The view from the honeymoon suite

When we set out to select a location for our first vacation in more than two years, we had some very specific parameters.

We live in Pennsylvania and our goal was to escape the cold wintery weather, so our destination had to be a place which had beach-friendly temperatures during spring break, and also had access to an ocean.

In the past we had visited Mexico or Aruba, but when my now 16-year-old daughter’s anaphylactic food allergies (milk, shellfish, egg, walnuts, potato, tomato, eggplant and pepper – including spices from peppers) made it too risky for her to eat food prepared by anyone but us, we stopped taking vacations altogether.

After two years of vacation hiatus, we were seriously craving some beach time. We wanted to find a destination within 20 minutes of a hospital – preferably a North American hospital – and in close proximity to a grocery store that would have a variety of foods my daughter could eat and prepare easily. And we had to be able to read the food ingredient labels – familiar brands would be easiest.

Because she or I cook every breakfast, lunch and dinner, every day of the year, we also didn’t want to spend a lot of time preparing meals. Part of our need for a vacation came from the magician-like skill we had to apply every day in making delicious food that both she and the rest of the family could enjoy. She is very experienced at bringing her own food to restaurants, so that’s what we planned to do on vacation.

We started by checking temperatures. No beach location in the U.S. offered the consistent mid-80′s of the Caribbean. Southeastern Florida seemed to be the warmest beach location we could find.

The next important consideration for us was that we wanted to be right on the beach – not across highway A1A from the beach. There are probably a lot of places where we could have rented a house or a condo, but we’re not experienced with the ins and outs of private rentals.

Also, there didn’t seem to be any resort that offered condos on a beach that would be warm enough during spring break. Amelia Island, near Jacksonville, Florida, has great condos that are in close proximity to groceries and are on the beach, but it’s not 80 degrees there in March.

There were other locations on the West coast of Florida that offered condos, but again they were not as warm or easy to get to, or weren’t reasonably priced during spring break. We eventually settled on Fort Lauderdale.

Next page: The ideal location found

On April 7, 2013, Adrian Gutierrez, an 8-year-old boy from Monmouth County, New Jersey, experienced a severe reaction and died in hospital. The reaction came over the boy on his family’s drive home from church, following a visit to a coffee shop. The boy’s mother suspects that Adrian, who was allergic to dairy and peanuts, may have accidentally sipped from his brother’s hot chocolate with milk. (Adrian had ordered a hot chocolate with  soy milk.)

One news report stated that an epinephrine auto-injector was administered to the boy. However, it is not clear whether the shot was given immediately after the reaction began, or  whether there was a significant delay. In the case of a severe allergic reaction, epinephrine should always be administered right away, as the drug can be less effective if a reaction has progressed.

On March 13, 2013, Maia Santarelli-Gallo, a 12-year-old girl from Burlington, Ontario (in Canada), appears to have experienced anaphylaxis during an outing to a shopping mall with her father and older sister. Local news reports suggest Maia had reacted to dairy and egg in the past, but her parents had been told she was intolerant rather than allergic, and she had never been prescribed an auto-injector. At this point, it is not definitively known what caused the reaction, but milk is suspected – since the last thing Maia ate was an ice cream cone.

Asked to comment on the girl’s fatal reaction, allergist Dr. Susan Waserman expressed profound concern to the local press. “It speaks to the need for proper diagnoses, proper education, how the family was told to handle this supposed food intolerance,” she said, adding that better support for the family would have led the girl to have an auto-injector. “The whole community feels terrible when we feel something like this,” she said.

On March 8, 2013, Cameron Groezinger-Fitzpatrick, a 19-year-old from Plymouth, Massachusetts, died from his peanut allergy while home from university for spring break. His family has said that a friend had offered him a cookie, which was supposed to be peanut-free but turned out to contain peanut butter.

According to ABC News, Cameron’s mother was told over the phone by a 911 operator not to administer an expired EpiPen which was in a nearby cupboard. Cameron’s current auto-injector couldn’t be found in time, as he had not finished unpacking for his visit.

“I didn’t know you can die from nut allergies. I feel foolish,” Robin Fitzpatrick, Cameron’s mother, told ABC News.

These tragic events reinforce the need for allergy education and having epinephrine always ready to access for those with food (and sting) allergies.

In more positive news, several states are beginning to see the importance of readily available epinephrine and are passing bills that allow doctors to prescribe “stock” auto-injectors to schools. These devices can used in emergencies for students who don’t have an auto-injector on school premises (in some cases, it may be a first allergic reaction).

Kentucky, Nevada, Oregon, Georgia and Tennessee have all seen recent progress in such bills in their state legislatures. In fact, Kentucky Governor Steve Beshear will be holding a formal ceremony to sign that state’ stock epinephrine bill into law on April 22, 2013.

Maybe you feel like you’re going to be sick to your stomach, or feel your throat tightening and your lungs beginning to wheeze. You may feel flushed and hot as your face turns beet red. Maybe you break into hives from head to toe, or feel like you’re going to pass out as your heart takes off like a bullet train.

Chances are that you are having an allergic reaction to seafood – the most common culprits in the allergy world.

What’s The Problem?

Seafood can be divided into two groups: shellfish and fish. Shrimp is behind most of the reactions, and shellfish as a group – which can include oysters, mussels, scallops, squid, crab, snails and many more – tends to be more problematic than finned fish. (In one survey by FAAN and Mount Sinai researchers, two per cent of respondents reported a shellfish allergy, whereas just 0.4 per cent reported an allergy to fish.)

Symptoms of a reaction to seafood can include flushing and swelling in the face, mouth and throat; digestive tract symptoms such as nausea and diarrhea; itching and hives; difficulty breathing; lightheadedness or faintness; a sudden drop in blood pressure and a rapid heartbeat.

In severe cases, a person may experience anaphylactic shock, a reaction that includes one or more of the body’s systems and can result in cardiac arrest and death.

Widespread Incidence

A whopping 2.3 per cent of Americans are allergic to some form of seafood, whether it’s fish, crustaceans or mollusks. In Canada, 1.69 per cent of people are allergic to shellfish and 0.48 per cent are allergic to fish. What’s more, a 15-nation study showed the incidence is similarly high right around the world.
See: Seafood Allergy Statistics

Because of its high incidence, Health Canada has named both shellfish and fish “priority food allergens”, which means tougher labeling rules for Canadian manufacturers. Other regions, including the United States and Europe, have also included seafood on their lists of top allergens.
See: Label Aware

It’s a Grown-Up Thing

What’s different about seafood allergies is that they are largely an adult phenomenon. In Canada, 1.69 per cent of adults have shellfish allergy, compared to just 0.5 per cent of children. According to the FAAN-Mount Sinai survey, 2.8 per cent of adults in the United States reported a seafood allergy, as compared with just 0.6 percent of children.

This can be especially problematic, since most adults are accustomed to eating seafood, so when they react, it doesn’t seem to make sense to them. Often they dismiss earlier, less severe reactions as food poisoning or simply “something they ate”; but then they get a tough lesson in science as the allergy grows more severe and the reactions more extreme.

Unfortunately, once an adult develops a shellfish allergy, he or she likely has that allergy for life.

Next page: Seafood Allergy Myths

While allergists stress that severe reactions to airborne food particles are extremely uncommon, there are some instances in which allergenic food proteins can get into the air and potentially cause trouble.

According to Dr. Scott Sicherer of the Jaffe Food Allergy Institute at Mount Sinai School of Medicine in New York, foods with proteins that are stable to cooking can get into the air during heating – and if they then get into the airways of someone who has a severe enough allergy to that food, they can lead to allergic symptoms.

For instance, allergic persons who are exquisitely sensitive to fish or shellfish can react to tiny aerosolized proteins that float in the air when seafood is being fried, steamed or boiled. There may be an increased risk of this in seafood restaurants where large quantities are being prepared and served piping hot.

In fact, airborne reactions are not just a concern for the seafood allergic. Commonly fried foods such as eggs, and powdery forms of some foods can cause similar problems if they get kicked up into the air.

Dried egg powder, soy flour and wheat flour are common culprits behind airborne food reactions, and some people who are able to eat wheat can get respiratory symptoms when they inhale it – a condition that is not uncommon in food processing and has been dubbed “Baker’s Asthma”. A similar condition called “Crab Asthma” is prevalent in the fish processing industry.

Sicherer says that some foods are less likely to get aerosolized – for example, oily and inert peanut butter – which is why they don’t present as much of an airborne danger.

Symptoms from aerosolized food proteins can range from hives and itching to more serious effects including asthma – but Sicherer strongly emphasizes that the risk of anaphylaxis from exposure to airborne food allergens is very low.

Bottom line: Small exposures to inhaled allergens are not usually a problem, but more significant exposures should be avoided. If you’re allergic to seafood, walking past a fish shop or a seafood restaurant likely won’t cause any harm; but sitting in a seafood restaurant for a long period may have you saying, “Check please!”

If you answered ‘peanut’, that’s incorrect. But you could hardly be blamed given that legume’s notoriety. The right answer is seafood – from fish to crustaceans and mollusks.

At a time when every “must-try” new restaurant is an over-priced sushi bar, an astounding 2.3 per cent of Americans are now allergic to one form or another of seafood. (There is no such specific Canadian data, but general rates of allergic prevalence are considered comparable.)

If that incidence comes as a surprise, however, you’re in good company. Even the researchers who surveyed 5,500 households for the Food Allergy & Anaphylaxis Network in Virginia and the Mount Sinai School of Medicine in New York to arrive at this finding were taken aback.

“We said, ‘can this be real?”‘ recalls Anne Munoz-Furlong, founder and former CEO of FAAN and co-author of the resulting seafood prevalence study published in 2004. “We learned that shellfish and fish is about double the incidence of peanut and tree nut combined.”

In fact, the researchers reviewed the data to see if something was, well, fishy. But it wasn’t. Those who were accepted as allergic in the detailed phone survey “were very clear in their answers and the symptoms were very clear,” says Munoz-Furlong. Supporting those findings was a 15-nation study that showed similarly high levels of seafood allergies.

Shrimp was the most common cause of reactions in the FAAN-Mount Sinai survey. In fact, shellfish as a group – crustaceans and mollusks – proved by far the larger cul­prit, with 2 per cent of survey participants reporting shellfish allergy while 0.4 per cent reported fish.

Another eye-opening finding was that this is largely an adult phenomenon. The survey found 2.8 per cent of adults were seafood allergic compared to 0.6 per cent of children. And that can be one of the most difficult aspects of this condition – since it strikes grownups, who’ve been eating for years as they pleased, they often don’t know what hit them.

What happened to Chris Oleson is not uncommon. The 41-year-old is a self‑described “beach guy” who lives in San Francisco and grew up surfing on the California coast.

One day in 2002, he was with his wife Julia at an upscale sushi restaurant. He’d eaten about five or six very tasty” items from the trays on offer, when a waiter approached. “Sir, your ears are turning red. You may want to get that checked out,”‘ Oleson recalls him saying.

Oleson was suddenly rather feverish and unwell, but he wasn’t that concerned. He and his wife just thought he was com­ing down with a bug and had better get home. Oleson has asthma, and on the drive home an attack started coming on. He was also feeling woozy when Julia said, “you know, you’ve got hives.”

By the time they got through the door at a nearby hos­pital, Oleson was staggering. He lost consciousness on a stretcher.

There would still be protein traces and no one is suggesting that the one in 50 Americans who are allergic to shellfish (the family that includes shrimp, lobster, clams and crab) begins tucking into a well-boiled chowder.

But the study, published in the Journal of Food Science in January, shows promising results on the possibility of lowering the allergenic properties of shrimp. Tropomyosin (TM) is the main allergen in seafood, including shrimp.

Food scientists have found that boiling shrimp for 10 minutes seems to reduce the  allergenic potency. Researchers compared raw and boiled shrimp that had been ground and freeze-dried and found that the boiled shrimp had fewer allergenic properties than its raw counterpart.

While a far cry from a cure, lead researcher Guang Ming Liu believes the findings are a step in the right direction: “Understanding the allergenic properties of shrimp as affected by the cooking process is critical for shrimp allergic individuals.”

Fish: includes salmon, tuna, cod.
Crustaceans: includes shrimp, lobster, crab.
Mollusks: snails, bivalves (mussels, scallops, oysters), squid.

Cross-Reactions

Within a seafood group …

Dr. Scott Sicherer, author of Understanding and Managing Your Child’s Food Allergies and associate professor of medicine at the Mount Sinai School of Medicine’s Jaffe Food Allergy Institute, concludes from his 2006 review of seafood allergy studies:

- That 30 to 50 per cent of those with an allergy to one of the seafood groups will react to more than one type of fish or shellfish.

However, you can also be allergic to just one type of fish or shellfish. It’s even possible to be allergic to just one type of shrimp.

- That it is common for people to be allergic to more than one shellfish. Sicherer finds up to 80 per cent who are allergic to one crustacean may be sensitized to others, and “40 per cent may react upon ingestion.”

In one study reviewed, blood samples from nine patients with shrimp anaphylaxis reacted to the proteins of 13 crustaceans and mollusks. As well, he finds between 10 and 15 per cent allergic not only to other crustaceans, but to mollusks as well.

- That the risk of reacting to more than one fish is high. Sicherer suggests to speaking to your allergist: “Your allergist may take into consideration the severity of your allergy, test results, and dietary preferences to determine what it is you can and can not eat.”

- That about 50 per cent with a mollusk allergy react to more than one mollusk.

Between shellfish and fish …

According to Sicherer, only about 10 per cent react to both, which have quite different key allergenic proteins (tropomyosin in shellfish; parvalbumin in fish).

Remember, however, that there may be cross-contact between the two groups at grocery seafood counters or in restaurants.

Sources: UpToDate 2006; interview Dr. Scott Sicherer

Perhaps you have experienced unexplained skin rashes (known as hives) or vomiting or diarrhea? Does your child refuse to eat a certain food, or complain that it makes his “tongue hurt”? These could be signs of a food allergy, and should be taken seriously.

It is common for the symptoms of food allergy to vary by individual – and from reaction to reaction in the same person. Not everyone will get all the symptoms, which range greatly in severity from mild to severe (and even fatal): your throat may feel tight on one exposure to your allergen or you may get itchy hives on your skin and vomiting with the next.

The Range of Symptoms

-Tingling in the mouth
-Swelling of the tongue and throat / feeling of throat tightness
-Itchy skin, hives or skin redness
-Abdominal cramps
-Vomiting or diarrhea
-Breathing difficulty, wheezing
-Faintness due to a sudden drop in blood pressure

Symptoms reviewed by Dr. Susan Waserman

Anaphylaxis

Anaphylaxis is the severe form of allergic reaction. It involves one or more of the body’s symptoms; for example, the gastrointestinal tract, the respiratory tract, the skin and the cardiovascular system. A person experiencing anaphylaxis often has difficulty breathing, and the person could lose consciousness. Anaphylaxis puts a person at risk of death.

Anaphylactic reactions can come on quickly, and it’s impossible to know when a reaction will become severe. It’s important that people with food allergies are prepared for a reaction by always carrying an epinephrine auto-injector (either EpiPen or Auvi-Q/Allerject).

Experts recommend using epinephrine early if a person known to be at risk of anaphylaxis begins to show signs of allergy symptoms – don’t wait until the symptoms worsen, as it may become to difficult put a halt to the reaction once it’s in progress.

Does your child refuse to eat a certain food, or complain that it makes his “tongue hurt”? These could be signs of a food allergy, and should be taken seriously.

It is common for the symptoms of food allergy to vary by individual – and from reaction to reaction in the same person. Not everyone will get all the symptoms, which range greatly in severity from mild to severe (and even fatal): your throat may feel tight on one exposure to your allergen or you may get itchy hives on your skin and vomiting with the next.

The Range of Symptoms

-Tingling in the mouth
-Swelling of the tongue and throat / feeling of throat tightness
-Itchy skin, hives or skin redness
-Abdominal cramps
-Vomiting or diarrhea
-Breathing difficulty, wheezing
-Faintness due to a sudden drop in blood pressure

Anaphylaxis

Anaphylaxis is the severe form of allergic reaction. It involves one or more of the body’s symptoms; for example, the gastrointestinal tract, the respiratory tract, the skin and the cardiovascular system. A person experiencing anaphylaxis often has difficulty breathing, and the person could lose consciousness. Anaphylaxis puts a person at risk of death.

Anaphylactic reactions can come on quickly, and it’s impossible to know when a reaction will become severe. It’s important that people with food allergies are prepared for a reaction by always carrying an epinephrine auto-injector (either EpiPen or Twinject).

Experts recommend using epinephrine early if a person known to be at risk of anaphylaxis begins to show signs of allergy symptoms – don’t wait until the symptoms worsen, as it may become to difficult put a halt to the reaction once it’s in progress.

Symptoms reviewed by Dr. Susan Waserman