera. In fact that happened. A friend happened to call me on FaceTime and I let him just sit there on my phone for hours while I was lying down. I couldn’t interact except the coughing, wheezing, and the occasional grunt signalling consciousness but he knows me well so I was happy to have him there monitoring me in a sense, even though he just balanced his checkbook and talked about it the whole time. Perfect. (he knew what he was doing.) But that’s me – I’m shy and generally find people stressful – other people might be different.

My friends are usually aghast when I explain this. “What! Why didn’t you go to the hospital? Stop taking risks with your life!” I understand their point. I don’t think I am going to die. Why? Because I haven’t died yet. That may not make sense but I just know I’m not going to call an ambulance unless I am really about to pass out. What if I don’t have the energy to call? Good question. I am also put off by all the bills and hassle any interaction with a hospital produces. Honestly it is too much for me to handle, so I don’t want to call. “But it’s your life!?!” I know, but I’m here today. I’ve been through this before. Did i use an epipen last night? No, and I’m here today. Can I extrapolate from this? Probably not, but I will take each reaction as it comes.

I felt really sick to my stomach the whole time – a couple of times I thought I might throw up but nothing. Then, around 9:50, I really felt like I was going to throw up. I grabbed a bag a threw up into it. A lot. I guess I drank a fair amount of water that afternoon. The barf left gritty pieces in my teeth which only grossed me out more, aside from that being intrinsically gross, it also made me think that perhaps those pieces were peanuts. A vomit-inducing thought. I threw up about 6 times and felt better, then tied the bag shut. A really gross thing that happened while throwing up – some pee came out. Part of the convulsions. Turns out this is normal, but it is the first time it happened to me. I put on some old undies to avoid getting urine on anything – not very much came out but gross. Then diarrhea started – a tiny amount but no matter how bad I felt I had to go to the bathroom obviously so I stumbled in and managed to get the rest in the toilet. This was also new for me and as it turns out also normal. It felt similar to having food poisoning. The problem was that the throwing up had never really stopped and came on really strong in the bathroom. So it was this awful comedy of turning around to poo then throw up then poo then throw up.. Not like there was anything left to throw up but my body didn’t care. I had to talk myself through it – calm down calm down calm down – I was empty and my body had to stop this. It did. I washed up and went back to bed.

I was still breathing with a lot of difficulty but the hives were beginning to go down. Less itchy and plaques less raised. So I felt I was going to be ok. At some point I fell asleep and woke up with eyes nearly puffed shut, poo that disgustingly smells like vomit somehow, but feeling normal energy levels again. I was pretty hungry and thirsty and fragile feeling but decided to get something to eat and get on with my day, and write this.