Possible Food allergy - how to proceed?

[cjzimmer1]

The other day DD went to a sushi restaurant.  Several hours later she broke out in hives.  She said she itched everywhere and her throat was raw but she didn't feel like she had problems breathing. Sushi was the only food she ate that day before the hives so we are suspecting she was allergic/sensitive to something there.  She has eaten all the major components many times over the years (crab, shrimp, avocado, rice, veggies) and has eaten sushi with raw fish before without issues.  She said she put hydrocortisone on the itchy parts and just suffered through it.  She's only had hives like that one other time several years ago but we were unable to pinpoint any specific foods.

I only found out about the reaction a couple of days after the fact so not much I can do about it now but am looking for guidance for the future.  Is this severe enough that I should look into food testing?  Does she need to avoid sushi?  Tell her to take Benadryl before eating sushi?  Having never really dealt with this before I'm not sure how serious or not this is.

[Arcadia]

Shrimp allergy come and go for my husband and his nieces. They can take one or two shrimp without problems now. My dad’s shrimp allergy went away permanently. In my case, a bed bug or mite bite would trigger rashes that look like hives.

[sweet2ndchance]

Food allergies can come on even though you've eaten a food many times before. Hives is a pretty serious reaction. I would look into allergy testing for sure. She would need to avoid fish and shellfish as well as antihistamines/steroids prior to the testing. Definitely do NOT tell her to take Benedryl before eating a possible allergen. She needs to avoid reactions, not try to cover them up. If she has another reaction, she could take Benedryl or another antihistamine, WHILE on her way to the doctor! But unless she is having trouble breathing, I wouldn't take anything on the way to the dr. You want them to see the full extent of the reaction.

[KSera]

Sesame might be another to avoid until testing. 

[ikslo]

I would get her tested, absolutely. The next reaction may be worse.

[Katy]

She could also be reacting to antibiotics fed to shrimp farmed in Asia. 

I’d get her an allergist appointment. That has common food & environment allergy testing, if that’s ruled out it would be more likely due to antibiotics. But you wouldn’t know what kind unless she has known drug allergies. 

[Arcadia]

I react to sodium tripolyphosphate when washing frozen shrimps from Safeway supermarket. We stopped buying packaged shrimps that have that ingredient listed. 

https://www.nytimes.com/2019/10/15/dining/shrimp-additives.html
“Tripolyphosphate and sodium bisulfite are considered safe in low doses by the Food and Drug Administration. However, about 1 percent of the general population in the United States has a sensitivity to sulfites.

Tripolyphosphate is generally added to shrimp after it’s been peeled, so to avoid it, try to buy shell-on shrimp and peel it yourself. (Save the shells for shrimp stock.) This is not true of sodium bisulfite, though.

You could also read the fine print on the packaging: Chemicals are required to be listed on labels, which you can find on bags of shrimp pulled directly from the freezer case.

As for the piles of shrimp on ice you find at supermarkets and fishmongers, the only way to know for sure if they’re chemical-free is to ask — and hope the person behind the counter knows the answer.”

[Spryte]

Agreeing that she needs to see an allergist. 

In the meantime, her GP can send in an Rx for an epipen to carry just in case. Tell her that two body systems means anaphylaxis, and it does not always look like the movies with swelling, etc, and can move fast.  Two body systems can mean any combo of lung, heart, throat, mouth, skin, GI, or a feeling of doom — and yes, I just copied that off of our anaphylaxis action plan. Two of those means epipen and 911. Full body hives = epipen and 911. Don’t wait till there are problems breathing!

Past reactions can’t predict the severity of future reactions, so the next time it could be much worse.

I don’t know what she’s allergic to, or if it’s an allergy, but I would suspect most strongly sesame, avocado and shellfish. It could be anything, of course!

For no reason other than speculating … Does she react to bandaids (latex)? Have a tickle in her ears or throat when she eats a banana (related to latex)? If so, I would be even more suspicious of the avocado (also related to latex allergy). 
 

ETA: that list of two body systems has caused my family a lot of angst. DS does not swell up, so we sometimes spend a lot of time wondering if an event is epi-worthy. Having clearly defined parameters and a plan for what to do helps. Sometimes we go sit in the ER parking lot, epipens in hand, until we decide. But we’ve made mistakes, and our allergist tells us we have been lucky.

Edited March 18 by Spryte

[Spryte]

Oh! And for anyone who doesn’t know, the FDA finally approved Xolair for anaphylaxis prevention. If a person is a candidate, it can really cut down on anaphylactic reactions, apparently, though it’s not a cure for food allergies. It’s an injection, and one would need it done at the allergist’s office, but in case OP’s DD is allergic — here’s some hope.

[cjzimmer1]

Thanks all.  I sent the question over to DD's doctor and will hope for a referral to the allergist.  Not having experience with food allergies, I wasn't sure if this was a big deal or not.

[Clemsondana]

If she has seasonal allergies, it's also possible that something cross-reacted with something that she is already responding to, or that she is responding strongly because her histamine response is already elevated.  There are some known ones - cucumber and ragweed, for instance.  I have a ton of environmental allergies but didn't test positive for any typical food allergies.  But, there are certain foods that make my mouth itchy at certain times of the year.  My allergist said it's common.  I also often have a response when I eat Indian food - not hives, but many of my typical allergy symptoms.  I take benedryl if I need it.  

[cjzimmer1]

3 minutes ago, Clemsondana said:

If she has seasonal allergies, it's also possible that something cross-reacted with something that she is already responding to, or that she is responding strongly because her histamine response is already elevated.  There are some known ones - cucumber and ragweed, for instance.  I have a ton of environmental allergies but didn't test positive for any typical food allergies.  But, there are certain foods that make my mouth itchy at certain times of the year.  My allergist said it's common.  I also often have a response when I eat Indian food - not hives, but many of my typical allergy symptoms.  I take benedryl if I need it.  

That's an interesting thought I hadn't considered.  She has been a kid whose mosquito bites just got enormous compared to anyone else in the family. Thursday she had been outside and got a few bites which had swelled and itched.  She said she didn't even first recognize the hives as something different because she had been scratching the mosquito bites for the last two days and it was just more itching.  

[Terabith]

Just to throw it out there, I have twice had anaphylactic reactions to mosquito bites. I try hard to avoid them, and I have not had a bad reaction in decades now, but it is a thing that can happen. I don’t have many other things I’m allergic to, though I have a “sensitivity” to sulfa meds.  

[Arcadia]

If your daughter tried soy sauce or wasabi for the first time or rarely, might be worth checking for that too. For what it’s worth, for me and some oncology department nurses I know, we have sensitivity to latex and bananas but not to avocados. 

[cjzimmer1]

1 hour ago, Terabith said:

Just to throw it out there, I have twice had anaphylactic reactions to mosquito bites. I try hard to avoid them, and I have not had a bad reaction in decades now, but it is a thing that can happen. I don’t have many other things I’m allergic to, though I have a “sensitivity” to sulfa meds.  

Curiosity, is there any medical connection between these two types of issues or just a fluke that these are two things you have issues with?

I'm only asking because I have quite a few relatives who have issues with sulfa drugs and if there is a connection between these two things, then it would definitely be worth investigating since she does have issues with the bites. 

[cjzimmer1]

50 minutes ago, Arcadia said:

If your daughter tried soy sauce or wasabi for the first time or rarely, might be worth checking for that too. For what it’s worth, for me and some oncology department nurses I know, we have sensitivity to latex and bananas but not to avocados. 

Soy sauce it pretty regular in our diet but she doesn't like wasabi so rarely has it (like only if a piece happened to touch it and she can't wipe it off).  But she did say some of the rolls came with wasabi on them so she just ate them.

[Arcadia]

4 minutes ago, cjzimmer1 said:

Soy sauce it pretty regular in our diet but she doesn't like wasabi so rarely has it (like only if a piece happened to touch it and she can't wipe it off).  But she did say some of the rolls came with wasabi on them so she just ate them.

The wasabi at sushi places are adulterated wasabi, so if that happens to be what she is sensitive to, the ingredient list is long. Like I like the taste of wasabi but am sensitive to sorbitol

e.g. https://www.sbfoods-worldwide.com/products/search/002.html#:~:text=Horseradish%2C Sorbitol%2C Food starch modified,(FD%26C Blue%231).

”Horseradish, Sorbitol, Food starch modified, Rice bran oil, Sugar, Salt, Water, Wasabi, Artificial flavor, Citric acid, Turmeric, Xanthan gum, Artificial color (FD&C Blue#1).”

 

[Terabith]

45 minutes ago, cjzimmer1 said:

Curiosity, is there any medical connection between these two types of issues or just a fluke that these are two things you have issues with?

I'm only asking because I have quite a few relatives who have issues with sulfa drugs and if there is a connection between these two things, then it would definitely be worth investigating since she does have issues with the bites. 

I don't think there's any connection.  I just meant that I'm a person who has had serious reactions to mosquito bites, which are not really a common allergen, but who doesn't have a ton of other allergies.  

[katilac]

2 hours ago, Terabith said:

I don't think there's any connection. 

Probably not, but, interestingly, I used to have allergic reactions to mosquito bites (not anaphylactic) and I'm also allergic to sulfa meds. 

I have a fair number of allergies and sensitivities, though. 

 

[Spryte]

I just got home from the ER for a food allergy event. Unbelievable timing.

Earlier when I posted, I forgot to mention one thing, and the ER doc reminded me tonight: one of the most dangerous parts of anaphylaxis is the sudden, dangerous drop in blood pressure. Which has nothing to do with breathing, and that’s part of why we don’t wait to epipen and go in. Benadryl won’t stop anaphylaxis, either, though I can attest that it does help with the full body hives.

[cjzimmer1]

8 hours ago, Spryte said:

I just got home from the ER for a food allergy event. Unbelievable timing.

Earlier when I posted, I forgot to mention one thing, and the ER doc reminded me tonight: one of the most dangerous parts of anaphylaxis is the sudden, dangerous drop in blood pressure. Which has nothing to do with breathing, and that’s part of why we don’t wait to epipen and go in. Benadryl won’t stop anaphylaxis, either, though I can attest that it does help with the full body hives.

I'm sorry to hear you got sick but thankful you shared the warning.  We will definitely be keeping a closer eye on what she is eating as well as if she has anymore reactions.

[EKS]

There are lots of reason that people get hives, not just food allergies.  I had hives once randomly and never figured out why.  My adult son has gotten them seemingly randomly for years, usually when he/his body is stressed in some way.

So just because she got hives after eating sushi doesn't mean it was the sushi though it could be.