Hello XXXXXX,
Thanks for writing in.

This is Dr Vivek answering your question.

From your information provided, it looks like you developed an acute adverse reaction (allergy) following food ingestion.
Most food allergies are due to presence of certain protein which when ingested by you (even in minute quantities) will trigger an immune mediated reaction leading to multiple signs and symptoms. On an earlier occasion, you had vomiting and now you got a swollen nose and upper lip.

Coming to your condition, I guess you have two questions running in your mind.

1. When should you visit to a doctor and what can you expect?

Signs of possible allergy are:
Severe nausea
Itching around the mouth
Severe swelling anywhere in your body
Noisy breathing
Cough (otherwise unexplained)
Shortness of breath and wheezing
Vomiting and diarrhea
Flushing
Rashes and itching any where in the body
Itching or swelling in the eye
Nasal congestion and sneezing
Abdominal pain
Feeling of impending doom
Fainting spells

Any of the above symptoms should make you visit a doctor.
You have already explained your two situations wherein you fell sick almost immediately after ingesting food.

On your earlier situation, it is worthy to note that you had taken little wine and alcohol. There are some allergic reactions that are potentiated by alcohol, exercise and painkillers.

I would take a detailed food intake history, details of preparation (if known), frequency of occurrence.
Symptoms occurred previously, severity, duration and treatment taken and response (even if self medication taken) are all important to note.

As a doctor I would first have to rule out any acute food poisoning and any underlying medical or surgical problems.

Tests you may have to take for suspected food allergy:
A. Specific IgE antibody test in serum
B. Basophil histamine-release assays
C. Following your diet diary and doing elimination diet and food challenge tests.
D. Skin patch testing.

2. What precautions are to be taken by you so that subsequent situations can be avoided.

Certain foods are highly allergic to many people in the general population:
Eggs and chicken
Cow milk and beef
Cow milk and goat milk
Fish
Peanuts and other legumes
Soy and other legumes
Wheat and other grains
Tree nuts and other nuts

Please avoid if any particular food is allergic and read labels on food cans while purchasing.

With doctor's permission, you can keep oral anti histamines (antiallergics) and life saving medication (epinephrine) with you at all times in case of emergency.

Never hesitate to seek medical attention if you feel that you are having an allergy. Please call your local emergency helpline (911) to handle the situation.

Further questions welcome.
If you don't have any questions, please close this thread and post a feedback.

Regards,
Dr Vivek

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Hello XXXXX,
You’re welcome and thanks for writing in again.

I am pleased to answer your questions.

1.     You are definitely recommending to go see a doctor to do some allergy testing? the swelling is still not completely gone ( almost but still a bit puffy and feeling a bit numb) is this something i should be worried about or is that common after such an extreme reaction last night? Should i keep taking benadryl?

If such occurrences are extreme in nature, as you have described, it would be best to see a doctor. May be you could get back to Germany and take medical attention if you are comfortable and not seriously ill at the moment.

There are chemicals (histamines) released due to allergy and these chemicals need to disappear completely from your system to get you back to normal, hence you are still a bit puffy. You can take Benadryl in doses mentioned in the label.

Do not involve yourself in any kind of activity like driving, crossing roads in busy traffic, mountain climbing, surfing or swimming immediately after having Benadryl as many people feel drowsy after taking it – this is usual.

The numbness feeling is a common side effect seen in some people after taking Bendryl. Please don’t worry for that. Benadryl marketed in US contains diphenhydramine, (first generation anti histamine preparation) anti allergic.

Please Note: In the UK and rest of Europe it may contain acrivastine (marketed as Benadryl Allergy Relief) or cetirizine (marketed as Benadryl One a Day Relief) – 2nd generation non sedative antihistamines). I am telling you this because you will move to Germany soon and please verify the medication with your pharmacist when you purchase.

2.     I dont have health insurance in the US and will be going back to Germany next week where i can go see a doctor without having to pay a lot of money out of my pocket... can it wait until then or should i see someone now?

You can surely wait until you get back to Germany. Next week is almost here and you can locate an allergy specialist doctor in Germany and take an early appointment. Just be alert on your food intake and bit careful. In the event of an emergency while still in the US, please call 911 helpline. They will respond to you immediately.

3.     The odd thing about these reactions is that it seems that i am having an allergic reaction to something ( like chicken, or white wine) that i eat and drink on a fairly regular basis. Last time there was a piece of older cheesecake that id like to blame it on although my friends that ate it too were all fine but in yesterdays case i am really quite baffled since ive eaten the chicken and had the same wine before..

Yes, it is baffling to know that the allergy causing factor may be in your food and more so if it’s something that you have had before.

There are medical explanations for this.

First, the allergy may not be due to ingesting chicken alone. It can be because of some protein additives used in preparation. Also as I have mentioned earlier, there is a potential for alcohol (even in small quantities) to trigger an allergy.

Second, allergic reactions take place due to the chaos created by antibodies and the immune system in our body. The allergy causing substance is considered as an enemy and the immune system fights against it. In many people the reaction of the immune system to the first episode of ingestion is mild to negligible, this causes sensitisation. When the person ingests the same allergic substance at a second occasion, the immune system is more prepared to fight the enemy. This results in a full blown reaction which may get difficult to control.

I don’t want you to get scared and stop eating your regular food. No one would like you to do that. The only prevention is to avoid any known allergy causing food and that may be found out by the various tests after consultation with a doctor.

Hope your questions have been answered. Further questions are welcome.

If you do not have any questions, I request you to please close this thread and post a feedback.

Wishing you good health.

Regards,
Dr Vivek

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